Primary care bypass among psychiatric patients: A comparative analysis of primary and tertiary care mental health clinics in Ratnapura, Sri Lanka

Introduction: Bypassing primary care is costly to the patient and health care system. It leads to underutilization of resources in primary care and overcrowding of tertiary care institutions.The present study investigated the reasons behind psychiatric patients’ decision either to bypass primary care institutes or not to bypass when seeking psychiatric care.Method: A qualitative study was conducted among the patients attending the Psychiatry Outreach Clinic, Divisional Hospital, Kiriella (DHK) and Psychiatric Outpatient clinic of Teaching Hospital Ratnapura (THR) using focus group discussions. All the participants were from the catchment area of DHK.Results: Reasons for preference for primary care psychiatric clinic were proximity, low-cost transport, ability to attend the clinic with minimal obstruction to occupation, less crowded and familiarity of a local clinic.The reasons given by the participants to bypass were uncertainty about medication availability, lack of investigation facilities and regular specialist care in primary care and higher frequency of clinics at the tertiary care facility. Majority of the participants from tertiary care facility were unaware of the existence of a psychiatric clinic at the primary care hospital.Discussion: The findings indicate that observed primary care bypass could be due to patient unawareness about the service, perceived uncertainty about the availability of medication, investigations, and health care staff. Increasing awareness about the locally available services, ensuring regular medication supply and availability of basic investigation could make more people utilize primary care.Limitations: A study limited to patients receiving state sector service will not be able to discern reasons for bypass among the patients who seek psychiatric care outside the government sector.