Early Interventions for Psychosis
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1 Early Interventions for Psychosis An assessment of an early intervention program in Winnipeg A PATHS Equity for Children Project 1 Manitoba Centre for Health Policy
2 Authors Jason Randall, Dan Chateau, Carole Taylor, James Bolton, Laurence Katz, Patricia Martens, Alan Katz, Mark Smith, Colette Raymond, Elaine Burland, Joykrishna Sarkar, Milton Hu, Chun Yan Goh, Marni Brownell, Nathan Nickel, the PATHS team. 2 Manitoba Centre for Health Policy
3 Background The Early Psychosis Prevention and Intervention Service (EPPIS) Established 2003 Intervention for those with first-episode of psychosis Based on previous early intervention programs Assertive community treatment (ACT) Assertive case management Community treatment Emphasized: adherence to medication, psychotherapy (including group therapy), and involvement of family in treatment 3 Manitoba Centre for Health Policy
4 Previous research Background Reducing hospital-based treatment Multiple studies on hospital-based outcomes No symptom measures in the Admin data Inconsistent significance Small samples/low power Favoured intervention 4 Manitoba Centre for Health Policy
5 Systematic review Review and meta-analysis To pool effect size estimates to determine significance Inclusion Criteria Early intervention program (ACT framework) First-episode/early psychosis patients Control group Hospital outcomes (bed days used, any hospitalization) Published in English 5 Manitoba Centre for Health Policy
6 Systematic review Data extraction Bed-days outcome Means and SD for Treatment and control groups Extracted from treatment cost evaluations Hospitalization outcome Number hospitalized and group N 6 Manitoba Centre for Health Policy
7 Systematic review Meta-analysis of ever hospitalized 7 Manitoba Centre for Health Policy
8 Systematic review Meta-analysis of bed-day usage 8 Manitoba Centre for Health Policy
9 EPPIS project Sought to evaluate the effectiveness of EPPIS Main outcomes Hospital usage, and ED usage; Suicidal behaviour; Justice department data. 9 Manitoba Centre for Health Policy
10 PATHs Studies Methods Administrative data Manitoba Adolescent Treatment centre (MATC) Client info Linked to MCHP data repository EPPIS clients ( ) Historical controls ( ) Controls matched to diagnostic pattern of EPPIS clients prior to program entrance 10 Manitoba Centre for Health Policy
11 PATHs Studies Methods Propensity-score adjustment for confounders SAS macro used to identify potential confounders Inverse-probability of treatment weights Average Treatment Effect (ATE) During and post-treatment period assessed Odds ratios (binary variables) Hazard ratios (binary variables) Rate ratios (count variables) 11 Manitoba Centre for Health Policy
12 Suicide and hospital-based service use Results ED episodes Hospital days Inpatient episodes Suicidal Behaviour Criminal accusations During treatment After treatment RR: 2.68 (1.56 to 4.58) RR: 1.76 (1.19 to 2.60) RR: 1.73 (0.57 to 5.22) RR: 2.70 (1.35 to 5.40) RR: 1.37 (0.78 to 2.41) RR: 2.30 (1.49 to 3.54) No events (p<0.0001) HR: 0.39 (0.17 to 0.94) OR: 0.48 (0.34 to 0.68) OR: 0.62 (0.47 to 0.82) 12 Manitoba Centre for Health Policy
13 Discussion/Conclusions First study on justice effects Reduced suicidal behaviour During and after treatment Hospital outcomes conflict with literature Different program implementation Due to low service use before program Emphasis on treatment engagement 13 Manitoba Centre for Health Policy
14 This study utilized data from Manitoba Health, Healthy Living and Seniors. The results and conclusions are those of the authors and no official endorsement by Manitoba Health, Healthy Living and Seniors is intended or should be inferred. 14 Manitoba Centre for Health Policy
15 Conference: Pathways to Health Equity: Levelling the Playing Field when: May 30 June 1, 2016 where: Fort Garry Hotel, Winnipeg International knowledge exchange and dissemination event, building on the theme of from research to policy Themes include: child health; social determinants of health & equity; economics & equity; measuring health equity; indigenous health; health interventions & equity; international health equity; ethics and equity; gender equity For more information, visit our website at: ciences/departmental_units/mchp/paths_conference.html 15 Manitoba Centre for Health Policy
16 16 Manitoba Centre for Health Policy
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