Assessing the quality of care for patients with first-episode psychosis

This study evaluated the quality of care in an early psychosis intervention programme (EPIP), as compared to standard treatment received by patients prior to the inception of the programme. The medical records of 50 patients with first-episode psychosis (FEP) who received psychiatric treatment in the calendar year of 2000, i.e. prior to the implementation of EPIP, and 87 FEP patients who were accepted in the EPIP, were reviewed for a period of one year. These patients were aged between 18 and 40 years. Each medical record was reviewed for a list of process indicators, which were identified from the published literature and other treatment guidelines, and covered different domains. None of the pre-EPIP patients met all the 13 process indicators, whereas 48 percent of EPIP patients met all the indicators (p-value is less than 0.001). Using the default rate as a proxy of outcome, we found that 19 percent of EPIP patients had defaulted at the end of one year, whereas the default rate was 52 percent for the pre-EPIP patients (p-value is less than 0.001). It is possible to improve the quality of care in patients with FEP through the use of treatment guidelines, regular monitoring of symptoms and side effects, and periodic audits.