Identifying Service Utilization Patterns in Primary Care by Young People with First-Episode Psychosis
Abstract
Minimizing the duration of untreated psychosis in the first few years after illness onset is essential for improving prognosis for people with psychotic disorders. Leading up to the first onset of psychosis, many people experience early signs and symptoms, suggesting that there may be help-seeking or service utilization prior to first diagnosis. The family physician has been found to play a pivotal role in the pathways to care for people with first-episode psychosis. In this study, we used health administrative data from Ontario to construct a population-based retrospective cohort. These data were used to explore whether people with psychotic disorders had distinctive patterns of primary care service utilization in the six years preceding the first diagnosis of psychosis, relative to the general population comparison group matched on age, sex, and postal code. Our findings suggest that people with psychosis contact primary care over twice as frequently during the six years leading up to first diagnosis, relative to the general population. They have higher contact frequency across nearly all conditions, including mental health, physical conditions, and preventative health-related contacts. We also used Latent Class Growth Modelling to identify three distinct service utilization profiles: low, medium, and high-increasing usage, and we used negative binomial models to identify characteristics associated with each trajectory. Findings from this study can help inform initiatives to support Canadian family physicians and improve detection of early psychosis in primary care, which has implications for improved social, educational, and professional development in young people with first-episode psychosis.