title: Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care.
abstract: OBJECTIVE
  The observed association between treatment delay and poor outcomes in first-episode psychosis has led to an interest in the topography of symptom development preceding the onset of psychosis and associated help-seeking behaviors. We estimated the extent to which socio-demographic, clinical, and health service indicators are associated with patterns of service use for mental health reasons preceding a first diagnosis of psychosis.
  
  
  METHODS
  Population-based administrative data from physician billings, hospitalizations, and public health clinics were used to identify incident cases of schizophrenia-spectrum psychosis among individuals aged 14-25 years in Montréal. Mental health contacts in the 4 years preceding the index diagnosis were analyzed.
  
  
  RESULTS
  Thirty-two percent of cases had no contact with services for a mental health reason preceding the index diagnosis, and nearly 50% received the index diagnosis of psychosis in the emergency department. Individuals in contact with primary care had a reduced likelihood of contact with the emergency department and inpatient services (OR = 0.15, 0.06-0.39) and of receiving the index diagnosis in the emergency department (OR = 0.36, 0.24-0.54), but also had a longer time to contact with a psychiatrist (HR = 0.32, 0.23-0.45).
  
  
  CONCLUSIONS
  Improving access to primary care may reduce the burden on emergency departments and inpatient units; however, primary care providers may need additional training in the symptoms of early psychosis and referral protocols. Given the limitations associated with using clinical samples from specialized services, population-based administrative data are an important source of information for understanding patterns of health services use preceding a first diagnosis of psychosis.
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada.
authors: Kelly K
authors: KK
authors: Anderson
authors: Rebecca
authors: R
authors: Fuhrer
authors: Willy
authors: W
authors: Wynant
authors: Michal
authors: M
authors: Abrahamowicz
authors: David L
authors: DL
authors: Buckeridge
authors: Ashok
authors: A
authors: Malla
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D012044:Regression Analysis; D012959:Socioeconomic Factors; D055815:Young Adult