Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
Early Interv Psychiatry. 2024 May;18(5):293-311. doi: 10.1111/eip.13497. Epub 2024 Feb 15.
Access to timely treatment is key to early intervention in psychosis. Despite this, barriers to treatment exist. In this review, we aimed to understand the structural barriers that patients and caregivers face in help-seeking for first-episode psychosis, and the recommendations provided to address these.
We conducted a systematic review (PROSPERO: CRD42021274609) of qualitative studies reporting structural barriers to help-seeking from the patient or caregiver perspective. Searches were performed in September 2023, restricted to studies published from 2001. Study quality was appraised using Critical Appraisal Skills Programme. Data were analysed using thematic synthesis.
Nineteen papers from 11 countries were included. Across all papers, participants reported experiencing structural barriers to receiving healthcare. For many patients and caregivers, the process of accessing healthcare is complex. Access requires knowledge and resources from parents, caregivers and healthcare providers, yet too often there is a misalignment between patients' needs and service resources. Expertise amongst healthcare providers vary and some patients and caregivers experience negative encounters in healthcare. Patients highlighted earlier caregiver involvement and greater peer support as potential routes for improvement.
Patients and caregivers face multiple structural barriers, with legislative practices that discourage family involvement, and healthcare and transport costs found to be particularly problematic. Understanding these barriers can facilitate the co-design of both new and existing services to provide easier access for patients and caregivers. Further research is needed focusing not only on the perspectives of patients and caregivers who have accessed professional help but also crucially on those who have not.
及时获得治疗是精神病早期干预的关键。尽管如此，治疗仍然存在障碍。在本综述中，我们旨在了解患者和照顾者在寻求首发精神病治疗时面临的结构障碍，以及为解决这些障碍而提出的建议。
我们对从患者或照顾者角度报告寻求帮助的结构障碍的定性研究进行了系统综述（PROSPERO：CRD42021274609）。搜索于 2023 年 9 月进行，限制在 2001 年以来发表的研究。使用关键评估技能计划评估研究质量。使用主题合成分析数据。
来自 11 个国家的 19 篇论文被纳入。在所有论文中，参与者报告说他们在获得医疗保健方面遇到了结构障碍。对许多患者和照顾者来说，获得医疗保健的过程很复杂。获得医疗保健需要父母、照顾者和医疗保健提供者的知识和资源，但患者的需求与服务资源之间常常存在错位。医疗保健提供者的专业知识参差不齐，一些患者和照顾者在医疗保健中经历了负面的遭遇。患者强调早期照顾者的参与和更多的同伴支持是潜在的改进途径。
患者和照顾者面临多种结构障碍，立法实践阻碍了家庭的参与，医疗保健和交通费用被发现是特别成问题的。了解这些障碍可以促进新的和现有的服务的共同设计，为患者和照顾者提供更方便的服务。需要进一步研究，不仅要关注已经获得专业帮助的患者和照顾者的观点，而且要关注那些没有获得帮助的患者和照顾者的观点。
