Clinic Appointment Attendance in Adults with Serious Mental Illness and Diabetes

A formative assessment of client characteristics associated with missed appointments in integrated primary care services in rural Arizona

INTRODUCTION

Integrating primary care services in mental healthcare facilities is an uncommon model of care in the United States that could bring several benefits (e.g., improved access to physical healthcare) for vulnerable populations experiencing mental health conditions, especially those living in underserved regions like rural Arizona.

AIM

This formative assessment aimed to understand the sociodemographic and clinical characteristics of clients accessing integrated primary care (IPC) services implemented in 2021 at a community mental healthcare facility in rural Arizona and to explore the proportion of missed appointments. Additionally, we analysed the association between client characteristics and IPC missed appointments.

METHODS

The authors collaborated with a community mental health facility in rural Arizona, which provided deidentified data from 280 clients who accessed IPC services from June 2021 to February 2022.

RESULTS

Most clients were White and of vulnerable socioeconomic status, with a substantial proportion of Native Americans (23.58%). The majority of clients (55.75%) had a mental health disorder (MHD), 23.74% had a substance use disorder (SUD), and 15.10% had comorbid MHD and SUD. Linear regression revealed that experiencing comorbid MHD and SUD was significantly associated with missed appointments. Compared with White clients, Native Americans missed fewer appointments.

CONCLUSION

Future studies conducted from a culturally-centred perspective are crucial to guide strategies to reduce missed appointments in rural IPC services.

Received Social Support Scale for Persons with Serious Mental Illness: Preliminary scale development and validation study

PURPOSE/OBJECTIVE

This study investigated the psychometric properties of a newly developed Received Social Support Scale for Persons with Serious Mental Illness (rSSS-SMI). The rSSS-SMI measures three support domains: Day-to-Day Living support, Mental Health Support, and Adherence Support.

RESEARCH METHOD/DESIGN

(a) to examine the item quality of the rSSS-SMI, (b) to investigate the construct validity and verify the dimensionality of the rSSS-SMI, and (c) to investigate the reliability and validity of the rSSS-SMI scores. A sample of 267 community-based case management service recipients with SMI completed the rSSS-SMI and three additional scales (Interpersonal Support Evaluation List-Short Form [ISEL-12]; Symptom Checklist-6 [SCL-6]; Satisfaction with Life Scale [SWLS]).

RESULTS

Three items were dropped from the scale resulting in a 21-item scale. Confirmatory factor analysis and Item Response Theory analyses revealed our proposed three-factor model fit the data best, with average loadings at .74 (SD = .09). The three-factor model had higher item discrimination and item difficulty parameters than the one-factor model. The rSSS-SMI achieved strong internal consistency with estimates of .94 (full scale), .83 (Day-to-Day Living Support), .84 (Mental Health Support) and .76 (Adherence Support). The three-week interval test-retest reliability coefficient was .59. Convergent and discriminant validity evidence revealed a small, positive correlation between the rSSS-SMI and perceived support (ISEL-12) and symptom distress (SCL-6) and a small, negative, nonsignificant relationship with life satisfaction (SWLS).

CONCLUSION

This study provides preliminary reliability and validity evidence for the rSSS-SMI and confirms our proposed three-factor structure (Day-to-Day Living Support, Mental Health Support, Adherence Support). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic

OBJECTIVE

To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status.

STUDY DESIGN

Retrospective cohort study.

METHODS

This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018.

RESULTS

Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71-0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976-0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64-0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979-0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98-1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25-3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75-3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99-1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not associated with attendance or no-shows.

CONCLUSION

Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes.

QUALITY OF EVIDENCE

Level 3 Laryngoscope, 2021.

The meaning of social support for persons with serious mental illness: A family member perspective

Objective: Social support is essential to the health and well-being of persons with serious mental illness (SMI), and family members are a primary source of this support. Despite the primary role of family in the lives of persons with SMI, family is an understudied source of support. This study investigated the types of social support beneficial for persons with SMI from the perspective of family members. Method: Participants were 14 adult family members recruited from a Bay Area National Alliance on Mental Illness who provided regular support for a family member with SMI. Focus group data was analyzed using NVivo10 and consensual qualitative research. Results: Results revealed five support categories: (a) person-centered support, (b) autonomy support, (c) community participation support, (d) health management support, and (e) day-to-day living support. Discussion: Participants described family supports that are conceptually distinct from traditional models of social support and uniquely tied to SMI-related stressors. Findings are also aligned with the mental health recovery model and self-determination theory. Conclusion: Results advance our understanding of SMI-specific types of social support by describing five support categories grounded in the voices of family members supporting a loved one with SMI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review

AIMS

To map existing research-based knowledge of everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness, and to identify study designs, aims, populations and themes.

METHODS

A systematic literature search was performed on 16 April 2019 using Medline, Embase, PsycINFO, Cinahl, the Cochrane Library, and the Web of Science to conduct a scoping review. Included studies were summarized with regard to the quantity of research, the study designs, aims, populations and themes RESULTS: From 3406 records, we included 23 studies about everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness. Four studies were qualitative (observations, interviews and focus groups), and 19 were quantitative (observational and interventions) and used questionnaires. Five themes emerged in the findings: (1) diet and exercise, but not other diabetes self-care activities, are consistently compromised in the target group; (2) psychiatric exacerbation diminishes diabetes self-care; (3) social support and high self-efficacy improve diabetes self-care; (4) use of healthcare services is compromised; and (5) quality of life and well-being is poor.

CONCLUSIONS

The limited research into the studied population's experiences with coexisting type 2 diabetes and severe mental illness is characterized by its heterogeneity in aims and methods and a strong focus on diabetes management and treatment. Further research focusing on the management of both conditions in everyday life is needed to improve specialized and integrated care targeting the population.

Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses?

PURPOSE

People with severe mental illnesses (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against increased CVD morbidity and mortality; however, this may not apply to those with SMI. We aimed to explore the association between perceived social support and attendance at primary care nurse CVD risk reduction clinic appointments and CVD risk-reducing behaviours in an SMI population with elevated CVD risk factors.

METHODS

We used longitudinal and cross-sectional data from a randomised controlled trial on 326 adults with SMI recruited via 76 general practices in England. Multilevel regression analysis estimated the effect of perceived social support on attendance at CVD risk reduction clinic appointments over 6 months, and adherence to CVD medication, physical activity, diet, smoking and alcohol use at baseline, adjusted by age, sex, ethnicity, deprivation, psychiatric diagnosis and employment.

RESULTS

Perceived social support predicted greater appointment attendance in unadjusted (IRR = 1.005; 1.000-1.010; p = 0.05) but not adjusted analysis (IRR = 1.003; 0.998-1.009; p = 0.25). Perceived social support was associated with greater adherence to medication; for each 1% increase in social support, there was a 4.2% increase in medication adherence (OR = 1.042; 1.015-1.070; p = 0.002). No association was found between greater perceived social support and greater physical activity, lower sedentary behaviour, healthier diet, lower alcohol use or being a non-smoker.

CONCLUSIONS

Social support may be an important facilitator for CVD medication adherence and is potentially important for primary care appointment attendance; however, alternative strategies might be needed to help people with SMI engage in physical activity, healthier diets and to reduce their smoking and alcohol use.