Lacking a Primary Care Physician Is Associated With Increased Suffering in Patients With Severe Mental Illness

2017 ◽  
Vol 38 (6) ◽  
pp. 583-596 ◽  
Author(s):  
Cynthia G. Olsen ◽  
John M. Boltri ◽  
Jenna Amerine ◽  
Mark E. Clasen
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Primary Care Physician ◽  
Care Physician

scholarly journals The Long-Term Effects of a Housing First Intervention on Primary Care and Non-Primary Care Physician Visits Among Homeless Adults with Mental Illness: A 7-Year RCT Follow-Up

2021 ◽  
Vol 12 ◽  
pp. 215013272110271
Author(s):  
Cilia Mejia-Lancheros ◽  
James Lachaud ◽  
Matthew J. To ◽  
Patsy Lee ◽  
Rosane Nisenbaum ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Primary Care Physician ◽  
Care Physician ◽  
Housing First ◽  
Long Term Effects ◽  
Homeless Adults ◽  
Adults With Mental Illness

Background: Housing First (HF)-based interventions have been implemented in North America and beyond to help people exit homelessness. The effect of these interventions on access to primary and specialist care services is not well-defined. This study assesses the long-term effects of an HF intervention for homeless adults with mental illness on primary care physician (PCP) and non-primary care physician (non-PCP) visits. Methods: This is a secondary analysis of the At Home/Chez Soi study, a randomized trial of HF for homeless adults with mental illness in Toronto, Canada. High-need (HN) participants were randomized to HF with assertive community treatment (HF-ACT) or treatment as usual (TAU). Moderate needs (MN) participants were randomized to HF with intensive case management (HF-ICM) or TAU. The primary outcomes were the incidence and the number of visits to a PCP and non-PCP over 7-years post-randomization, compared to the 1-year pre-randomization. Results: Of 575 enrolled participants, 527 (80 HN and 347 MN) participants were included in the analyses. HN participants who received HF-ACT had a significant reduction in the number of visits to a PCP compared to TAU participants (ratio of rate ratios (RRR): 0.66, 95% CI: 0.48-0.93) and a significant reduction in the number of non-PCP visits compared with TAU participants (RRR: 0.64, 95% CI: 0.42-0.97) in the 7-years post-randomization compared to the 1-year pre-randomization. MN participants who received HF-ICM had a significant increase in incident visits to a PCP compared to TAU participants (RRR: 1.66, 95% CI: 1.10-2.50). No effect of HF-ICM was observed on the incidence or number of non-PCP visits. Conclusion: HF has differing effects on visits to PCPs and non-PCPs among homeless people with high and moderate needs for mental health supports. HF does not result in a consistent increase in PCP and non-PCP visits over a 7-year follow-up period. The At Home/Chez Soi study is registered with ISRCTN (ISRCTN, ISRCTN42520374).

Physicians Should “Assist in Suicide” When it is Appropriate

2012 ◽  
Vol 40 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Timothy E. Quill
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Palliative Care ◽  
Primary Care Physician ◽  
Primary Care Practice ◽  
Care Physician ◽  
Care Practice

In my career as a primary care physician and as a palliative care consultant, I have assisted many patients to die with their full consent. None of them wanted to die, and all would have chosen other paths had their disease not been so severe and irreversible. To a person, none of these patients thought of themselves as “suicidal,” and they would have found that label preposterous and demeaning. In fact, the kind of personal disintegration that the label implies is just what is trying to be prevented by those choosing this possibility. So on behalf of patients who have chosen this option, I reject the title of this debate as it unnecessarily tars the discussion with the suggestion of mental illness. In my primary care practice, I have also met many patients who were “suicidal” in the mental health sense of the word, and rest assured I have assisted none of them to die. In fact, I have at times had them involuntarily hospitalized to prevent them from carrying out their wishes.

scholarly journals Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness

2012 ◽  
Vol 27 (8) ◽  
pp. 945-952 ◽  
Author(s):  
Danielle F. Loeb ◽  
Elizabeth A. Bayliss ◽  
Ingrid A. Binswanger ◽  
Carey Candrian ◽  
Frank V. deGruy
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Primary Care Physician ◽  
Care Physician ◽  
Physician Perceptions ◽  
Complex Patients

scholarly journals Assessing Primary Care Contributions to Behavioral Health: A Cross-sectional Study Using Medical Expenditure Panel Survey

2021 ◽  
Vol 12 ◽  
pp. 215013272110238
Author(s):  
Anuradha Jetty ◽  
Stephen Petterson ◽  
John M. Westfall ◽  
Yalda Jabbarpour
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Behavioral Health ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Medical Expenditure Panel Survey ◽  
Care Physician ◽  
Medical Expenditure ◽  
Primary Care Visit ◽  
Panel Survey

Objectives To assess primary care contributions to behavioral health in addressing unmet mental healthcare needs due to the COVID-19 pandemic. Methods Secondary data analysis of 2016 to 2018 Medical Expenditure Panel Survey of non-institutionalized US adults. We performed bivariate analysis to estimate the number and percentage of office-based visits and prescription medications for depression and anxiety disorders, any mental illness (AMI), and severe mental illness (AMI) by physician specialty (primary care, psychiatry, and subspecialty) and medical complexity. We ran summary statistics to compare the differences in sociodemographic factors between patients with AMI by seeing a primary care physician versus those seeing a psychiatrist. Binary logistic regression models were estimated to examine the likelihood of having a primary care visit versus psychiatrist visit for a given mental illness. Results There were 394 023 office-based visits in the analysis sample. AMI patients seeing primary care physician were thrice as likely to report 1 or more chronic conditions compared to those seeing psychiatrist. Among patients with a diagnosis of depression or anxiety and AMI the proportion of primary care visits ([38% vs 32%, P < .001], [39% vs 34%, P < .001] respectively), and prescriptions ([50% vs 40%, P < .001], [47% vs 44%, P < .05] respectively) were higher compared to those for psychiatric care. Patients diagnosed with SMI had a more significant percentage of prescriptions and visits to a psychiatrist than primary care physicians. Conclusion Primary care physicians provided most of the care for depression, anxiety, and AMI. Almost a third of the care for SMI and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians’ critical role in combating the COVID-19 related rise in mental health burden.

Review of The fifteen minute hour: Applied psychotherapy for the primary care physician.

1988 ◽  
Vol 6 (4) ◽  
pp. 483-487
Author(s):  
Richard P. McQuellon ◽  
Guyton J. Winker
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician
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