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Overcoming Patient Access Barriers in Complex Conditions: Lessons from Schizophrenia for Broader Healthcare

Saartje Burgmans1, Anne Rieper Hald2, Sayagi Tina Markandaier3

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Systemic barriers, not clinical uncertainty, limit patient access to innovative schizophrenia care. Improving care requires strengthening early identification, rehabilitation services, and aligning reimbursement with long-term outcomes.

Keywords:
access to carecognitive impairment (CIAS)complex conditionshealth technology assessmentmultidisciplinary careschizophreniavalue-based reimbursement

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Area of Science:

  • Psychiatry
  • Health Services Research
  • Health Economics

Background:

  • Patient access to innovative treatments for complex conditions like schizophrenia is often hindered by systemic, clinical, and policy barriers.
  • Cognitive impairment associated with schizophrenia (CIAS) is a critical symptom domain frequently overlooked, impacting long-term patient outcomes.
  • Understanding the factors influencing CIAS care access is crucial for developing effective interventions.

Purpose of the Study:

  • To examine systemic, infrastructural, and economic factors affecting access to CIAS care in eight mid-sized European countries.
  • To identify shared constraints and opportunities for improving CIAS care across diverse healthcare systems.
  • To inform policy and practice for better management of cognitive impairment in schizophrenia.

Main Methods:

  • Conducted semi-structured interviews with 32 healthcare professionals and 9 health policy experts across eight European countries.
  • Employed thematic analysis to identify consistent and variable barriers to CIAS care.
  • Focused on systemic, infrastructural, and economic factors influencing care delivery.

Main Results:

  • Consistent barriers identified include fragmented care pathways, limited cognitive assessment capacity, underdeveloped community rehabilitation, and reimbursement favoring pharmacological over psychosocial interventions.
  • Variability in care access is linked to differences in community infrastructure, professional training, and health technology assessment approaches.
  • Countries with robust community infrastructure and broader reimbursement frameworks demonstrated better capacity for comprehensive CIAS care.

Conclusions:

  • Structural constraints, rather than clinical uncertainty, are the primary impediments to providing comprehensive care for complex conditions like schizophrenia.
  • Addressing these barriers requires coordinated reforms to enhance early identification, expand multidisciplinary rehabilitation, and align reimbursement with functional and long-term outcomes.
  • Policy and infrastructural improvements are essential for optimizing patient access to innovative and effective schizophrenia treatments.