Acute Versus Primary Care: The Health Care Decision Making Process for Individuals With Severe Mental Illness

Abstract

Health care seeking behaviors are learned and learning that will promote the use of outpatient services in SMI must include positive experiences in the delivery of care in the primary care setting. Participants were knowledgeable regarding their illnesses and able to articulate symptoms of illness well. Failure to communicate symptoms appeared to reflect the participant's perception of a lack of response to their reports.

Reducing barriers to accessing primary care for individuals with severe mental illness: examining characteristics of Canadian nurse practitioner practice

“…Sub-optimal therapeutic relationships arise when the patient and the care provider do not engage with one another to effect positive change for the patient because of insufficient communication, trust, and respect (DeCoux, 2005). Individuals commonly report that not therapeutic relationships with primary care providers are negatively affected when complaints related to the SMI diagnosis are dismissed as somatic (Davis, 2004).…”

“…Individuals with SMI have described the ways in which the current model of delivery fails to recognize their unique health needs and restricts access to services (DeCoux, 2005). Having identified the most common barriers and the ways in which they restrict access to primary care, it is possible to search for alternative approaches to providing primary care to individuals with SMI.…”

“…Complex service delivery is a barrier that exists because of the organizational, logistical, and bureaucratic challenges of delivering primary care resulting from a fragmented primary care system (DeCoux, 2005). Complex service delivery restricts access to care by requiring individuals with SMI to attend multiple primary care related appointments in different locations.…”

“…Individuals with SMI also identify ineffective communication between care providers as a barrier to accessing services (Boardman, 2006). A lack of effective communication between primary care providers requires patients to undergo numerous, redundant assessments that discourages follow-up (DeCoux, 2005).…”

“…Difficulty obtaining transportation to services, a perceived lack of respect by health care providers (DeCoux, 2005), a fragmented health care system (Wortans, Happell, & Johnstone, 2006), and stigma (Groh, 2007) are some of the many factors contributing to reduced access to primary care.…”