Programme no. 457-P
Use of primary care during the years before first psychiatric diagnosis
Hans Christian Brix Nørgaard*1, Henrik Søndergaard Pedersen2, Thomas Munk Laursen3, Mogens Vestergaard4, Niels Peter Ole Mors5
1Forskningsenheden for almen praksis, Aarhus Universitet ,Aarhus University Hospital,Aarhus C,Denmark, 2Forskningsenheden for almen praksis, Aarhus Universitet ,Aarhus University Hospital,Aarhus C,Denmark, 3National Centre for Register-based Research,Aarhus University,Aarhus C,Denmark, 4Forskningsenheden for almen praksis, Aarhus Universitet ,Aarhus University Hospital,Aarhus C,Denmark, 5Forskningsenheden afd. P,Aarhus Universitetshospital Risskov,Aarhus C,Denmark
* = Presenting author
Objectives: The present study seeks to determine when the possible first symptoms of schizophrenia could be detected in general practice.
Background: Objective: Schizophrenia is the most common psychosis illness, and is characterized by a slowly progressing onset of symptoms. A long duration of untreated psychosis is associated with an unfavorable long term prognosis.
Results: Results: Patients with schizophrenia utilized primary care more than the control cohort during all six years before diagnosis. For daytime contacts the first two months with an IRR = 1.55 (95% CI: 1.50-1.60). This excess use grew consistently and steadily towards the time of diagnosis with an IRR = 2.60 (95% CI: 2.55-2.66) during the last two months before diagnosis. Out-of-hours contacts the first two months with an IRR = 1.55 (95% CI: 1.40-1.70) and the last two months before diagnosis showing 4 fold increased visit rates, IRR = 4.14 (95% CI: 3.90-4.40)
Material/Methods: Methods: We conducted a population-based matched comparative study using nationwide registry data. We included as cases, all patients in Denmark above 15 years of age (N = 23.078) diagnosed with schizophrenia disorders (ICD-8 code 295 and ICD-10 code F.20) from January 1st 1998 till June 5th 2014. As controls, 20 per case were matched on gender and age (N = 461.560). Utilization of primary health care services (day time contacts and out-of-hours contacts) during six years preceding diagnosis/index date was measured for cases and controls.
Conclusion: Conclusions: The study shows excess health care use for patients with schizophrenia years before established diagnosis. We found that the cases had significant more visits than the controls in all 72 months before diagnosis was established.
Points for discussion: More knowledge about early symptoms and the diagnostic pathway for schizophrenia would be clinically relevant. This in order to ensure a better, and faster diagnostic pathway for this vulnerable group of patients.