Barriers and facilitators of accessing primary healthcare for patients with severe mental illness: a mixed-methods systematic review using framework synthesis.

BACKGROUND: Serious Mental Illness (SMI) is associated with significant physical health inequalities and a shortened life expectancy of approximately 20 years compared to the general population. Access to primary care (PC) services is crucial for addressing the complex healthcare needs of individuals with SMI. AIMS: To identify and analyse the barriers and facilitators that individuals with SMI encounter when accessing PC. METHODS: Five electronic databases (PsycInfo, EMBASE, Medline, CINAHL, Web of Science) were searched to identify primary studies, in the English language, that investigated factors affecting SMI patients' access to PC, published from inception to November 2022 and again in May 2024. All studies were assessed for their quality using the JBI critical appraisal tools (i.e. JBI checklists for analytical cross-sectional studies and qualitative research) and extracted data were synthesised using framework synthesis and a convergent integrated mixed-methods approach. RESULTS: 38 studies were found eligible and were included in the synthesis. The identified barriers included, among others, the SMI-related stigma leading to the lack of holistic care, the absence of continuity and rapport in the patient-clinician relationship, the short length of appointments, the fragmented communication between PC and mental health (MH) services, clinicians' inadequate training on SMIs & patients' socioeconomic circumstances. Conversely, reported facilitators were the education and active involvement of patients in healthcare-related decisions, the presence of long-term trusting patient-clinician relationships, the implementation of structured annual reviews, as well as the presence of professional contacts or social networks that can support patients with the coordination of their healthcare, accompany them to appointments and provide advocacy. CONCLUSIONS: The review highlights the urgent need for strategies that will reduce the persistent stigma around SMIs, enable care continuity, promote a shared-care approach between PC and MH services and offer adequate support to patients to access healthcare when needed. Future research should focus on evaluating the effectiveness of such approaches and expanding the evidence base in this critical area. PROSPERO REGISTRATION: The review was registered in PROSPERO with registration number CRD42023430415.