title: Mental health consumers' with medical co-morbidity experience of the transition through tertiary medical services to primary care.
abstract: Medical comorbidity in people with long-term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health-care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video-recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers' experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments.
authors.affiliation: Community Services, Western Health, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Cranwell
authors.affiliation: Community Services, Western Health, Australia.|Centre for Chronic Disease, College of Health and Biomedicine, Discipline of Nursing, Victoria University, Melbourne, Victoria, Australia.
authors.forename: Meg
authors.initials: M
authors.lastname: Polacsek
authors.affiliation: Centre for Chronic Disease, College of Health and Biomedicine, Discipline of Nursing, Victoria University, Melbourne, Victoria, Australia.
authors.forename: Terence V
authors.initials: TV
authors.lastname: McCann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000451:nursing* / Q000523:psychology*; D015897:Comorbidity; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000451:nursing* / Q000523:psychology*; D008875:Middle Aged; D010359:Patient Readmission; D017060:Patient Satisfaction; D010360:Patient Transfer; D011320:Primary Health Care; D012944:Social Support; D063128:Tertiary Health Care; D014739:Victoria
keywords: Mental Health Hospital Admission Reduction Programme; augmented care; consumers and carers’ experience; experience-based co-design; medical comorbidity; transition