Facilitating access to mental healthcare for patients with long-term conditions in general practice: a qualitative collective case study

Mental health problems among patients with type 2 diabetes (T2D) and ischemic heart disease (IHD) are common, but often undertreated. General practice is a relevant setting for addressing this complex health condition. However, research suggests that this group of patients often experience problems accessing care. This study aimed to explore how access to mental healthcare in general practice for patients with T2D and/or IHD is facilitated by processes of organizing care. The study was designed as a qualitative collective case study in four general practices in Central Denmark Region participating in The Healthy Mind Study. Data were collected through ethnographic observations of, and qualitative interviews with patients and healthcare professionals. We found that when healthcare professionals adapted services to specific patient needs, the patients felt welcome and accepted. Furthermore, finding a balance between letting the patient take responsibility while still providing sufficient support led to patients feeling empowered while still feeling cared for. Organizational prioritization of patients in vulnerable situations created circumstances that enabled healthcare professionals to provide better access to care and better treatment outcomes. Healthcare professionals in general practice must think about their role in facilitating access to mental healthcare. An important part of this is that general practices prioritize patients in vulnerable situations, for example through specialized services, outreach work, structured staff supervision, and extra time. Recruitment of participants for mental healthcare interventions in general practice may benefit from using informal strategies relying on the patient-provider relationship. Adapting services to specific patient needs is essential to facilitating access to mental healthcare for patients with long-term conditions. Provider continuity plays an important role in this, and general practice is thus a relevant site for targeting mental health problems among these patients.To facilitate the best treatment outcome in mental healthcare for patients with a long-term condition, it is important that healthcare professionals find a balance between facilitating patient empowerment and providing sufficient support.Organizational prioritization of patients in vulnerable situations is crucial for creating circumstances that enable healthcare professionals to facilitate access to care. The current study showed how this can be accomplished through specialized services, outreach work, structured staff supervision, and extra recruitment time. Adapting services to specific patient needs is essential to facilitating access to mental healthcare for patients with long-term conditions. Provider continuity plays an important role in this, and general practice is thus a relevant site for targeting mental health problems among these patients. To facilitate the best treatment outcome in mental healthcare for patients with a long-term condition, it is important that healthcare professionals find a balance between facilitating patient empowerment and providing sufficient support. Organizational prioritization of patients in vulnerable situations is crucial for creating circumstances that enable healthcare professionals to facilitate access to care. The current study showed how this can be accomplished through specialized services, outreach work, structured staff supervision, and extra recruitment time.