title: Barriers and facilitators to primary care for people with mental health and/or substance use issues: a qualitative study.
abstract: BACKGROUND
  Mental health and/or substance use issues are associated with significant disparities in morbidity and mortality. The aim of this study was to identify the mechanisms underlying poor primary care access for this population.
  
  
  METHODS
  This was a community-based participatory action qualitative study, in which 85 adults who self-identified as having a serious mental health and/or substance use issue and 17 service providers from various disciplines who worked with this population participated in a semi-structured interview.
  
  
  RESULTS
  Client, service provider and health system barriers to access were identified. Client factors, including socioeconomic and psychological barriers, make it difficult for clients to access primary care, keep appointments, and/or prioritize their own health care. Provider factors, including knowledge and personal values related to mental health and substance use, determine the extent to which clients report their specific needs are met in the primary care setting. Health system factors, such as models of primary care delivery, determine the context within which both client and service provider factors operate.
  
  
  CONCLUSIONS
  This study helps elucidate the mechanisms behind poor primary health care access among people with substance use and/or mental health issues. The results suggest that interdisciplinary, collaborative models of primary healthcare may improve accessibility and quality of care for this population, and that more education about mental health and substance use issues may be needed to support service providers in providing adequate care for their clients.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College St. Suite 560, Toronto, Ontario, Canada, M5T 3M7. l.ross@utoronto.ca.|Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell St. Room T406, Toronto, Ontario, Canada, M5S 2S1. l.ross@utoronto.ca.
authors.forename: Lori E
authors.initials: LE
authors.lastname: Ross
authors.affiliation: Women's College Hospital and Research Institute, 76 Grenville Street Rm. 7234, Toronto, Ontario, M5S 1B2, Canada. simone.vigod@wchospital.ca.
authors.forename: Simone
authors.initials: S
authors.lastname: Vigod
authors.affiliation: Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. jess.wishart@gmail.com.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wishart
authors.affiliation: Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. myera.zoey@gmail.com.
authors.forename: Myera
authors.initials: M
authors.lastname: Waese
authors.affiliation: Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. jasondeanspence@yahoo.ca.
authors.forename: Jason Dean
authors.initials: JD
authors.lastname: Spence
authors.affiliation: Department of Psychiatry, University of Toronto, 250 College St., 8th Floor, Toronto, Ontario, Canada, M5T 1R8. jasonaaronoliver1981@gmail.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Oliver
authors.affiliation: The Empowerment Council, 33 Russell St. Room 2008, Toronto, Ontario, M5S 2S1, Canada. jennifer.wayward@gmail.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chambers
authors.affiliation: CATIE, 555 Richmond Street West, Suite 505, Box 1104, Toronto, Ontario, M5V 3B1, Canada. sanderson@catie.ca.
authors.forename: Scott
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Communications and Partnerships, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada. roslyn.shields@camh.ca.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Shields
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000628:therapy*; D055815:Young Adult