Access to and satisfaction with care comparing patients with and without serious mental illness.
OBJECTIVE
We compared perceived access to and satisfaction with health care between patients diagnosed with serious mental illness (SMI: schizophrenia or bipolar disorder) and among those with no SMI diagnosis.


METHODS
We conducted a national, cross-sectional study of VA patients in Fiscal Year (FY) 1999 (N = 7,187) who completed the VA's Large Health Survey of Veteran Enrollees (LHSV) section on access and satisfaction and either received a diagnosis of schizophrenia or bipolar disorder, or did not and were randomly selected from the general non-SMI VA patient population (non-SMI group). We compared the probability of perceived poor access and dissatisfaction using multivariable logistic regression adjusting for patient covariates.


RESULTS
Compared to non-SMI patients, patients diagnosed with bipolar disorder were more likely to report difficulty in receiving care they needed (adjusted OR = 1.36,p < .05) or seeing a specialist (adjusted OR = 1.44, p < .001). Patients diagnosed with schizophrenia were more likely to report dissatisfaction, including thoroughness by their provider (adjusted OR = 1.37, p < .001) and the provider's explanation of problems (adjusted OR = 1.54, p < .001) compared to non-SMI patients.


CONCLUSIONS
Patients diagnosed with bipolar disorder reported greater problems with access to health care, while those diagnosed with schizophrenia were less satisfied with the process of care.
Kilbourne
Amy M
AM
VA Pittsburgh Center for Health Equity Research and Promotion, USA. Amy.Kilbourne@gmail.com
McCarthy
John F
JF
Post
Edward P
EP
Welsh
Deborah
D
Pincus
Harold Alan
HA
Bauer
Mark S
MS
Blow
Frederic C
FC
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D012042:Registries / Q000706:statistics & numerical data; D012044:Regression Analysis; D012559:Schizophrenia / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*