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

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.