‘Time to remove the blinkers?’ Exploring patient and primary care practitioner perspectives on quality of care for people with serious mental illness.
On average, people with SMI die 15-20 years younger than the general population, principally from the same preventable conditions such as cardiovascular and respiratory disease. They also develop comorbidities earlier. This mortality/morbidity gap is inequitable and unacceptable. To date research on the physical health of this population has been largely quantitative. This study used qualitative methods to generate unique insights from patients and practitioners about the quality of care for people with SMI. It aims to deepen our understanding of the physical health needs of people with SMI to enable them to live longer healthier lives.
A qualitative semi-structured interview design was chosen to explore patient and provider perspectives of quality of care. Thirty interviews were conducted (Yorkshire and Humber region), 19 people with schizophrenia or bipolar disorder and 11 practitioners (GPs/practice nurses). The majority of patients were recruited through family practices, purposively sampled according to diagnosis, age, sex and deprivation level to maximise data variation. Interviews were audio recorded, transcribed verbatim, and, analysed using thematic analysis and constant comparison. The study was approved by the Social Care Research Ethics Committee, London (17/IEC08/0025).
Findings demonstrated both congruence and dissonance between practitioners and patients. For example, both groups view continuity of care as pivotal to care quality. Most patients expressed strong preference to see their own GP, even if long waiting times were incurred. Similarly practitioners agreed relationships and trust are paramount for providing high quality care to this group. Both groups shared concern over an apparent disconnect in communication between primary and secondary care and its negative impact on care quality. Contrastingly, discord arose in how health is conceptualised. Patients reported an absence of holistic care, stating practitioners typically separate physical and mental health. Conflict also arose over prioritisation of health needs. Patients reported feeling let down by lack of time and opportunity to discuss the negative and impairing side effects of psychotropic medication. Chief among their concerns was the unprecedented weight gain associated with medication.
This study provides new evidence about the quality of care for SMI patients and what is happening in practice. Practitioner and patient perspectives offer rare insights which can inform policy from the bottom up. The data demonstrate there is a need for serious mental illness to become more visible and more of a priority in primary care. Continuity of care – a guiding principle of primary care – is increasingly difficult to achieve but is imperative to delivering high quality of care for this group, perhaps more so than for people without SMI.