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.
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 language | English |
|---|---|
| Journal | British Journal of General Practice Open (BJGP Open) |
| Early online date | 14 Feb 2024 |
| DOIs | |
| Publication status | E-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