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A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists

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Abstract

We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists’ scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists’ scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.

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Authors and Affiliations

  1. The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA

    Christina Mangurian, Chelsea Modlin, Lindsey Williams, Nicholas S. Riano, Martha Shumway & James W. Dilley

  2. New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 100, New York, NY, USA

    Susan Essock & Dean Schillinger

  3. Florida Atlantic University, 777 Glades Road, BC-71 Rm 241, Boca Raton, FL, USA

    John W. Newcomer

Authors
  1. Christina Mangurian
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  2. Chelsea Modlin
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  3. Lindsey Williams
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  4. Susan Essock
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  5. Nicholas S. Riano
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  6. Martha Shumway
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  7. John W. Newcomer
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  8. James W. Dilley
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  9. Dean Schillinger
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Corresponding author

Correspondence to Christina Mangurian.

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Conflict of interest

Author A was supported by the National Institutes of Mental Health (K23MH093689), the UCSF Hellman Fellows Award for Early-Career Faculty, and the National Center for Research Resources, the National Center for Advancing Translational Sciences, and the Office of the Director, National Institutes of Health, through UCSF-CTSI Grant Number KL2 RR024130. Author E was supported by the National Institutes of Mental Health (K23MH093689), and by the UCSF Public Psychiatry Fellowship at ZSFG. Author G has grant support from Otsuka America Pharmaceutical Inc., consulting fees from Indivior Pharmaceuticals, and he serves on a Data Safety Monitoring Board for Amgen, outside the submitted work. Author I was supported by the NIH Center Grant from the National Institute of Diabetes and Digestive and Kidney Diseases for The Health Delivery Systems-Center for Diabetes Translational Research (CDTR) (P30DK092924) and the NIH/National Institute of Minority Health and Health Disparities (NIMHD) Comprehensive Center of Excellence for Health and Risk in Minority Youth and Young Adults (P60MD006902). The remaining authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Mangurian, C., Modlin, C., Williams, L. et al. A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists. Community Ment Health J 54, 507–513 (2018). https://doi.org/10.1007/s10597-017-0198-4

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  • DOI: https://doi.org/10.1007/s10597-017-0198-4

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