• Christina Mangurian, Aishat Giwa, Erin Brosey, Martha Shumway, James Dilley, Elena Fuentes-Afflick, Eliseo J Pérez-Stable, and Dean Schillinger.
• From Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (CM, MS, JD, AG); UCSF Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (CM); Department of Psychiatry, Northern California Institute of Research and Education, University of California, San Francisco (EB); San Francisco VA Medical Center (EB); Center for Vulnerable Populations, University of California, San Francisco (CM); Department of Pediatrics, University of California, San Francisco (EF-A); National Institute on Minority Health and Health Disparities, National Institute of Health (EJP-S); Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (DS). christina.mangurian@ucsf.edu.
• J Am Board Fam Med. 2019 May 1; 32 (3): 418-423.

ObjectiveAlthough people with severe mental illness (SMI) have high rates of diabetes and other metabolic disorders, adherence to recommended screening guidelines is low. This study aimed to compare primary care clinicians' and psychiatrists' attitudes toward metabolic monitoring and treatment of patients with SMI.MethodsPrimary care clinicians and psychiatrists within 1 large urban integrated public health system were recruited to participate in this online survey study. Multivariate logistic regression analyses were used to examine if clinician characteristics were associated with attitudes or perceived barriers toward metabolic monitoring and treatment.ResultsResponse rates were 77% (164/214) of primary care providers and 69% (56/81) of psychiatrists completing the survey. There were no significant differences in age or race/ethnicity between provider groups, although primary care clinicians were more likely to be women when compared with the psychiatrists (69% vs 39%, P < .001). Psychiatrists were more likely than primary care clinicians to believe that psychiatrists should conduct metabolic monitoring even if patients had a primary care provider (80% vs 60%, P = .011) However, fewer psychiatrists than primary care clinicians believed that psychiatrists should treat identified cardiometabolic abnormalities (15% vs 42%, P < .001).ConclusionSystemic problems with care coordination and these varying expectations likely contribute to poor cardiometabolic outcomes in this vulnerable population.© Copyright 2019 by the American Board of Family Medicine.

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