Effects of primary care clinician beliefs and perceived organizational facilitators on the delivery of preventive care to individuals with mental illnesses

Abstract

Background: Although many studies have documented patient-, clinician-, and organizational barriers/facilitators of primary care among people with mental illnesses, few have examined whether these factors predict actual rates of preventive service use. We assessed whether clinician behaviors, beliefs, characteristics, and clinician-reported organizational characteristics, predicted delivery of preventive services in this population. Methods: Primary care clinicians (n = 247) at Kaiser Permanente Northwest (KPNW) or community health centers and safety-net clinics (CHCs), in six states, completed clinician surveys in 2014. Using electronic health record data, we calculated preventive care-gap rates for patients with mental illnesses empaneled to survey respondents (n = 37,251). Using separate multi-level regression models for each setting, we tested whether survey responses predicted preventive service care-gap rates. Results: After controlling for patient-level characteristics, patients of clinicians who reported a greater likelihood of providing preventive care to psychiatrically asymptomatic patients experienced lower care-gap rates (KPNW γ= -.05, p =.041; CHCs γ= -.05, p =.033). In KPNW, patients of female clinicians had fewer care gaps than patients of male clinicians (γ= -.07, p =.011). In CHCs, patients of clinicians who had practiced longer had fewer care gaps (γ= -.004, p =.010), as did patients whose clinicians believed that organizational quality goals facilitate preventive service provision (γ= -.06, p =.006). Case manager availability in CHCs was associated with higher care-gap rates (γ=.06, p =.028). Conclusions: Clinicians who report they are likely to address preventive concerns when their mentally ill patients present without apparent psychiatric symptoms had patients with fewer care gaps. In CHCs, care quality goals may facilitate preventive care whereas case managers may not.