title: Rural and remote early psychosis intervention services: the Gordian knot of early intervention.
abstract: OBJECTIVE
  One of the basic challenges of Early Psychosis Intervention (EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models (hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada.
  
  
  METHODS
  This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chi-square tests were used to test differences between two groups.
  
  
  RESULTS
  The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%).
  
  
  CONCLUSIONS
  The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations.
authors.affiliation: First Place Clinic and Regional Resource Centre, Canadian Mental Health Association, Thunder Bay, Ontario, Canada; Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Chiachen
authors.initials: C
authors.lastname: Cheng
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Dewa
authors.forename: Gord
authors.initials: G
authors.lastname: Langill
authors.forename: Mirella
authors.initials: M
authors.lastname: Fata
authors.forename: Desmond
authors.initials: D
authors.lastname: Loong
mesh_terms: D003430:Cross-Sectional Studies; D061345:Early Medical Intervention / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D009864:Ontario; D011618:Psychotic Disorders / Q000628:therapy*; D019035:Rural Health Services / Q000458:organization & administration*; D055815:Young Adult
keywords: early intervention; northern health services; psychosis; rural health services