Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3049 — Access to and Satisfaction with Medical Care among Patients with Serious Mental Illness

Author List:
Kilbourne AM (CHERP, Pittsburgh)
McCarthy JF (SMITREC, Ann Arbor)
Bauer MS (VA Providence Medical Center)
Post EP (University of Pittsburgh)
Welsh D (SMITREC, Ann Arbor)
Pincus HA (University of Pittsburgh)
Blow FC (SMITREC, Ann Arbor)

Objectives:
Veterans with serious mental illness (SMI: schizophrenia or bipolar disorder) experience disproportionate rates of medical comorbidity. Research suggests that potential disparities in medical care exist for persons with SMI. Moreover, patient satisfaction with care may directly influence adherence to treatment recommendations. We compared perceived access to and satisfaction with general medical care among VA patients with schizophrenia, those with bipolar disorder, and those with neither diagnosis.

Methods:
We conducted a national, cross-sectional study of VA patients in Fiscal Year (FY) 1999 who completed the 10-item patient satisfaction questionnaire in the VA’s Large Health Survey of Veteran Enrollees and who received a diagnosis of schizophrenia or bipolar disorder or were included in a random sample of non-SMI VA patients in FY1999. Using multivariable logistic regression and generalized estimating equations, we compared the probability of dissatisfaction with patients’ regular general medical doctor. Model covariates included patient socio-economic and clinical factors.

Results:
Of 7,187 patients in the study, 10% had problems accessing medical care when they needed it and 11% had problems seeking specialty referrals. Overall, 22% of patients were dissatisfied with their regular medical doctor’s knowledge about what worried them the most, 16% dissatisfied with their doctor’s thoroughness, 15% dissatisfied with their doctor’s attention, and 16% dissatisfied with their doctor’s explanation of problems. Multivariable models indicated that, compared to non-SMI patients, patients with bipolar disorder were more likely to report difficulty in accessing medical care (OR=1.39,p<.05) or with seeking specialty referrals (OR=1.48,p<.001). In contrast, patients with schizophrenia were more likely to report dissatisfaction with their primary medical doctor, including their doctor’s explanation of problems (OR=1.53,p<.001) and thoroughness (OR=1.37,p<.001), compared to non-SMI patients. Reports of overall quality of care did not differ by SMI diagnosis.

Implications:
Patients with bipolar disorder were more likely to report problems with access to medical care, while those diagnosed with schizophrenia reported less satisfaction with their medical care.

Impacts:
Strategies to improve medical care for patients with SMI need to be customized by psychiatric diagnosis. Efforts are needed to address access concerns for patients with bipolar disorder, and general medical providers need to be sensitized to the needs of patients with schizophrenia.