Severe mental illness and cardioprotective medication prescribing: qualitative study in general practice

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Patients with severe mental illness (SMI) die 10-20 years earlier than the general population. They have a higher risk of cardiovascular disease (CVD) yet may experience lower cardioprotective medication prescribing.
AIM: To understand the challenges experienced by GPs in prescribing cardioprotective medication to patients with SMI.

DESIGN AND SETTING: A qualitative study with 15 GPs from 11 practices in two Scottish Health Boards, including practices servicing highly-deprived areas (Deep End).

METHOD: Semi-structured 1:1 interviews with fully-qualified GPs with clinical experience of patients with SMI. Interviews were transcribed verbatim and analysed thematically.

RESULTS: Participants aimed to routinely prescribe cardioprotective medication to relevant patients with SMI but were hampered by various challenges. These included: lack of funding for chronic disease management, insufficient consultation time, workforce shortages, IT infrastructure and navigating boundaries with mental health services. Patient-related challenges included: patients’ complex health and social needs, their understandable prioritisation of mental health needs/existing physical conditions and presentation during crises. Participants emphasised continuity of care as fundamental in engaging this patient group in effective cardiovascular health management. A cross-cutting theme was the current GP workforce crisis leading to ‘firefighting’ and diminishing capacity for primary prevention. This was particularly acute in Deep End practices, which have a high proportion of patients with complex needs and greater resource challenges.

CONCLUSION: Although participants aspire to prescribe cardioprotective medication to patients with SMI, professional, system and patient-level barriers often make this challenging, particularly in deprived areas due to patient complexity and the inverse care law.

KEYWORDS
Cardiovascular Disease; General Practice; Healthcare Inequalities; Mental Disorders; Prescribing Patterns; Qualitative Research.
Original languageEnglish
JournalBritish Journal of General Practice Open (BJGP Open)
Early online date14 Feb 2024
DOIs
Publication statusE-pub ahead of print - 14 Feb 2024

Keywords / Materials (for Non-textual outputs)

  • Cardiovascular Disease
  • General Practice
  • Healthcare Inequalities
  • Mental Disorders
  • Prescribing Patterns
  • Qualitative Research

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