Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis
Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis
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DOI：
10.1007/s00127-012-0571-0
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发表时间：
2013-01-01
影响因子：
4.4
通讯作者：
Malla, Ashok K.
中科院分区：
文献类型：
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作者：
Anderson, Kelly K.;Fuhrer, Rebecca;Malla, Ashok K.
虽然已经有许多关于首发精神病（FEP）护理途径的研究，但很少有人研究护理途径的决定因素及其对随后参与精神卫生服务的影响。我们使用来自Montr，al的集水区早期干预（EI）计划的324名FEP患者的样本，估计了几种社会人口统计学，临床，和服务水平因素，对护理和治疗延误有负面影响。我们还评估了护理途径对脱离EI服务时间的影响。很少有社会人口统计或临床因素可以预测护理途径的负面影响。相反，服务水平因素，如与初级保健提供者的接触，对多个指标的卫生服务使用模式有更大的影响。与初级保健接触的患者减少了护理的负面途径的可能性，但也有更长的转诊延迟到EI服务。社会人口统计学和临床因素更相关的预测随后参与EI服务，和指标的负面途径，以照顾与服务disengage.Primary保健提供者可能是一个有效的目标，旨在减少整体治疗延误的干预措施。增加初级保健服务的使用也可能减少消极护理途径的可能性。我们的研究结果提请注意，需要进一步调查的作用，初级保健系统在早期干预FEP，并支持服务提供者在这方面的作用的战略。
Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services.Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montr,al, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services.Few socio-demographic or clinical factors were predictive of negative pathways to care. Rather, service-level factors, such as contact with primary care providers, have a stronger impact on patterns of health service use across multiple indicators. Patients who were in contact with primary care had a reduced likelihood of negative pathways to care, but also had longer referral delays to EI services. Socio-demographic and clinical factors were more relevant for predicting subsequent engagement with EI services, and indicators of negative pathways to care were not associated with service disengagement.Primary care providers may be an efficacious target for interventions aimed at reducing overall treatment delay. Increasing the uptake of primary care services may also reduce the likelihood of negative pathways to care. Our findings draw attention to the need for further investigations of the role that the primary care system plays in early intervention for FEP, and strategies for supporting service providers in this role.