Adherence to Follow-Up in First-Episode Psychosis: Ethnicity Factors and Case Manager Perceptions

To determine whether visible minority patients with first-episode psychosis are at higher risk for treatment nonadherence than white patients and elicit the perceptions of case managers regarding visible minority patients.

Data for 168 patients referred to a tertiary first-episode psychosis clinic from January 2008 to January 2012 were collected via chart review. For 110 patients, a questionnaire filled out by each patient's case manager collected quantitative and qualitative data regarding the case managers' perceptions of patients' insight, cooperation, and adherence to appointments and medication. Differential treatment adherence in white and visible minority patients was tested via χ² analyses. Case manager ratings of adherence were compared to objective data via Cohen κ. Qualitative data were analyzed via thematic analysis.

Black patients had poorer follow-up compared to other patients (adjusted χ²₁ = 4.3, P = .04). Concordance of case manager-reported adherence and chart data was significant for the visible minority group only (κ = 0.4, P = .002). In case manager perceptions, there was no significant difference between ethnic groups in adherence to appointments and medication, insight, or family involvement.

Although Canada is often perceived as tolerant of diversity, our data regarding poor follow-up in black patients indicate similar problems to those reported in the United Kingdom and United States. Clinicians may have low expectations for visible minority patients and thus notice more consistently when these patients adhere to treatment. This is the first study to examine ethnic differences in adherence to first-episode psychosis follow-up in a Canadian setting.