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Article Title

Removing Barriers to Preventive Care for People With Serious Mental Illnesses: Preliminary Results From the PRIME Study

Publication Date

4-30-2015

Keywords

preventive services, serious mental illness

Abstract

Background/Aims: People with serious mental illnesses (SMI) experience premature morbidity and mortality, largely due to preventable conditions, and may not receive guideline-concordant preventive care. Understanding modifiable factors that produce health disparities among this population will inform efforts to improve care delivery and reduce excess mortality.

Methods: Interview and survey data was obtained from primary care providers (PCPs) practicing in a not-for-profit integrated health plan, Federally Qualified Health Centers and safety-net clinics, and patients with SMI. Formative interviews with both groups explored approaches, experiences, barriers and perceived effectiveness of preventive services for people with SMI. Web-based surveys with PCPs (n=249; response rate=51%) and interviews with patients diagnosed with schizophrenia-spectrum disorders, affective psychosis or mood disorders, followed formative interviews. Patient data collection is ongoing (projected n=150).

Results: PCPs felt patients with SMI lacked future orientation and interest in prevention and perceived that these patients have too many needs and are seen too infrequently to affect their health. For providers, lack of time was the most common barrier to providing preventive care (89%). Providers felt office visits were too short, particularly when patients were experiencing psychiatric symptoms; 59% said psychiatric stability greatly/moderately affected ability to provide preventive services. Patients agreed visits were short but saw symptoms as a barrier only when they interfered with making/attending appointments or made providers uncomfortable. Provider-patient relationships were a barrier if providers were dismissive/rude. Patients mentioned appointment logistics (e.g. scheduling, transportation), costs, avoidance and forgetfulness as barriers. A lack of interest in prevention was not supported among patients. Both groups mentioned lack of time, lack of coordination with mental health providers, lack of insurance coverage and lack of understanding insurance as barriers.

Discussion: To increase preventive service use among patients with SMI, patients need assistance overcoming logistical barriers that prevent them from getting into the office. Psychiatric symptoms can make it difficult to get in, but once patients are in front of the PCP they are amenable to prevention, particularly when recommendations come from a provider who engages them. Providers need more time, resources that support collaboration with mental health providers, and some may need additional training to increase their comfort with these patients and their confidence that their recommendations can be effective.

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