Skip to main content
×
×
Home

Understanding the role of the family physician in early psychosis intervention

  • Kelly K. Anderson (a1), Suzanne Archie (a2), Richard G. Booth (a3), Chiachen Cheng (a4), Daniel Lizotte (a5), Arlene G. MacDougall (a6), Ross M. G. Norman (a7), Bridget L. Ryan (a8), Amanda L. Terry (a8) and Rebecca Rodrigues (a9)...
Abstract
Background

The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.

Aims

Our objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.

Method

We will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.

Discussion

These findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Understanding the role of the family physician in early psychosis intervention
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Understanding the role of the family physician in early psychosis intervention
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Understanding the role of the family physician in early psychosis intervention
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: Kelly K. Anderson, Department of Epidemiology & Biostatistics, The University of Western Ontario, Room K213, Kresge Building, 1151 Richmond Street, London, ON N6A 5C1, Canada. Email: kelly.anderson@schulich.uwo.ca
References
Hide All
1Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005; 62: 975–83.
2Perkins, DO, Gu, H, Boteva, K, Lieberman, JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005; 162: 1785–804.
3Harrison, G. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178: 506–17.
4Ontario Ministry of Health and Long Term Care. Program Policy Framework for Early Intervention in Psychosis. Government of Ontario, 2004.
5Anderson, KK, Fuhrer, R, Malla, AK. The pathways to mental health care of first-episode psychosis patients: a systematic review. Psychol Med 2010; 40: 1585–97.
6Goldberg, D, Huxley, P. Models for mental illness. In Common Mental Disorders: A Bio-Social Model: 152. Tavistock Routledge, 1992.
7Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 593602.
8Wang, PS, Angermeyer, M, Borges, G, Bruffaerts, R, Tat Chiu, W, DE Girolamo, G, et al. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 2007; 6: 177–85.
9Anderson, KK, Fuhrer, R, Schmitz, N, Malla, AK. Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 125–36.
10Flora, N, Anderson, KK, Ferrari, M, Tuck, A, Archie, S, Kidd, S, et al. Comparative analysis of pathways to early intervention services and duration of untreated psychosis in two Canadian cities. Early Interv Psychiatry 2017; 11: 517–21.
11Anderson, KK, Flora, N, Ferrari, M, Tuck, A, Archie, S, Kidd, S, et al. Pathways to first-episode care for psychosis in African-, Caribbean-, and European-origin groups in Ontario. Can J Psychiatry 2015; 60: 223–31.
12Archie, S, Akhtar-Danesh, N, Norman, R, Malla, A, Roy, P, Zipursky, RB. Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophr Bull 2010; 36: 688701.
13Anderson, KK, Fuhrer, R, Malla, AK. ‘There are too many steps before you get to where you need to be’: help-seeking by patients with first-episode psychosis. J Ment Heal 2013; 22: 384–95.
14Anderson, KK, Kurdyak, P. Factors associated with timely physician follow-up after a first diagnosis of psychotic disorder. Can J Psychiatry 2017; 62: 268–77.
15Anderson, KK, Fuhrer, R, Wynant, W, Abrahamowicz, M, Buckeridge, DL, Malla, A. Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 1389–98.
16Anderson, KK, Norman, R, MacDougall, AG, Edwards, J, Palaniyappan, L, Lau, C, et al. Disparities in access to early psychosis intervention services: comparison of service users and nonusers in health administrative data. Can J Psychiatry 2018; 63: 395403.
17El-Adl, M, Burke, J, Little, K. First-episode psychosis: primary care experience and implications for service development. Psychiatr Bull 2009; 33: 165–8.
18Renwick, L, Gavin, B, McGlade, N, Lacey, P, Goggins, R, Jackson, D, et al. Early intervention service for psychosis: views from primary care. Early Interv Psychiatry 2008; 2: 285–90.
19Simon, AE, Lauber, C, Ludewig, K, Braun-Scharm, H, Umbricht, DS. General practitioners and schizophrenia: results from a Swiss survey. Br J Psychiatry 2005; 187: 274–81.
20Simon, AE, Lester, H, Tait, L, Stip, E, Roy, P, Conrad, G, et al. The International Study on General Practitioners and Early Psychosis (IGPS). Schizophr Res 2009; 108: 182–90.
21Giannopoulos, P, Carroll, A, Ebmeier, KP. Improving the detection and treatment of schizophrenia. Practitioner 2014; 258(2): 11–6.
22Nørgaard, H, Søndergaard Pedersen, H, Fenger-Grøn, M, Mors, O, Nordentoft, M, Vestergaard, M, et al. Increased use of primary care during 6 years of prodromal schizophrenia. Acta Psychiatr Scand 2016; 134: 225–33.
23Yung, AR, McGorry, PD. The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull 1996; 22: 353–70.
24Lester, H, Tritter, JQ, Sorohan, H. Patients’ and health professionals’ views on primary care for people with serious mental illness: focus group study. BMJ 2005; 330: 1122.
25Verdoux, H, Cougnard, A, Grolleau, S, Besson, R, Delcroix, F. How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals? A postal survey in south-western France. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 892–8.
26Gavin, B, Cullen, W, O'Donoghue, B, Ascencio-Lane, JC, Bury, G, O'Callaghan, E. First episode schizophrenia in general practice: a national survey. Ir J Psychol Med 2006; 23: 69.
27Anderson, KK, Norman, R, MacDougall, A, Edwards, J, Palaniyappan, L, Lau, C, et al. Effectiveness of early psychosis intervention: comparison of service users and nonusers in population-based health administrative data. Am J Psychiatry 2018; 175: 443–52.
28Shiers, D, Lester, H. Early intervention for first episode psychosis. BMJ 2004; 328: 1451–2.
29Reynolds, N, Wuyts, P, Badger, S, Fusar-Poli, P, McGuire, P, Valmaggia, L. The impact of delivering GP training on the clinical high risk and first-episode psychosis on referrals and pathways to care. Early Interv Psychiatry 2015; 9: 459–66.
30Power, P, Iacoponi, E, Reynolds, N, Fisher, H, Russell, M, Garety, P, et al. The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis. Br J Psychiatry 2007; 191: 310.
31Lester, H, Birchwood, M, Freemantle, N, Michail, M, Tait, L. REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis. Br J Gen Pract 2009; 59: e18390.
32Lloyd-Evans, B, Crosby, M, Stockton, S, Pilling, S, Hobbs, L, Hinton, M, et al. Initiatives to shorten duration of untreated psychosis: systematic review. Br J Psychiatry 2011; 198: 256–63.
33Perez, J, Jin, H, Russo, DA, Stochl, J, Painter, M, Shelley, G, et al. Clinical effectiveness and cost-effectiveness of tailored intensive liaison between primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial. Lancet Psychiatry 2015; 2(11): 984–93.
34Creswell, JW, Plano Clark, VL. Designing and Conducting Mixed Methods Research. Sage Publications, 2007.
35Kurdyak, P, Lin, E, Green, D, Vigod, S. Validation of a population-based algorithm to detect chronic psychotic illness. Can J Psychiatry 2015; 60: 362–8.
36Shah, BR, Hux, JE, Laupacis, A, Zinman, B, Cauch-Dudek, K, Booth, GL. Administrative data algorithms can describe ambulatory physician utilization. Health Serv Res 2007; 42: 1783–96.
37Bradford, DW, Kim, MM, Braxton, LE, Marx, CE, Butterfield, M, Elbogen, EB. Access to medical care among persons with psychotic and major affective disorders. Psychiatr Serv 2008; 59: 847–52.
38Mitchell, T. Machine Learning. McGraw Hill, 1997.
39Yung, AR, Nelson, B, Stanford, C, Simmons, MB, Cosgrave, EM, Killackey, E, et al. Validation of ‘prodromal’ criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophr Res 2008; 105: 10–7.
40Zhao, H, Wee-Chung Liew, A, Wang, DZ, Yan, H. Biclustering analysis for pattern discovery: current techniques, comparative studies and applications. Curr Bioinform 2012; 7: 4355(13).
41Sandelowski, M. Focus on research methods whatever happened to qualitative description? Res Nurs Health 2000; 23: 246–55.
42Sullivan-Bolyai, S, Bova, C, Harper, D. Developing and refining interventions in persons with health disparities: the use of qualitative description. Nurs Outlook 2010; 53: 127–33.
43Patton, MQ. Qualitative Research and Evaluation Methods, 2nd edn: 145–98. Sage Publications, 1990.
44Miller, WL, Crabtree, BF. Depth interviewing. In Doing Qualitative Research, 2nd edn (eds Crabtree, BF, Miller, WL): 89107. Sage Publications, 1999.
45Sturges, JE, Hanrahan, KJ. Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res 2004; 4: 107–18.
46Hsieh, H-F, Shannon, SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15: 1277–88.
47Morse, JM. The significance of saturation. Qual Health Res 1995; 5: 147–9.
48Vasiliadis, H-M, Lesage, A, Adair, C, Boyer, R. Service use for mental health reasons: cross-provincial differences in rates, determinants, and equity of access. Can J Psychiatry 2005; 50: 614–9.
49Kurdyak, P, Stukel, TA, Goldbloom, D, Kopp, A, Zagorski, BM, Mulsant, BH. Universal coverage without universal access : a study of psychiatrist supply and practice patterns in Ontario. Open Med 2014; 8: e8193.
50Boydell, KM, Gladstone, BM, Volpe, T. Understanding help seeking delay in the prodrome to first episode psychosis: a secondary analysis of the perspectives of young people. Psychiatr Rehabil J 2006; 30: 5460.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Understanding the role of the family physician in early psychosis intervention

  • Kelly K. Anderson (a1), Suzanne Archie (a2), Richard G. Booth (a3), Chiachen Cheng (a4), Daniel Lizotte (a5), Arlene G. MacDougall (a6), Ross M. G. Norman (a7), Bridget L. Ryan (a8), Amanda L. Terry (a8) and Rebecca Rodrigues (a9)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *