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Table 1 Definitions of the treatment gap dimensions and how they may be measured

From: The psychosis treatment gap and its consequences in rural Ethiopia

Care/treatment gap dimensions Definition How measured
Subjective Objective
Access
• Lifetime Whether there ‘ever’ was access to evidence-based care since onset of illness without any judgment about efficacy Self-reported access over the course of illness since onset Linkage based on databases (electronic or other records)
• Current Whether there was access to evidence-based care for the current or most recent episode of illness Self-reported access during the current or most recent episode of illness Linkage based on databases (electronic or other records)
Adequacy Whether adequate quantity of treatment was provided in terms of the nature, dose and duration of treatment Self-reported minimum adequacy standard Recorded information compared with established standard of care
Quality Attainment of a certain standard and meeting certain intrinsic characteristics of care such as patient satisfaction and concordance with patient values Self-reported patient satisfaction Evaluation of whether care is concordant with established quality standards and guidelines
Effectiveness Intended outcomes of clinical improvement achieved with little untoward consequences and inconvenience to user Self-reported benefit of care Standard scales of effectiveness
Recovery This is the ultimate goal of treatment and understood in three ways:
• Sustained clinical wellness (well for at least 6 months)
• Functional wellness (regaining full functionality)
• As a process of change that allows individuals to “improve their health and wellness, live a self-directed life, and strive to reach their full potential” [17]
Self-reported recovery Standard scales of recovery may be used
Equity Is relevant to all dimensions of care or treatment gap and equitable care ensures that access, quality or impact of care “does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location, or socioeconomic status.”   Analysis of variation of care and treatment gap by the various equity dimensions.