Nicholls Dasha, Budd Jobie, Nunn Philippa, French Paul, Smith Jo, Gupta Veenu, Holdship Jonathan, Quirk Alan
Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK; and Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Faculty, London, UK; and Division of Medicine, University College London, London, UK.
Br J Psychiatry. 2024 Dec;225(6):556-562. doi: 10.1192/bjp.2024.132.
Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP).
To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake.
We used data from 6813 patients from the 2021-2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model.
Observational results showed that patients aged 18-24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0-0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient -0.13, 95% CI -0.07 to -0.18, < 0.001), and moderator analysis suggested targeting particular groups for interventions.
Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK.
了解不同人口群体在治疗结果上的不平等是在临床护理中解决这些问题的必要步骤。不同人口群体在治疗接受度上的不平等可能解释了首发精神病（FEP）患者在治疗结果上的差异。
调查FEP患者在症状改善方面不同广泛人口群体之间的差异及其与治疗接受度的关系。
我们使用了来自2021 - 2022年全国精神病临床审计数据集的6813名患者的数据。数据按类别类型分组，以在调整前获得平均结果，看看在考虑治疗接受度差异后结果差异是否仍然存在。匹配后，计算每个人口统计学变量在结果变化方面的平均效应。使用回归模型中的交互项研究对特定治疗的调节效应。
观察结果表明，18 - 24岁的患者改善的可能性较小，除非对干预接受度进行调整。在调整治疗接受度和人口统计学因素后，被归类为黑人及英国黑人的患者改善的可能性较小（调节效应0.04，95%置信区间0 - 0.07）。回归分析显示支持性就业干预在改善结果方面具有总体积极效应（系数 - 0.13，95%置信区间 - 0.07至 - 0.18，<0.001），调节分析建议针对特定群体进行干预。
社会和人口因素导致的FEP治疗接受度和精神病症状结果的不平等需要长期监测。我们的分析为监测英国全国临床审计中的健康不平等提供了一个框架。
