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Waiting time variation in Early Intervention Psychosis services: longitudinal evidence from the SEPEA naturalistic cohort study

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Kirkbride, JB 
Hameed, Y 
Wright, L 
Russell, K 
Knight, C 


PURPOSE: Early Intervention Psychosis [EIP] services have gained traction internationally, but are currently undergoing various forms of reconfiguration. In England, such services are now mandated to ensure 50% of accepted referrals commence care within 14 days, but no empirical evidence exists. We sought to estimate waiting times to EIP services in a large, representative epidemiological cohort in England, and investigate possible reasons for any variation. METHODS: We estimated median waiting time from referral to acceptance by EIP services and investigated whether this varied by clinical, demographic or neighbourhood-level factors, amongst 798 participants, 16-35 years old, presenting to six EIP services over 3.5 years in a defined catchment area serving 2.5 million people. We used parametric survival analysis to inspect variation in waiting times (in days). RESULTS: Median waiting time was 15 days (interquartile range 7-30), although this varied across services (p < 0.01). Waiting times increased over the case ascertainment period by an average of 4.3 days (95% CI 1.3, 6.2; p < 0.01). Longer waiting times were associated with greater diagnostic uncertainty, indexed by an organic presentation (+ 9.1 days; 95% CI 1.9, 16.6; p < 0.01), polysubstance abuse (+ 2.6; 0.6, 3.9; p < 0.01), absence of psychotic disorder (+1.8; -0.1, 3.0; p = 0.05) and insidious onset (+1.8; -0.1, 3.0; p = 0.06). Waiting times did not vary by most demographic or neighbourhood-level characteristics. CONCLUSIONS: EIP services operate close to new waiting time standards in England, with little systematic variation by sociodemographic position. However, waiting times increased over the study period, coinciding with substantial service reorganisation. Longer waiting times associated with greater diagnostic uncertainty highlight opportunities to reduce delays in certain clinical groups at initial referral.



Cohort studies, Early intervention (education), Health services research, Mental health services, Psychotic disorders

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Social Psychiatry and Psychiatric Epidemiology

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National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) (unknown)
Wellcome Trust (085540/Z/08/Z)
National Institute for Health and Care Research (RP-PG-0606-1335)
The work for this paper was supported by: a Sir Henry Wellcome Research Fellowship from the Wellcome Trust (Grant No. WT085540) to Dr James Kirkbride, a Sir Henry Dale Fellowship to Dr James Kirkbride, jointly funded by the Wellcome Trust and the Royal Society (Grant No. 101272/Z/13/Z), and an NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) grant for Cambridgeshire and Peterborough (Grant No. RP-PG-0606-1335) to Prof Peter Jones. The funders had no involvement in any aspect of the design of this study, preparation of results, or decision to submit for publication. We thank the Cambridgeshire and Peterborough (CPFT) and Norfolk and Suffolk Foundation Trusts (NSFT) for sponsoring this research.