Reducing Barriers to Primary Care among Persons with a Mental Illness in an Urban Mental Health Clinic

Abstract

The purpose of this DNP project was to conduct a survey of persons with a mental illness to ascertain their experiences, good or bad, when seeking health care services. Persons with a mental health diagnosis have significantly higher rates of chronic diseases including hypertension, cardiovascular issues, diabetes, obesity, asthma, cancer, respiratory illnesses, and gastrointestinal problems, when compared to the general population without a mental health diagnosis. In addition, persons with a mental health diagnosis have higher rates of tobacco and alcohol abuse. Persons with a mental health diagnosis have a significantly higher premature mortality rate when compared to the general population without a mental health diagnosis. This gap is widening and needs to be mitigated to prevent further disparity in healthcare outcomes in this population. A needs assessment, designed as a quality improvement project, was been chosen to guide the methodology of the DNP project aims that include: 1) assess barriers to accessing primary care as described by patients with a mental illness using the structured PCAT survey tool, 2) analyze the findings from the survey and develop a plan to address the patient described barriers to accessing primary care, and 3) implement a corrective action based upon findings from the PCAT survey, to minimize barriers to primary care for persons with mental illness in this urban clinic setting. The participants (n=7) answered between 22 to 27 questions about their perceptions of care at their primary care clinic. A descriptive analysis of the data was performed to describe patient’s perceptions to four domains of care. Participants reported a perceived lack of access to someone in a timely manner as troublesome. This resulted in the participant’s report of apathy about their own wellness and management of acute or chronic illnesses. The lack of availability of their identified PCP resulted in participant’s acknowledgement that use of the emergency department (ED) as the most viable option. Although the PCAT did not question for use of the ED, most subjects acknowledged use of the ED when the need arose. The research unanimously agrees that ED usage is more expensive when compared to the same treatment delivered in the primary care office. When ED replaces primary care there is a cost to the health and well-being of the patient. The implications are that many chronic diseases are being managed in the ED and that follow up and continuous management of illness is lacking in persons with a mental illness. An unexpected realization from doing this project was that participants were picking up on a perception that their PCP was indifferent with providing care. This perception of indifference made clients feel apathetic about their own management of their illnesses. The lack of patient/provider relationship was very evident. It remains unclear if this perception affected behaviors that are not conducive toward the participant’s active involvement in lifestyle changes that would improve their chronic health issues. Another realization that became evident is the role of the advanced practice nurse provider. Advance practice nurse providers need to be instrumental in seeking evidence to support efforts for enhanced clinical practice through such efforts as QI projects.