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Which sociodemographic, clinical, and pathway to care factors influence the wait time for early intervention for psychosis? A mental health electronic health records analysis in South London
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  • Nikki Wood,
  • Joanne Hodgekins,
  • Hitesh Shetty,
  • Eduardo Iacoponi,
  • Brian O'Donoghue ,
  • Robert Stewart,
  • Sheri Oduola
Nikki Wood
University of East Anglia Norwich Medical School
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Joanne Hodgekins
University of East Anglia Norwich Medical School
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Hitesh Shetty
South London and Maudsley NHS Foundation Trust
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Eduardo Iacoponi
South London and Maudsley NHS Foundation Trust
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Brian O'Donoghue
Royal College of Surgeons in Ireland Department of Psychiatry
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Robert Stewart
South London and Maudsley NHS Foundation Trust
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Sheri Oduola
South London and Maudsley NHS Foundation Trust

Corresponding Author:[email protected]

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Abstract

Aim: In 2016, the Access and Waiting Time Standard (AWTS) was introduced in England, UK, outlining that people with first-episode psychosis should receive treatment from an early intervention for psychosis (EIP) service within two weeks. We examined sociodemographic, pathways to care (PtC), and clinical factors associated with EIP service wait time. Method: We collected de-identified data from a large mental health provider in South London, UK. We included patients referred and accepted to EIP services as inpatient or community contacts between 1st May 2016 and 30th April 2019, providing 3 years of data from the introduction of AWTS. Descriptive statistics and multivariable linear regression were performed. Results: A total of 1806 patients were identified with a mean age of 30 (SD:10.7) years, of whom 86.3% (n=1559) accessed community EIP and 13.7% (n=247) accessed inpatient EIP; of these, 26.7% were not seen within 2 weeks. Community EIP patients waited longer adj.β =2.21 days (95% CI: 2.05 – 2.37) compared with inpatient EIP patients, and being older was associated with longer wait time. Conversely, a shorter wait time was associated with A&E [adj.β = -0.22 days (95% CI: -0.36, -0.10)] and ‘other’ [adj.β = -0.21 days (95% CI: -0.36, -0.03)] PtC. White non-British and South Asian patients had shorter wait times compared with White British patients; however, this difference diminished after adjusting for PtC and clinical factors. Conclusions: Our findings indicate that individual factors, PtC, and mode of contact influence wait time for EIP services. More than a quarter of patients were not seen within 2 weeks, indicating that targeted support in community EIP services is needed to meet clinical guidelines.