Anderson Kelly K, Kurdyak Paul
1 Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario.
2 Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario.
Can J Psychiatry. 2017 Apr;62(4):268-277. doi: 10.1177/0706743716673322. Epub 2016 Oct 14.
Physician follow-up after a first diagnosis of psychotic disorder is crucial for improving treatment engagement. We examined the factors associated with physician follow-up within 30 days of a first diagnosis of schizophrenia.
We conducted a retrospective cohort study using linked health administrative data to identify incident cases of schizophrenia between 1999 and 2008 among people aged 14 to 35 years in Ontario. We estimated the proportion of patients who had physician follow-up within 30 days of the index diagnosis. We used multilevel logistic regression models to examine the factors associated with any physician follow-up and follow-up by a psychiatrist.
We identified 20,096 people with a first diagnosis of schizophrenia. Approximately 40% of people did not receive any physician follow-up within 30 days, and nearly 60% did not receive follow-up by a psychiatrist. Males had lower odds of receiving any physician follow-up, and the odds of psychiatrist follow-up decreased with increasing age and were lower for those living in rural areas. Both prior contact with a general practitioner for a mental health reason and prior contact with a psychiatrist were strongly associated with higher odds of receiving both types of follow-up.
Many people do not have any physician contact within 30 days of the first diagnosis of schizophrenia, and patients without prior engagement with mental health services are at highest risk. We need information on the reasons behind this lack of physician follow-up to inform strategies aimed at improving engagement with services during the early stages of psychosis.
首次诊断为精神障碍后医生的随访对于提高治疗参与度至关重要。我们研究了首次诊断为精神分裂症后30天内与医生随访相关的因素。
我们进行了一项回顾性队列研究，使用关联的卫生行政数据来确定1999年至2008年安大略省14至35岁人群中精神分裂症的新发病例。我们估计了在索引诊断后30天内接受医生随访的患者比例。我们使用多水平逻辑回归模型来研究与任何医生随访以及精神科医生随访相关的因素。
我们确定了20096例首次诊断为精神分裂症的患者。约40%的人在30天内未接受任何医生随访，近60%的人未接受精神科医生随访。男性接受任何医生随访的几率较低，精神科医生随访的几率随着年龄的增加而降低，并且对于居住在农村地区的人来说较低。因心理健康原因之前与全科医生接触以及之前与精神科医生接触均与接受两种随访的较高几率密切相关。
许多人在首次诊断为精神分裂症后的30天内没有与任何医生接触，并且之前未参与心理健康服务的患者风险最高。我们需要了解这种缺乏医生随访背后的原因，以便为旨在改善精神病早期阶段服务参与度的策略提供信息。
