Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
Soc Psychiatry Psychiatr Epidemiol. 2013 Jan;48(1):125-36. doi: 10.1007/s00127-012-0571-0. Epub 2012 Sep 14.
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 Montréal, 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.
尽管已有大量研究关注首发精神病（FEP）患者的治疗路径，但很少有研究探讨治疗路径的决定因素及其对后续心理健康服务参与度的影响。
我们使用了蒙特利尔基于人群的早期干预（EI）计划中 324 名 FEP 患者的样本，估计了几个社会人口统计学、临床和服务水平因素与负面治疗路径和治疗延迟的关联。我们还评估了治疗路径对从 EI 服务中脱离的时间的影响。
少数社会人口统计学或临床因素可预测负面治疗路径。相反，服务水平因素，如与初级保健提供者的接触，对多种指标的卫生服务使用模式有更强的影响。与初级保健提供者有接触的患者负面治疗路径的可能性较低，但 EI 服务的转诊延迟也较长。社会人口统计学和临床因素与后续参与 EI 服务的相关性更高，负面治疗路径的指标与服务脱离无关。
初级保健提供者可能是减少整体治疗延迟的干预措施的有效目标。增加初级保健服务的利用率也可能降低负面治疗路径的可能性。我们的研究结果提请注意进一步调查初级保健系统在 FEP 早期干预中的作用以及支持服务提供者发挥这一作用的策略的必要性。
