Predicting risk of psychosis in primary care: a qualitative study.

Abstract

P Risk is a new tool that aims to help GPs identify people who are at risk of developing psychosis. It uses electronic health record data on non-psychotic symptoms, medications, and sociodemographic factors. To explore clinicians' and patients' views of the acceptability and usefulness of using P Risk in primary care for identifying people at risk of developing psychosis. Qualitative study using semi-structured interviews conducted with GPs, early intervention (EI) team clinicians, and patients between May and December 2023. Participants were recruited from Bristol and London, and three topic guides were developed to ensure consistency across interviews. Interviews were transcribed verbatim and analysed thematically. A total of 10 GPs, six EI clinicians, and 13 patients were interviewed. Most clinicians and patients welcomed the development of P Risk as a tool for improving the identification of people at risk of developing psychosis; however, some clinicians raised concerns about the quality of clinician coding in primary care medical records, availability of effective treatments, limited capacity of EI teams to work with people at risk, increased workload for GPs, and the negative impact on patients from being told about their risk of developing psychosis. For patients, identifying people at risk only made sense if treatment for them would be available. Interviewees said that clinicians should explain to patients what psychosis is, what it means to be at risk, which factors drive the risk, and how to address those factors. Although most clinicians and patients welcomed the development of P Risk, there needs to be a clear pathway for assessing patients and offering treatment to those who are identified as being at risk of developing psychosis.