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Table 2 Primary care model for CHD risk factor screening in SMI: Advantages and disadvantages

From: Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care

 

View expressed by *

Perceived advantages of delivering CHD screening in primary care

CMHT

GP

SU

N

• GPs possess medical expertise in CHD screening and can provide appropriate management of results

 

14

• It is more normalising/less stigmatising to attend primary care for screening

 

13

• Patients attend the GP practice regularly to pick up their prescriptions, which would offer the opportunity for screening

 

7

• Clinical systems and equipment are all in place to provide screening

 

6

• Patients have better links, trust and a longer history with their GP, which would enhance the uptake of screening

 

6

• GPs can access other relevant physical health services more easily than the CMHT – they are the 'gate keepers'

 

6

• Geographically, GPs are often closer than the CMHT

 

6

• It would allow the CMHT to focus on mental health issues

  

2

• It would engage clients with their GP and encourage people with SMI to be less reliant on mental health services

  

2

Perceived disadvantages

    

• Lack of resources to provide this service due to GP's high workload

17

• High rates of non-attendance to general practice screening

 

8

• Specialist SMI screening clinics in primary care could be stigmatising

8

• Communication from primary to secondary care is very rare so psychiatrists won't receive screening results to inform prescribing

 

7

• Some patients get anxious about attending primary care and the more severely ill are often not in contact – they will not receive screening

7

• Some GPs may be negative towards or disinterested in people with SMI and offer a poor service to them – it could be a 'patchy' service

 

5

• Some GP staff may lack confidence in working with people with SMI

 

4

• It maintains a split between physical health (at GP) and mental health (in psychiatry), preventing the person from being seen holistically

  

1

• Lack of specialist knowledge of possible metabolic effects of antipsychotics amongst GPs

 

1

• If screening revealed a possible adverse effect of antipsychotics, such as diabetes, GP may lack the confidence to alter the antipsychotic

  

1

• It can be difficult to get an appointment with the GP

  

1

  1. * Note: Tick-boxes indicate which group(s) of participants expressed the view: CMHT = staff from community mental health team; GP = staff from general practice; SU = service users. Numbers (N) indicate the prevalence of each view within the total sample.