Access to and Satisfaction with Care Comparing Patients with and without Serious Mental Illness

Abstract

Objectives: We compared perceived access to and satisfaction with health care between patients diagnosed with serious mental illness (SMI: schizophrenia or bipolar disorder) and among those with no SMI diagnosis. Method: We conducted a national, cross-sectional study of VA patients in Fiscal Year (FY) 1999 (N=7,187) who completed the VA's Large Health Survey of Veteran Enrollees (LHSV) section on access and satisfaction and either received a diagnosis of schizophrenia or bipolar disorder, or did not and were randomly selected from the general non-SMI VA patient population (non-SMI group). We compared the probability of perceived poor access and dissatisfaction using multivariable logistic regression adjusting for patient covariates. Results: Compared to non-SMI patients, patients diagnosed with bipolar disorder were more likely to report difficulty in receiving care they needed (adjusted OR =1.36, p < .05) or seeing a specialist (adjusted OR=1.44, p < .001). Patients diagnosed with schizophrenia were more likely to report dissatisfaction, including thoroughness by their provider (adjusted OR=1.37, p < .001) and the provider's explanation of problems (adjusted OR=1.54, p < .001) compared to non-SMI patients. Conclusions: Patients diagnosed with bipolar disorder reported greater problems with access to health care, while those diagnosed with schizophrenia were less satisfied with the process of care.