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3. Delivery of Primary Care Health Services to Patients with Serious Mental Illness (SMI)
J Fotiades, Bronx VAMC/VISN 3 MIRECC; M Lasco, Bronx VAMC; D Kaplow, Brooklyn VAMC; T Craig, Headquarters
Objectives: 1) To determine the per-cent of SMI patients actively followed in mental health clinics during fiscal year 99 (FY99) who did not have a single visit to any primary care clinic.
(2) To distinguish the per-cent of SMI patients not seen in primary care due to never having been scheduled an appointment versus having been given an appointment and not showing up.
(3) To determine the impact that schizophrenia versus mood disorders had on SMI patients not being seen in primary care.
(4) To determine the per-cent of SMI patients of any given race not seen in primary care.
Methods: A cross-sectional analysis was conducted by reviewing all medical records for patients with an SMI diagnosis seen within the VISN 3 network, during FY99. Patients with established International Classification of Disease (ICD) codes of 295, 296, 297 and 298 were eligible, but only those with three or more visits to a mental health clinic during FY99 were enrolled. All patient encounters entered into the Computerized Patient Record System (CPRS) were accessed using a Vista routine. A stop code of 323 was used to ascertain primary care visits and 501-590 for mental health visits.
Results: A total of 11,743 charts were reviewed. More than half (53.04%) of these patients were not seen in primary care during FY99. The majority of these patients (87.27%) were not seen in primary care due to never having been given an appointment. Patients with a diagnosis of schizophrenia had a significant greater per-cent of not seen, compared to mood disorders at the 95% confidence interval. Finally, 46.35% Caucasian, 47.82% Hispanic and 60.22% African American SMI patients were not seen in primary care. The African-American group had a significant higher proportion of not being seen in primary care compared to the two other groups at the 99% confidence interval.
Conclusions: The results of this study reveal that greater than 50% of patients with an SMI diagnosis in VISN 3 were not seen in primary care during FY 99. The standard of care in the VISN is that all patients are assigned a primary care provider and have at least one annual visit. Furthermore, most of these patients were not seen due to never having an appointment scheduled, rather than their failure to keep a scheduled appointment. There was a significantly greater percent of patients with schizophrenia, compared to mood disorders; and African-Americans compared to all other races, who were not seen in primary care.
Impact: Patients with SMI have documented increased morbidity and mortality rates compared to the general population. Lack of proper access to primary care and medical health services, has been identified as an important cause. The findings in this study suggest that more than half the patients with SMI receiving their care in a VA setting will not be seen in primary care during the year. This finding underscores the need for improving the access to health services to this population, with a special emphasis on the African-American and Schizophrenic patient.