Primary Care Engagement Among Adults Hospitalized with Serious Mental Illness

Adults with serious mental illness (SMI) experience disproportionately high rates of chronic medical disease and premature mortality, making primary care engagement essential. Although the presence of a primary care provider (PCP) is frequently used as a marker of healthcare access, whether patients hospitalized with SMI meaningfully engage with primary care remains unclear. A retrospective chart review of 278 adults admitted to an inpatient psychiatric unit with major depressive disorder, bipolar disorder, schizophrenia, or schizoaffective disorder was conducted. We examined the prevalence of an identified PCP, PCP utilization within the 12 months preceding hospitalization, and demographic and clinical characteristics associated with PCP engagement. Overall, 64.4% of patients had an identified PCP, but only 45.3% of those patients had attended a PCP visit within the preceding year. Patients with a PCP were older (p=.033), more likely to be female (p=.009), and had more medical conditions treated during hospitalization (p=.010). Unhoused patients were less likely than housed patients to have a PCP (55.7% vs. 69.0%), although the difference did not reach statistical significance (p=.056). Despite nearly two-thirds of adults hospitalized with SMI having an identified PCP, fewer than half had engaged with primary care in the year preceding admission. It remains unclear whether the presence of an identified PCP accurately reflects meaningful primary care engagement. Further research is needed to characterize the quality and continuity of primary care in this population and determine the impact of meaningful primary care engagement among hospitalized patients with SMI.