Exploring Barriers to Primary Care For Patients with Severe Mental Illness: Frontline Patient and Provider Accounts

Abstract

The goal of this study was to obtain in-depth descriptions of barriers to primary care for adults with serious mental illness (SMI) and to provide solutions to these barriers. Qualitative interviews were administered to mental health and medical providers, as well as patients. Several major themes were reported including: poor access to care; patient limitations (e.g., psychopathology, cognitive difficulties); societal, health care system, and provider bias; integrated/fragmented care, communication difficulties; and quality of care issues. Results point to a need for nursing professionals to continue to improve access to medical care for this population, as well as to continue to integrate mental health and primary care.

Contours of Usual Care: Meeting the Medical Needs of Diverse People with Serious Mental Illness

“…Geographic and organizational barriers were found to impact the care coordination loop by complicating efforts to efficiently get consumers to medical sites for appointments, establish reciprocal working relationships with primary care physicians, and obtain consumers’ health records, mirroring findings from an Institute of Medicine 53 report on improving health care quality for people with mental illness and other research. 50,52 These barriers stoked staffs’ tendencies to operate outside of traditional referral avenues and more in isolation. 54 To reverse this trend, more structured and accessible patient data mechanisms are necessary, and may be achieved in part through greater education on how to use available patient record resources and/or executive-level data-sharing agreements that both improve and expand access to patient records.…”

Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial

“…As limited clinician time is cited as a barrier to providing preventive care in general primary care settings [13,43,44] and mental health care settings [45,46], it has been recommended that the 5A’s (ask, advise, assess, assist and arrange) model of preventive care be shortened to ‘2As and an R’, whereby clinicians ask, advise and refer clients on for specialized further care [13,44,47,48]. This approach emphasizes referral of clients to specialist services rather than clinicians providing the extended care themselves, thereby limiting the demand on clinicians’ time, and encouraging client access to specialized health behavior change interventions.…”

A Randomized Clinical Trial Investigating the Effect of a Healthcare Access Model for Individuals with Severe Psychiatric Disabilities

“…A lack of coordination and continuity of care as well as a lack of integration of primary and mental health care may compromise the medical care that individuals with psychiatric disabilities do receive (Cradock-O'Leary et al 2002;McCabe and Leas 2008;Lawrence and Kisely 2010). Systemic and provider-level factors have also been implicated in qualitative studies including problems related access and integration (Pahwa et al 2010;Kaufman et al 2012) as well as non-medical reasons such as societal stigma and self-stigma (Pahwa et al 2010;Borba et al 2012;Van Den Tillaart et al 2009). Negative attitudes among healthcare providers have been cited in several studies as an important factor, leading to poor communication with primary care providers and the provision of less than adequate care (McCabe and Leas 2008;Lester et al 2005;Pahwa et al 2010;Van Den Tillaart et al 2009).…”