Access to treatment for long-term respiratory disease (Asthma, COPD) in people who also have a severe mental illness (SMI): a qualitative study of patient perspectives

Problem

A severe mental illness (SMI) is defined as any illness needing long term psychotropics, bipolar disease, psychosis and severe depression (combined UK prevalence of almost 4%). Research suggests that overshadowing of physical health by the mental illness may pose a barrier to access to healthcare. People with a SMI experience premature mortality, mostly due to cardio-metabolic disease. Significantly higher rates of smoking and relative socioeconomic deprivation in the SMI population increase the risk of respiratory disease, but there is little empirical research. The SMI population has almost double the prevalence of COPD compared to the general population (3.5%vs1.8%). The 2014 UK “Asthma Deaths’ report highlighted that 17% of people who died had co-existing mental illness and poorer access to care. UK guidelines for Asthma and COPD recommend optimized medication and self-management, alongside practitioner reviews.

Approach

A qualitative interview study which aims to explore the patient experience of access to care for Asthma and/ or COPD in adults who also have a SMI.

The topic guide and recruitment strategy were developed with reference to the literature and discussed with two patient groups. Following ethics and HRA approval, the study was adopted to the NIHR Clinical Research Network portfolio, enabling an intensive approach, with service support costs, to purposive sampling by practice and diverse patient demographics Semi-structured interviews will be completed with a sample of consenting adults with COPD and/or Asthma AND a history of a SMI (identified using registers and until data saturation).

Findings

Data will be transcribed and organized (NVivo software). Thematic analysis will be undertaken with independent verification of emergent themes for presentation at the conference. Identified facilitators and barriers to primary care research, in this population, will be shared.

Consequences

This study is one of five qualitative, 'research inclusion’ studies being undertaken in our group: the 'IMPAC' studies (Understanding barriers and IMProving ACcess to healthcare for underserved populations).

This study will investigate if theories such as ‘candidacy and ‘organisation permeability’ in relation to ‘Access to healthcare by vulnerable groups’ apply. The study findings will help define the elements of an intervention to optimize access to respiratory healthcare for people with a SMI who also have Asthma and/ or COPD.