Effects of primary care clinician beliefs and perceived organizational facilitators on the delivery of preventive care to individuals with mental illnesses

Bobbi Jo H Yarborough,Nancy A Perrin,John Muench,Carla A Green,Scott P Stumbo,Ginger C Hanson

doi:10.1186/s12875-017-0693-2

Abstract

BackgroundAlthough many studies have documented patient-, clinician-, and organizational barriers/facilitators of primary care among people with mental illnesses, few have examined whether these factors predict actual rates of preventive service use. We assessed whether clinician behaviors, beliefs, characteristics, and clinician-reported organizational characteristics, predicted delivery of preventive services in this population.MethodsPrimary care clinicians (n = 247) at Kaiser Permanente Northwest (KPNW) or community health centers and safety-net clinics (CHCs), in six states, completed clinician surveys in 2014. Using electronic health record data, we calculated preventive care-gap rates for patients with mental illnesses empaneled to survey respondents (n = 37,251). Using separate multi-level regression models for each setting, we tested whether survey responses predicted preventive service care-gap rates.ResultsAfter controlling for patient-level characteristics, patients of clinicians who reported a greater likelihood of providing preventive care to psychiatrically asymptomatic patients experienced lower care-gap rates (KPNW γ= − .05, p = .041; CHCs γ= − .05, p = .033). In KPNW, patients of female clinicians had fewer care gaps than patients of male clinicians (γ= − .07, p = .011). In CHCs, patients of clinicians who had practiced longer had fewer care gaps (γ= − .004, p = .010), as did patients whose clinicians believed that organizational quality goals facilitate preventive service provision (γ= − .06, p = .006). Case manager availability in CHCs was associated with higher care-gap rates (γ=.06, p = .028).ConclusionsClinicians who report they are likely to address preventive concerns when their mentally ill patients present without apparent psychiatric symptoms had patients with fewer care gaps. In CHCs, care quality goals may facilitate preventive care whereas case managers may not.

Highlights

Many studies have documented patient, clinician, and organizational barriers/facilitators of primary care among people with mental illnesses, few have examined whether these factors predict actual rates of preventive service use
Patient panel data was unavailable for two clinicians who returned surveys; the remaining 247 clinicians had an average of 6.8 (SD = 6.8) patients with schizophrenia spectrum disorders on their panel, 17.7 (SD = 11.0) patients with bipolar disorder, 36.3 (SD = 22.0) patients with anxiety disorders, and 90.0 (SD = 43.9) patients with unipolar depressive disorders
While the survey response rate was higher among Kaiser Permanente Northwest (KPNW) clinicians than community health clinics (CHC) clinicians, the CHC sample size was larger such that survey respondents were more likely to practice in CHCs (55% of sample) than KPNW

Summary

Introduction

Many studies have documented patient-, clinician-, and organizational barriers/facilitators of primary care among people with mental illnesses, few have examined whether these factors predict actual rates of preventive service use. Especially among people with serious mental illnesses like schizophrenia and bipolar disorder, is largely attributable to preventable chronic conditions [2], sometimes caused or exacerbated by higher rates of behavioral risk factors [3,4,5] or by the metabolic side effects of antipsychotic medications sometimes used to treat these illnesses [6,7,8]. One group found that low rates of metabolic testing were more strongly associated with patient characteristics and frequency of visits than with clinician and practice characteristics (e.g., care setting location, type, size; colocation of medical and mental health services) [20]. Very little is known about the role that other organizational characteristics, including team-based care [21, 22], outreach related to preventive care use [23, 24], and organizational cultures conducive to quality care [25] may play in preventive service completion among this population

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