Online Program

Patient-reported barriers and facilitators of preventive care among individuals with serious mental illnesses in primary care settings

Monday, November 2, 2015

Bobbi Jo Yarborough, PsyD, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
Scott Stumbo, M.A., Center for Health Research, Kaiser Permanente Northwest, Portland, OR
Micah Yarborough, M.A., Center for Health Research, Kaiser Permanente Northwest, Portland, OR
Nancy Perrin, PhD, Kaiser Permanente, Center for Health Research, Portland, OR
Carla Green, PhD, MPH, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
Background: Individuals with serious mental illnesses experience physical diseases which are preventable at higher rates than those without mental illnesses. Understanding factors that influence utilization of preventive care is important to improving  health in this population.

Methods: This mixed-methods study assesses preventive care use among patients with and without serious mental illnesses. Settings are an integrated health system and federally qualified health centers. Electronic medical record-derived diagnoses and preventive service gaps identified a purposeful sample representing a range of prevention practices within diagnostic categories. Sixty-nine participants completed questionnaires and semi-structured interviews (goal=175, October 2015).

Findings: Sixty percent of patients often experienced at least one barrier to using preventive care; 16% experienced four or more. The most commonly reported barriers included anxiety/depression (17%), disability (17%), financial (19%), and wanting to focus on more important health problems (21%).

Perceived effort also influenced preventive service use. Patients report that following guidelines which are “easier” (e.g. labs, vaccinations) was more attractive than guidelines requiring behavior change (e.g. diet). Ease of access and affordabilitywere also important. More than 70% reported greater likelihood of using preventive services if laboratories were co-located with appointments, and if insurance covered all costs. Multivariate analyses will explore predictors of barriers and gaps in preventive service use.

Implications: Mental illness and stress can interfere with the utilization of preventive services, especially when these services are understood to be as less important than immediate health concerns. Improving access to preventive care will require targeted efforts to reduce mental health-related barriers and promote the importance of preventive care relative to current health problems.

Learning Areas:

Administration, management, leadership
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
List barriers and facilitators of preventive service use among individuals with serious mental illnesses and potential solutions to improve care.

Keyword(s): Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My work involves improving care and outcomes for individuals with serious mental illnesses. I have participated in the data collection and analysis of the quantitative and qualitative data that informs this presentation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.