Influence of schizophrenia diagnosis on providers' practice decisions.
OBJECTIVE
Persons with schizophrenia often receive suboptimal physical health care, but the reasons are poorly understood. Vignettes have been used to examine how a patient's race, gender, or physical health influences a provider's practice; in this study, we used vignettes to examine the effect of a mental health diagnosis (schizophrenia) on providers' clinical expectations and decision making regarding physical health care.


METHODS
A cross-sectional survey was administered from August 2011 to April 2012 to 275 primary care and mental health providers in 5 US Department of Veterans Affairs medical centers. Vignettes described identical scenarios for patients with and without schizophrenia. The survey assessed providers' clinical expectations of patients (adherence, competence, ability to read and understand health education materials) and practice behaviors (referrals to weight reduction, pain management, and sleep study).


RESULTS
Clinicians expected persons with schizophrenia would be less adherent to treatment (P = .04), less able to read and understand educational materials (P = .03), and less capable of managing their health and personal affairs (P < .01). Providers were less likely to refer a patient with schizophrenia to a weight-reduction program (P = .03). Other types of referral decisions (for pain management and sleep study) were not influenced by a schizophrenia diagnosis.


CONCLUSIONS
For both mental health and primary care providers, a history of schizophrenia was found to negatively affect provider expectations of patients' adherence to treatment, ability to understand educational materials, and capacity to manage their treatment and financial affairs as well as some treatment decisions, such as referral to a weight-reduction program.
VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, Arkansas.
Greer
G
Sullivan
Dinesh
D
Mittal
Christina M
CM
Reaves
Tiffany F
TF
Haynes
Xiaotong
X
Han
Snigdha
S
Mukherjee
Scott
S
Morris
Laura
L
Marsh
Patrick W
PW
Corrigan
D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D009726:Nurses / Q000592:standards; D010820:Physicians / Q000592:standards; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation; D012559:Schizophrenia / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs