Integrating primary care in a specialized forensic psychiatric setting: predictors of program adherence

This study investigates patient adherence to an integrated primary care intervention within medium secure forensic psychiatric services. Using a prospective cohort design, we evaluated the implementation of a 1-year integrated primary care intervention across seven medium secure wards in the Central Denmark Region. Using descriptive statistics, baseline data were analyzed to compare completers and non-completers, with a focus on somatic health indicators and preexisting attitudes toward primary care services. Of the 75 patients included in the intervention, almost 40% did not complete it. Baseline data demonstrated a high burden of health risk factors, with 75% of patients being daily smokers and 58% meeting the criteria for metabolic syndrome. Negative preexisting perceptions of primary care services were particularly prevalent among non-completers (42%). Those who completed the intervention had a greater illness burden (p = 0.02) and tended to have more favorable attitudes toward primary care, although this was not statistically significant. Notably, over 30% of eligible inpatients either declined or were deemed unable to participate in the intervention. High rates of health risk factors were identified, highlighting the sensibility of integrating primary care services in forensic psychiatric settings. Such integration may represent a necessary standard of care, aligning Denmark with international practices. The high rates of non-adherence underscore the serious issue of negative preexisting perceptions of primary care. The results emphasize the need to strengthen relationships between forensic psychiatric patients and primary care services, both within and beyond forensic settings.