Access to and satisfaction with care comparing patients with and without serious mental illness

Objectives: We compared perceived access to and satisfaction with health care between patients diagnosed with serious mental illness (SMI: schizophrenia, or bipolar disorder) and among those with no SMI diagnosis. Method: We conducted a national, cross-sectional study of VA patients in Fiscal Year (FY) 1999 (N = 7,187) who completed the VA's Large Health Survey of Veteran Enrollees (LHSV) section on access and satisfaction and either received a diagnosis of schizophrenia or bipolar disorder, or did not and were randomly selected from the general non-SMI VA patient population (non-SMI group). We compared the probability of perceived poor access and dissatisfaction using multivariable logistic regression adjusting for patient covariates. Results: Compared to non-SMI patients, patients diagnosed with bipolar disorder were more likely to report difficulty in receiving care they needed (adjusted OR = 1.36,p <.05) or seeing a specialist (adjusted OR = 1.44,p <.001). Patients diagnosed with schizophrenia were more likely to report dissatisfaction, including thoroughness by their provider (adjusted OR = 1.37, p <.001) and the provider's explanation of problems (adjusted OR = 1. 54, p <.001) compared to non-SMI patients. Conclusions: Patients diagnosed with bipolar disorder reported greater problems with access to health care, while those diagnosed with schizophrenia were less satisfied with the process of care.