چکیده (انگلیسی):

Background:Mental health and/or substance use issues are associated with significant disparities in morbidity and
mortality. The aim of this study was to identify the mechanisms underlying poor primary care access for this
population.
Method:This was a community-based participatory action qualitative study, in which 85 adults who self-identified
as having a serious mental health and/or substance use issue and 17 service providers from various disciplines who
worked with this population participated in a semi-structured interview.
Results:Client, service provider and health system barriers to access were identified. Client factors, including
socioeconomic and psychological barriers, make it difficult for clients to access primary care, keep appointments,
and/or prioritize their own health care. Provider factors, including knowledge and personal values related to mental
health and substance use, determine the extent to which clients report their specific needs are met in the primary
care setting. Health system factors, such as models of primary care delivery, determine the context within which
both client and service provider factors operate.
Conclusions:This study helps elucidate the mechanisms behind poor primary health care access among people
with substance use and/or mental health issues. The results suggest that interdisciplinary, collaborative models of
primary healthcare may improve accessibility and quality of care for this population, and that more education
about mental health and substance use issues may be needed to support service providers in providing adequate
care for their clients.