Study Describes Differences in Communication between Providers in VA Mental Health Clinics and General Medical Providers in Treating Veterans with Serious Mental Illness
Serious mental illness (i.e., schizophrenia, bipolar disorder) is associated with substantial functional impairment and healthcare costs, and can lead to premature mortality. Integrated care for co-occurring substance use and general medical disorders is considered essential for improving quality of care for individuals with serious mental illness (SMI), and is one of VA's priority goals. This qualitative study sought to describe the barriers and facilitators of integrated care (from the perspective of mental health providers) for nearly 20,000 Veterans with SMI. Investigators conducted telephone interviews with 32 mental health providers from a national sample of eight VA facilities that scored in the top (n=4) or bottom (n=4) percentile in medical care quality based on VA's 2007 External Peer Review Program (EPRP). Interviews were conducted in FY2007-08.
Findings show that mental health providers from VA mental health clinics with high versus low quality of care scores differed in their ability to communicate with general medical providers regarding care for Veterans with SMI. Among mental health providers from low-performing sites, lack of communication with primary care providers was a key barrier. Barriers to communication included lack of opportunities to interact on a face-to-face basis and lack of opportunities to have team meetings. In addition, they were concerned that primary care providers did not want to see patients with SMI because of the perception that they were difficult to treat. Stigma was not mentioned as a problem for providers among the high-performing sites, with general medical providers viewed as sensitive to the needs of Veterans with SMI.
The authors suggest that these findings indicate that efforts to improve communication between mental health and primary care providers, as well as delineating roles and responsibilities across both types of providers may potentially facilitate integrated medical care for Veterans with serious mental illness.
Kilbourne A, Greenwald D, Bauer M, Charns M, and Yano E. Mental health provider perspectives regarding integrated medical care for patients with serious mental illness. Administration and Policy in Mental Health July 7, 2011;Epub ahead of print.
This study was funded through HSR&D (IAB 07-115). Dr. Kilbourne is part of HSR&D's Center for Clinical Management Research in Ann Arbor, MI; Dr. Greenwald is part of HSR&D's Center for Health Equity Research and Promotion in Pittsburgh, PA; Drs. Bauer and Charns are part of HSR&D's Center for Organization, Management, and Leadership Research in Boston, MA; and Dr. Yano is part of HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA.