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BMC Fam Pract. 2015 Oct 13;16:135. doi: 10.1186/s12875-015-0353-3.

Barriers and facilitators to primary care for people with mental health and/or substance use issues: a qualitative study.

Author information

1
Dalla Lana School of Public Health, University of Toronto, 155 College St. Suite 560, Toronto, Ontario, Canada, M5T 3M7. l.ross@utoronto.ca.
2
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell St. Room T406, Toronto, Ontario, Canada, M5S 2S1. l.ross@utoronto.ca.
3
Women's College Hospital and Research Institute, 76 Grenville Street Rm. 7234, Toronto, Ontario, M5S 1B2, Canada. simone.vigod@wchospital.ca.
4
Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. jess.wishart@gmail.com.
5
Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. myera.zoey@gmail.com.
6
Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. jasondeanspence@yahoo.ca.
7
Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. jasonaaronoliver1981@gmail.com.
8
The Empowerment Council, 33 Russell St. Room 2008, Toronto, Ontario, M5S 2S1, Canada. jennifer.wayward@gmail.com.
9
CATIE, 555 Richmond Street West, Suite 505, Box 1104, Toronto, Ontario, M5V 3B1, Canada. sanderson@catie.ca.
10
Communications and Partnerships, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada. roslyn.shields@camh.ca.

Abstract

BACKGROUND:

Mental health and/or substance use issues are associated with significant disparities in morbidity and mortality. The aim of this study was to identify the mechanisms underlying poor primary care access for this population.

METHOD:

This was a community-based participatory action qualitative study, in which 85 adults who self-identified as having a serious mental health and/or substance use issue and 17 service providers from various disciplines who worked with this population participated in a semi-structured interview.

RESULTS:

Client, service provider and health system barriers to access were identified. Client factors, including socioeconomic and psychological barriers, make it difficult for clients to access primary care, keep appointments, and/or prioritize their own health care. Provider factors, including knowledge and personal values related to mental health and substance use, determine the extent to which clients report their specific needs are met in the primary care setting. Health system factors, such as models of primary care delivery, determine the context within which both client and service provider factors operate.

CONCLUSIONS:

This study helps elucidate the mechanisms behind poor primary health care access among people with substance use and/or mental health issues. The results suggest that interdisciplinary, collaborative models of primary healthcare may improve accessibility and quality of care for this population, and that more education about mental health and substance use issues may be needed to support service providers in providing adequate care for their clients.

PMID:
26463083
PMCID:
PMC4604001
DOI:
10.1186/s12875-015-0353-3
[Indexed for MEDLINE]
Free PMC Article

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