Primary Care After Psychiatric Crisis: A Qualitative Analysis

Abstract

PURPOSE Patients with serious psychiatric problems experience diffi culty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis.METHODS A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTSAt baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was benefi cial. Patients in the intervention group had signifi cantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group.CONCLUSIONS This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes. Ann Fam Med 2008;6:38-43. DOI: 10.1370/afm.760. INTRODUCTIONP atients with serious mental illness have medical comorbidity and may not receive adequate primary care; they have impaired physical and emotional health and use the emergency department rather than the primary care setting. [1][2][3] There is evidence that even if individuals with serious mental illness have a regular source of primary care, they may not access services because of a lack of coordination between mental and medical health care. 4,5 Primary care is of value to patients with behavioral disorders. In one study, patients with psychiatric disorders viewed primary care as the cornerstone for both their physical and mental health care; they emphasized continuity of care and listening skills as critical components. 6 Getting connected to the physician, however, may pose a problem for patients with serious mental illness who are emerging from psychiatric crisis. Responsiveness of the treatment system and collaboration between mental health and primary care systems can enhance communication between medical and mental health care professionals and positively affect PR IM A RY ...

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