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Abstract
Objectives To explore patient and stakeholder perspectives on primary respiratory care for people with severe mental illness (SMI) and comorbid obstructive airways disease (OAD).
Design Qualitative, semistructured qualitative interviews were undertaken with a purposive sample of people with a diagnosis of SMI (bipolar illness, schizophrenia, affective disorder with psychosis) and comorbid asthma or chronic obstructive pulmonary disease. Transcribed data were analysed using an interpretive phenomenological approach. Study results were discussed with stakeholders.
Setting Eight UK general practices.
Participants 16 people aged 45–75 years, with SMI and comorbid asthma or chronic obstructive pulmonary disease, were interviewed. Twenty-one people, four with lived experience of SMI and seventeen health/social care/third sector practitioners, participated in discussion groups at a stakeholder event.
Results Participants described disability and isolation arising from the interplay of SMI and OAD symptoms. Social support determined ease of access to primary care. Self-management of respiratory health was not person-centred as practitioners failed to consider individual needs and health literacy. Participants perceived smoking cessation impossible without tailored support. Less than half of the practices facilitated personalised access to timely primary care and continuity. Overall, there was a reliance on urgent care if service adaptations and social support were lacking. The stakeholder group expressed concern about gaps in care, the short-term funding of community organisations and fear of loss of benefits. Potential solutions focused on supported navigation of care pathways, relational continuity, individual and community asset building and the evolving social prescriber role.
Conclusion This study suggests that despite UK guidelines and incentives to optimise physical healthcare, primary care fails to consistently deliver integrated biopsychosocial care for patients with SMI and OAD. Collaborative, personalised care that builds social capital and tailors support for self-management is needed, alongside service-level interventions to enhance access to healthcare for patients with comorbid SMI and OAD.
- primary care
- mental health
- asthma
- chronic airways disease
Data availability statement
No data are available. This a qualitative database and to protect anonymity of the participants, the data is not available publically, even in an anonymised complete format. Reasonable requests to discuss explanatory quotes with the lead researcher may be made.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
No data are available. This a qualitative database and to protect anonymity of the participants, the data is not available publically, even in an anonymised complete format. Reasonable requests to discuss explanatory quotes with the lead researcher may be made.
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Footnotes
Twitter @dclovesGP
Contributors CM is the responsible for the overall content and is guarantor for the work. All authors have fulfilled the four ICMJE criteria for authorship. Original conception and design and writing of the study protocol (CM, JH, HT, EW, BD). Ethical approvals (CM, BD, NW). Acquisition of the data (BD, NW, ND, CM, EW), analysis and interpretation of the data (all authors). Drafting the work (all authors). Final Approval of the version to be published (all authors). Agreement to be accountable for all aspects to the work (all authors). Integrated stakeholder and PPIE work by CM, NZ, ND, BD.
Funding Grant funded by the Clare Wand Fund (BMA). The research was also part-funded by the NIHR CLAHRC Yorkshire and Humber. www.clahrc-yh.nihr.ac.uk.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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