Of the 30 included studies, only nine examined the sex, socio-economic, and/or ethnic determinants of the pathways to care of patients with FEP (Table 1). Some studies tiffany key ring explored other determinants of the pathway to care. However, these are beyond the scope of this review given our stated objective and the limited number of studies available.
Seven studies explored sex as a determinant of the care pathway (Table 1), and three found no association (Cole et al. 1995; Cougnard et al. 2004 b ; Kohn et al. 2004). A Canadian tiffany money clip found that males were nearly five times more likely to make first contact with the emergency department (Archie et al. 2009), and a British study found that males were less likely to be admitted by a general practitioner (Morgan et al. 2005 b ). A study from South Africa found that males were more likely to be admitted involuntarily (Temmingh & Oosthuizen, 2008). Two British studies found evidence that sex may act as an effect modifier in the relationship between ethnicity and compulsory admission; however, the findings were conflicting, with one finding ethnic differences for tiffany necklace only (Morgan et al. 2005 b ) and the other finding ethnic differences only for females (Harrison et al. 1989).
Several socio-economic indicators were examined as determinants of the pathway to care in six studies (Table 1). Five studies found no evidence that socio-economic factors are predictive of the care pathway (Cole et al. 1995; Burnett et al. 1999; Cougnard et al. 2004 b ; Morgan et al. 2005 b ; Archie et al. 2009). Findings from a tiffany pendant study suggest that patients with semi-skilled or no vocational training were more likely to make first contact with police (Kohn et al. 2004).
Ethnicity as a determinant of the pathway to care was examined in seven studies (Table 1), of which three found no evidence of ethnic differences (Cole et al. 1995; Turner et al. 2006; Temmingh & Oosthuizen, 2008). Two British studies found that Afro-Caribbean patients were less likely to be referred by a general practitioner and more likely to have police involvement on their pathway to care (Burnett et al. 1999; Morgan et al. 2005 b ), and a third found longer treatment-delays for Afro-Caribbean patients (Harrison et al. 1989). A study from Canada found that Asian and patients of other ethnic tiffany ring (not including Afro-Canadian) were three to four times more likely to make first contact with emergency services than white patients (Archie et al. 2009). Lastly, three of the four studies reporting ethnic differences in the pathway to care also found evidence of differences in compulsory admissions for ethno-racial minority patients (Harrison et al. 1989; Morgan et al. 2005 b ; Archie et al. 2009).
The pathway to care and DUP
DUP, Duration of untreated psychosis; n.a., not available; s.d., standard deviation; IQR, interquartile range.
First contact on the pathway to care
Twenty studies examined the first contact on the pathway to care, with one study presenting data from two different countries (Bhugra et al. 2000), for a total of 21 datasets (Table 2). The tiffany uk contact for the largest proportion of patients was a physician in 13 of 21 studies. Three additional studies found a similar proportion of patients used a physician or emergency services as the first contact, three studies found that the majority (52-66%) used emergency services, and two found that the majority (62-63%) of patients made first contact with a non-physician.
When we examined the findings by region, all of the eight European studies found that a physician was the first contact for the largest proportion of patients. By contrast, none of the five North American studies found that a physician was the first contact for the largest proportion of patients, with two studies finding that the largest proportion of patients used emergency services, and three finding that approximately equal proportions used a physician or emergency tiffany bangle (Table 2). We also examined the findings by availability of universal health insurance and by whether the country uses a gatekeeper system for access to specialist services, but did not observe notable trends for either of these factors.
Referral source on the pathway to care
Twenty-two studies examined the referral source on the pathway to care (tiffany bracelet 3). In contrast to the first contact, the referral source for the largest proportion of patients was emergency services in nine of 22 studies. One additional study found that an approximately equal proportion of patients were referred by emergency services and a physician. A physician was the referral source for the largest proportion of patients in eight studies, and a non-tiffany cufflink in four studies.
When we examined the findings by region, six of the eight European studies found that the physician was the source of referral for the largest proportion of patients. By contrast, six of seven North American studies found that emergency services were the referral source for the largest proportion of patients, with the seventh study finding an equal proportion referred by emergency services and a physician. Four of five Asian studies found that the largest proportion of patients tiffany earring a non-physician as the referral source (Table 3). We again examined the findings by both the availability of universal health insurance and the use of a gatekeeper system in the jurisdiction of interest, but did not observe any notable trends.
Determinants of the pathway to care
The electronic database search retrieved 1110 studies, of which 45 were deemed relevant for this review. The manual search additionally retrieved 14 studies that were missed in the electronic search, likely due to the lack of frank gehry jewellery standardized search term for pathways to care (Appendix 1). In total, 59 full-text articles were identified, and we excluded 35 of these studies because they did not use an FEP population ( n =18), provide quantitative data on pathways to care ( n =12), and/or use an observational design ( n =9), or because they presented duplicate data that were available in another article ( n =4) (Bhugra et al. 1999; Fuchs & Steinert, 2002; Cougnard et al. 2004 a ; Morgan et al. 2005 a ). An additional six studies were located paloma picasso jewellery regular updates of the literature search.
Thirty studies met the inclusion criteria for our review (Appendix 3). Specifically, 21 studies examined pathways to care generally, and nine explored the sex, socio-economic, and/or ethnic determinants of the pathways (Fig. 1). Additionally, 15 studies examined the impact of the pathway to care on the DUP.
The characteristics of the included studies are summarized in Table 1. Studies were conducted in a variety of countries ( n =16), and one was published in a language return to tiffany jewellery than English (Kohn et al. 2004). The sample sizes varied substantially, ranging from 21 to 462 participants (median across studies=86). The studies generally used a descriptive and cross-sectional design. Given that there is no validated instrument for measuring pathways to care (Singh & Grange, 2006), the data collection methods varied across the studies, which used some combination of patient, family, or clinician interviews and/or tiffany 1837 jewellery records (Table 1).
The studies used different indices of the pathway to care, with eight examining the first contact, 10 examining the referral source, and 12 presenting data on both (Table 1). Additionally, 12 studies assessed the total number of care pathway contacts (Table 1), with the median number of contacts ranging from 1 to 4.5 (median across studies=3). In some circumstances, the first contact on the pathway to care was also the referral source into treatment, but only five studies provided the data in sufficient detail to allow the impact of this to be assessed (Fuchs & Steinert, 2004; Kohn et al. 2004; Chiang et al. 2005; tiffany somerset jewellery et al. 2005; Sharifi et al. 2009). Finally, six studies included family members and 19 included police as potential care pathway contacts (Tables 2 and 3), highlighting differences across studies in the definition of the pathway to care.
Table 2.
Summary of findings from studies examining the first contact on the pathway to care (n=21). Data represent the percentage of patients making contact with a physician, non-physician or emergency services. Shaded cells indicate the type of contact that the largest proportion of patients used in each study, and bolded figures indicate that similar percentages of patients made contact with two of the care pathway contacts
Method: We searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and Tiffany Necklace and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).
Results: Included studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the Tiffany Pendant to care on treatment delay.
Conclusions: Additional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services
Introduction
Recent efforts in psychosis research have focused on the period from the onset of psychotic symptoms to appropriate psychiatric intervention, known as the duration of untreated psychosis (DUP). Findings from literature reviews suggest that delays in the treatment of the first episode are associated with poor clinical and functional outcome, and that it may Tiffany Ring possible to reduce the duration of this delay (Norman & Malla, 2001; Melle et al. 2004; Marshall et al. 2005; Perkins et al. 2005). Although there is little consensus as to what constitutes a long DUP, it is consistently associated with lower overall functioning, more severe positive and negative symptoms, lower quality of life, and a reduced likelihood of achieving remission (Marshall et al. 2005), in addition to poor response to psychiatric treatment (Perkins et al. 2005). This evidence has sparked substantial efforts in secondary prevention and early tiffany for sale for psychosis (McGorry et al. 2007).
The emphasis on early detection and reduction of treatment delay in first-episode psychosis (FEP) has led to an interest in the modes and routes by which patients experiencing psychotic symptoms access help. These pathways to care are defined as 'the sequence of contacts with individuals and organizations prompted by the distressed person's efforts, and those of his or her significant others, to seek help' (Rogler & Cortes, 1993). Care pathways are not random, and are influenced by social, cultural, and health service factors. The pathways to care encompass not only the help-seeking behavior of the patient and family members, but also the accessibility of health services and the identification of, and response to, the symptoms of early psychosis by each contact on the pathway (tiffany bangles & Grange, 2006). This concept is of particular importance in FEP, given the poor functional and clinical outcomes associated with a long DUP (Norman & Malla, 2001; Marshall et al. 2005; Perkins et al. 2005), and the suffering endured by patients and their families. Both help-seeking and referral delays impact the length of time that psychotic symptoms go untreated, and there is evidence that referral delays may be responsible for a substantial proportion of the DUP (Norman et al. 2004; Bechard-Evans et al. 2007).