Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; North East London NHS Foundation Trust, London, UK.
Schizophr Res. 2021 Nov;237:47-53. doi: 10.1016/j.schres.2021.08.023. Epub 2021 Sep 6.
Early intervention in psychosis services (EIS) support individuals experiencing a first episode of psychosis. Support required will vary in response to the remittance and reoccurrence of symptoms, including relapses. Characterising individuals who will need more intensive support can inform care planning. This study explores service utilisation profiles and their trajectories of service use in a sample of individuals referred to EIS.
We analysed service utilisation during the 3 years following referral to EIS (n = 2363) in West London between 2011 and 2020. Mental health service utilisation data were submitted to model-based clustering. Latent growth models were then estimated for identified profiles. Profiles were compared regarding clinical and demographic characteristics and onward pathways of care.
Analyses revealed 5 profiles of individuals attending EIS based on their service utilisation over 3 years. 55.5% of the sample were members of a low utilisation and less clinically severe profile. The distinct service use patterns of these profiles were associated with Health of the Nations Outcome Scale scores at treatment initiation (at total, subscale, and individual item level), along with age and gender. These patterns of use were also associated with onward care and ethnicity.
Profiles and trajectories of service utilisation call for development of integrated care pathways and use of more personalised interventions. Services should consider patient symptoms and characteristics when making clinical decisions informing the provision of care. The profiles represent typical patterns of service use, and identifying factors associated with these subgroups might help optimise EIS support.
精神病早期干预服务（EIS）为首次出现精神病症状的个体提供支持。支持的需求将根据症状的缓解和复发情况而有所不同，包括复发。对需要更密集支持的个体进行特征描述可以为护理计划提供信息。本研究探讨了在 2011 年至 2020 年期间，在伦敦西部接受 EIS 转介的个体样本中，服务利用情况的特征和轨迹。
我们分析了 2011 年至 2020 年期间在伦敦西部接受 EIS 转介的 2363 名个体在 3 年内的心理健康服务利用数据。提交给基于模型的聚类分析。然后为确定的模式估计潜在的增长模型。对具有相似服务利用模式的个体进行了临床和人口统计学特征以及后续护理途径的比较。
分析结果显示，根据个体在 3 年内的服务利用情况，EIS 患者存在 5 种不同的服务利用模式。55.5%的样本属于低利用、临床症状较轻的模式。这些模式的明显服务利用模式与治疗开始时的健康国家结果量表评分（总分、子量表和单项）以及年龄和性别相关。这些利用模式还与后续护理和种族有关。
服务利用模式和轨迹需要制定综合护理途径，并使用更个性化的干预措施。服务机构在做出影响护理提供的临床决策时，应考虑患者的症状和特征。这些模式代表了典型的服务利用模式，确定与这些亚组相关的因素可能有助于优化 EIS 支持。
