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Patient Safety and Quality

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Improving physician knowledge of psychiatric problems and relevant medications could improve quality of care

People with psychiatric disabilities such as depression and schizophrenia tend to suffer from worse physical health and face more barriers to care than others. In a recent focus group study supported by the Agency for Healthcare Research and Quality (HS10223), 16 people with psychiatric disabilities identified the major barriers to primary care they experience:

  1. Difficulty identifying a primary care physician with good empathic and communication skills.
  2. Physicians failing to recognize psychiatric disability as a chronic illness that can be managed. Primary care doctors having inadequate knowledge about the side effects of psychotropic medications.
  3. Problems related to the costs of care and inadequate insurance coverage.

To help improve their quality of care, the focus group participants suggested that primary care doctors develop effective communication techniques, become more knowledgeable about psychiatric problems and the psychotropic drugs used to treat them, and use a patient-centered, respectful approach. Focus group members also stated that their psychiatric disability itself sometimes impeded their efforts to seek medical help or to develop healthy living habits. For example, many had trouble maintaining a healthy weight, since weight gain and lethargy are side effects of a number of psychotropic medications. Others felt too depressed or overwhelmed to follow medical advice. They stated that greater physician awareness of their struggles could support their efforts to improve their health.

See "Primary care experiences of people with psychiatric disabilities: Barriers to care and potential solutions," by Bonnie O'Day, Ph.D., Mary B. Killeen, M.A., Janet Sutton, Ph.D., and Lisa I. Iezzoni, M.D., M.Sc., in the Spring 2005 Psychiatric Rehabilitation Journal 28(4), available online at www.bu.edu/prj.

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