Design of the BiRmingham Early Detection In untREated psyChosis Trial (REDIRECT): cluster randomised controlled trial of general practitioner education in detection of first episode psychosis [ISRCTN87898421]

This paper describes the design of a stratified-cluster randomised controlled trial of an educational intervention on first episode psychosis in primary care. The primary outcome is the number of general practitioner referrals of young people with first episode psychosis to Early Intervention Services. Secondary outcomes are duration of untreated psychosis, time to recovery, use of the Mental Health Act, and general practitioner consultation rate. Young people with first episode psychosis referred to Early Intervention Services will be recruited over a two-year period from 1 March 2004. Seventy-eight out of 89 eligible general practices were recruited. The educational intervention has been implemented and evaluated by general practitioners. The education was well received and considered relevant to clinical practice by the general practitioners.The results suggest that the recruitment strategy and implementation of the educational intervention are feasible and acceptable in a primary care setting. The Redirect trial will provide robust information about the efficacy of an evidence-based complex educational intervention targeted at general practitioners on referral rates of young people with first episode psychosis to Early Intervention Services.Studies have shown that young people with first episode psychosis (FEP) experience lengthy delays between the onset of psychotic symptoms and receipt of treatment [1,2]. The average period from first onset of psychosis to initiation of adequate treatment (duration of untreated psychosis, or DUP) is one to two years [3]. During this untreated period, irreversible biological, social and psychological damage may take place [2], and a delay in treatment is associated with poorer short-term outcome and slower recovery [1]. Early intervention in this 'critical period' [4] is therefore important for both patients and families. Strategies to reduce DUP include providing early access to specialist mental health services, such as early