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

• Published in: Early intervention in psychiatry 2024-07, Vol.18 (7), p.513-523
• Main Authors: Rodrigues, Rebecca, Reid, Jennifer N. S., Wiener, Joshua C., Archie, Suzanne, Booth, Richard G., Cheng, Chiachen, MacDougall, Arlene G., Palaniyappan, Lena, Ryan, Bridget L., Voineskos, Aristotle, Kurdyak, Paul, Jan, Saadia Hameed, Anderson, Kelly K., Candido, Elisa, Chang, Chiachen, Jaakkimainen, Liisa, Lizotte, Daniel, Norman, Ross, Terry, Amanda L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Diagnosis; early intervention; early psychosis; family physicians; Female; health administrative data; Health care; Health Services Accessibility - statistics & numerical data; Humans; Male; Ontario - epidemiology; Physicians; Physicians, Primary Care - statistics & numerical data; Population control; Primary care; Primary Health Care - statistics & numerical data; Psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - epidemiology; Psychotic Disorders - therapy; Residential areas; Young Adult; Young adults
• ISSN: 1751-7885; 1751-7893; 1751-7893
• DOI: 10.1111/eip.13487

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.