Patients With OAD and SMI Can Benefit From Integrated Personal Health and Social Care Interventions

People with severe mental illness (SMI) also have a higher prevalence of physical comorbidities compared with the general population. Patients with SMI also face barriers to care, necessitating collaborative, personalized care that improves self-management and enhancing access to care, according to a study published in BMJ Open.

Researchers evaluated patient and stakeholder perspectives of primary respiratory care for people with SMI and comorbid obstructive airways disease (OAD) and found that these patients are experiencing extraordinary disability and isolation as a result of having both SMI and OAD.

The authors noted the link between OAD and SMI “is partially explained by higher rates of smoking tobacco and/or cannabis, but socioeconomic deprivation and other environmental factors may also be relevant.”

They used a qualitative interpretive phenomenological study to understand the experiences of people with SMI and OAD receiving respiratory health care in the primary care setting. They interviewed 16 patients (9 women and 7 men) between the ages of 45 and 75 years old. Most (n = 10) had comorbid asthma and the rest (n = 6) had chronic obstructive pulmonary disease (COPD).

While 1 patient was receiving care for COPD at a hospital clinic, 10 lived alone and “almost all lived in areas of significant socioeconomic deprivation. Twelve patients were current smokers or ex-smokers. In addition, 12 patients were either unemployed or had retired.

The data collected was split into 3 themes:

• Social support—access to care was influenced by social support, the researchers found. For instance, patients might have support in the shape of someone accompanying them to an appointment.
• Self-management challenges—interventions to stop smoking or improve medication use, as well as pulmonary rehabilitation were poorly accessed and none of the patients recalled a written care plan created with their practitioner that helped them recognize exacerbations and then manage them.
• Service accessibility—navigating the fragmented health care services for both SMI and OAD is difficult for these patients to do alone.

The interviews also highlighted that the “complex interplay of social, mental and physical challenges experienced by our participants contributed to normalisation of poor physical health.” As a result, the participants had increased use of urgent care.

The researchers presented the results at a public stakeholder event attended by people who lived with SMI, charity workers, clinicians, and more. A total of 21 people participated in 3 discussion groups and they “expressed similar concerns about gaps in care,” the authors wrote.

“Potential solutions focused on adequate resources, supported navigation of care pathways, relational continuity, individual and community asset building and the evolving integrated social prescriber role,” they added.

The stakeholders were in favor of a redesign that mandated inclusive access to health care as well as the use of a tailored “social prescribing” intervention, which can enhance the self-management skills and the social networks of patients with SMI and OAD.

The researchers suggested future research on developing integrated personalized health and social care interventions for this patient population.

“The provision of personalised, collaborative health and social care for this group, which prioritises relational continuity by practitioners, builds individual social capital, tailors support for self-management and addresses barriers in access toprimary care appointments is warranted,” the authors concluded.

Reference

Mitchell C, Zuraw N, Delaney B, et al. Primary care for people with severe mental illness and comorbid obstructive airways disease: a qualitative study of patient perspectives with integrated stakeholder feedback. BMJ Open. 2022;12(3):e057143. doi:10.1136/bmjopen-2021-057143