Predicting risk of psychosis in primary care: a qualitative study

Background P Risk is a new tool which aims to help GPs identify people at risk of developing psychosis using electronic health record data of nonpsychotic symptom consultations, medications and sociodemographic factors. Aim To explore clinicians' and patients' views of the acceptability and usefulness of using P Risk in primary care. Design and setting Semi-structured interviews with GPs, Early Intervention (EI) team clinicians and patients from Bristol and London area. Method Three topic guides were developed to ensure consistency across interviews. Interviews were transcribed verbatim and analysed thematically. Results A total of 10 GPs, 6 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 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 psychosis. For patients, identification of people at risk only made sense if there was treatment 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 them. Conclusion Whilst most clinicians and patients welcomed the development of P Risk, there needs to be a clear pathway for assessing and offering treatment to those identified as being at risk.