Identifying Service Utilization Patterns in Primary Care by Young People with First-Episode Psychosis

Minimizing the duration of untreated psychosis in the first few years after illness onset is essential for improving prognosis for people with psychotic disorders. Leading up to the first onset of psychosis, many people experience early signs and symptoms, suggesting that there may be help-seeking or service utilization prior to first diagnosis. The family physician has been found to play a pivotal role in the pathways to care for people with first-episode psychosis. In this study, we used health administrative data from Ontario to construct a population-based retrospective cohort. These data were used to explore whether people with psychotic disorders had distinctive patterns of primary care service utilization in the six years preceding the first diagnosis of psychosis, relative to the general population comparison group matched on age, sex, and postal code. Our findings suggest that people with psychosis contact primary care over twice as frequently during the six years leading up to first diagnosis, relative to the general population. They have higher contact frequency across nearly all conditions, including mental health, physical conditions, and preventative health-related contacts. We also used Latent Class Growth Modelling to identify three distinct service utilization profiles: low, medium, and high-increasing usage, and we used negative binomial models to identify characteristics associated with each trajectory. Findings from this study can help inform initiatives to support Canadian family physicians and improve detection of early psychosis in primary care, which has implications for improved social, educational, and professional development in young people with first-episode psychosis

Differences in duration of untreated psychosis for racial and ethnic minority groups with first-episode psychosis: an updated systematic review and meta-analysis.

PURPOSE: Ethnic minority groups with early psychosis may have longer treatment delays, potentially leading to poorer outcomes. We updated a previous systematic review of the literature on racial and ethnic differences in duration of untreated psychosis (DUP) among people with first-episode psychosis. RESULTS: Six of 17 studies described significant differences across aggregated racial groups; however, the pooled estimates did not show differences across groups. Additional data from this update allowed for disaggregated analyses, finding that Black-African groups have a shorter DUP, whereas Black-Caribbean groups have longer DUP, relative to White groups. CONCLUSIONS: These findings highlight the importance of in-depth research on disaggregated ethnic groups to inform targeted early intervention strategies for minority populations

Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d’utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada

Background: Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. Methods: We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. Results: People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. Discussion: We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis