Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care

Quality of Psychiatric Care for Immigrants and People With a Non-English Language Preference: A Systematic Scoping Review

OBJECTIVE

Immigrants and persons with a non-English language preference (NELP) face unique challenges in the mental health care system. This systematic scoping review aimed to evaluate the literature for disparities in psychiatric care delivery, beyond access and utilization barriers, experienced by these two populations.

METHODS

The authors queried four databases: PubMed, PsycInfo, Web of Science, and CINAHL. Studies published between August 1993 and August 2023 were selected if they had a population that included immigrants to English-language countries or patients with a NELP and a mental illness, had a relevant comparison group, and included outcome measures focused on quality of psychiatric care delivery. Studies focusing solely on care access or utilization, studies without original data, case reports, and commentaries were excluded.

RESULTS

The search identified 2,860 studies. Seventeen studies were included for full-text review (Cohen's κ=0.96). Large variability was found in the measures of quality used in the studies. Outcome variables were involuntary treatment rate, symptom management, unmet needs, medication use and monitoring, diagnosis, and psychiatric referral. Immigrants were more likely than nonimmigrants to receive involuntary treatments in all seven pertinent studies. An insufficient number of studies focused on other outcome measures, limiting analyses.

CONCLUSIONS

Many studies highlighted differences in care, especially with regard to involuntary hospitalization. Outcome measures varied and deviated from established quality metrics. Insufficient data were available to determine whether the identified differences in care represent a care delivery gap. Studies that use standardized measures would assist in evaluating the quality of care received by immigrants and patients with a NELP.

Disparities in Access to a Regular Primary Care Physician Among First-Generation Migrants with Early Psychosis in Ontario, Canada

Disparities in primary care utilization among migrants with early psychosis may be related to lack of access to a regular primary care physician. This study aimed to investigate access to a regular primary care physician among first-generation migrants with early psychosis. People aged 14-35 years with first onset non-affective psychotic disorder in Ontario, Canada were identified in health administrative data (N = 39,440). Access to a regular primary care physician through enrollment in the year prior to diagnosis was compared between first-generation migrants (categorized by country of birth) and the general population using modified Poisson regression. Most migrant groups had a lower prevalence of regular primary care physician access relative to the general population, particularly migrants from Africa (African migrants: 81% vs. non-migrants: 89%). Adjustment for sociodemographic and clinical factors attenuated these differences, although the disparities for migrants from Africa remained (PR = 0.96, 95%CI = 0.94-0.99). Interventions aimed at improving primary care physician access in migrant groups may facilitate help-seeking and improve pathways to care in early psychosis.

Early Psychosis Intervention and Primary Care: A Mixed Methods Study of Family Physician Knowledge, Attitudes, Preferences, and Needs

Family physicians (FPs) play an important but underappreciated role in the pathways to care for people with early psychosis. We conducted a mixed-methods study to describe the knowledge, attitudes, preferences, and needs of FPs towards the recognition and management of early psychosis. We sent a cross-sectional postal survey to a random sample of FPs in Ontario, Canada, and conducted in-depth qualitative interviews with twenty. FPs were generally aware of important early psychosis symptoms, however, there were some knowledge gaps. Among surveyed FPs, 25% were unsure of the availability of early psychosis intervention services in their region, and most (80%) would prefer to co-manage with specialists. In the qualitative interviews, FPs expressed varied comfort levels in recognizing psychosis, and that timely access to psychiatry was a main concern. Our findings suggest that FPs require better support in recognizing and managing early psychosis and facilitating connections with specialized care.

Access to a regular primary care physician among young people with early psychosis in Ontario, Canada

AIM

Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access.

METHODS

Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence ratios (PR) for access to a regular primary care physician in the year prior to first diagnosis of psychotic disorder, and the sociodemographic and clinical factors associated with access.

RESULTS

A larger proportion of people with early psychosis had a regular primary care physician, relative to the general population (89% vs. 68%; PR = 1.30, 95%CI = 1.30-1.31). However, this was accounted for by a higher prevalence of comorbidities among people with psychosis, and this association was no longer present after adjustment (PR = 0.97, 95%CI = 0.97, 0.98). People with early psychosis who were older, male, refugees and those residing in lower income or high residential instability neighbourhoods were less likely to have a regular primary care physician.

CONCLUSION

Approximately one in ten young people with early psychosis in Ontario lack access to a regular primary care physician. Strategies to improve primary care physician access are needed for management of physical comorbidities and to ensure continuity of care.