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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.