F129. FAMILY PHYSICIAN ACCESS AMONG YOUNG PEOPLE WITH FIRST-EPISODE PSYCHOSIS
Bibliographic record
Abstract
Family physicians are a key player in facilitating access to psychiatric treatment for people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. However, approximately a third of people do not seek help for mental health reasons from primary care in the period leading up to the first diagnosis, and it is unclear whether this help-seeking gap is related to lack of access to a regular family physician. Our objective was to estimate the proportion of people with first-episode psychosis who do not have access to a family physician at psychosis onset, and to examine and factors associated with lack of access. Using population-based health administrative data, we constructed a retrospective cohort of people aged 14 to 35 years with a first diagnosis of psychosis in Ontario between 2005 and 2015. We randomly selected four general population controls matched on age, sex, and neighborhood. We compared factors associated with access to a primary care physician at the time of psychosis onset between the two groups using prevalence ratios (PR) estimated from modified Poisson regression models with robust variance estimators. Over one quarter (28%) of young people with early psychosis (n = 39,449) did not have access to a family physician at illness onset. People with psychotic disorders were more likely to have a regular family physician relative to matched controls (PR = 1.28; 95%CI = 1.27, 1.29). However, after adjustment for physical and psychosocial comorbidities, people with psychotic disorders were less likely to have access to a regular family physician (PR = 0.96; 95%CI = 0.96, 0.97). Among young people with psychotic disorders, factors associated with lack of access to a family physician included older age, male gender, low neighborhood-level income quintile, residential instability, and migrant status. People living in rural areas and those with chronic physical or psychosocial comorbidities were more likely to have access to a regular family physician. Approximately one in four young people with early psychosis in Ontario lack access to a regular family physician at psychosis onset, suggesting that the help-seeking gap in primary care prior to the onset of psychotic disorder may be partially attributed to this lack of access. Interventions aimed at improving access to family physicians among vulnerable groups, and at supporting family physicians in referral to early psychosis intervention services, may improve pathways to care for youth with first-episode psychosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.016 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".