VIHA MHAS Story Board May 21, 2010

Enhanced Collaborative Care Service

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Our TeamMarnie Jones

Lynn Hahn

Aline Ngai

Pearl Pal-Reid

Devin Lynn

Sharon Ali

Paulette Coe

Dr. Helen Campbell

Dr. Laura Chapman

Dr. Miriam Korn

Dr. Pushpa Malavi

Dr. Robert Miller

Dr. Lucy Nerenberg

Dr. Keith Sigmundson

Dr. Kiri Simms

Dr. Kate Whitaker

Dr. Richard Williams

Dr. Rivian Weinerman

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Team Statement

To support General Practitioners (GPs) in Victoria to provide primary care to their patient’s for mental health and addiction care.

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Our Results So FarPatient Satisfaction Survey’s Received: 16 in April and 16 in May

(1=Not at all, 7=Very much so)4

GP Satisfaction Survey’s Received: 5 in April and 11 in May

(1=Strongly Disagree, 5=Strongly Agree)

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Provider Satisfaction Survey’s Received: 6 in April and 6 in May

(1=Strongly Disagree, 5=Strongly Agree)

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Patient Comments (April)• This is the most successful psychiatrist I

have ever had in all my years. I know he will help me.

• This experience was way better than expected.

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GP Comments (March)• Referred this patient on Feb 3/10 after she was assessed. I was

notified Feb 12 that she would get an OTC with a Psychiatrist. Subsequently, this was changed to Collaborative Care. I was notified of this on Mar 11/10. She was finally seen on Mar 25/10, 7 weeks after referral. I guess that is an improvement? I am not sure I full understand the Collaborative Care Program (perhaps because of my own negligence in reading my mail). Could I have had earlier access to help if needed? Some info about the program sent to me (or a website to refer to - even better). And the time the patient is deemed eligible would be useful.

• Psychiatrist could not refer patient directly for treatment so I had to do another referral to USTAT.

• GP requesting clarification of survey question #3, “this change initiative has resulted in improvement”, improvement in what?

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GP Comments (April)• I don't think I had telephone collaboration regarding patient.

This client was a N/S.

• I was actually teleconferenced in for the end of the visit, which was helpful. Felt collaborative!

• Excellent, thorough consultation regarding a complex patient who hadn't seen psychiatrist before.

• Consults on both these patients was timely and of great assistance in developing plan for ongoing management. Thank you!

• Appointment was within one month but I have not reviewed the consult yet. Patients meds were changed and was helpful.

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Provider Comments (March)

• Requested ECC was exactly appropriate although complex. I found I did a more complete consultation than I ever have because I was responsible for telephone follow up.

• Of 3 slots available only 1 resulted in seeing a patient. The patient I did see was quite complex and, in my opinion, not likely to be well-managed by GP due to the complexity. However, I stuck to the protocol of seeing her only once. Patients are being booked for the ECC-OTC when this is not what has been requested by the GP and the patient has not had a screening intake interview before the decision is made to book for an ECC-OTC. Suggestion: If an ECC-OTC is not requested but is the only available option (and something else or nothing specific requested) then do the usual telephone screening interview to assist in making the triage decision. For complex patients we might want to discuss other options to consider other than just an ECC-OTC.

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Provider Comments (April)• Total: 3 Telephone Consultations

• I discovered that the feedback form was not in my chart packet, but let admin know and now it is working fine. They also supplied extras so I could access it if missing again.

• Some referrals are very complex co-occurring patients originally referred to VIOCT by the GP. I am trying to have intake refer one to VICOT as I agreed with the GP on this and would prefer to not have them start all over again months after initiating the request. But a second opinion re: diagnosis and treatment recommendations from an Addiction Psychiatrist was appropriate in my opinion.

• Some safety concerns as several patients had history of recent violence and/or homicidal ideation, but staff at ADOUT were helpful.

• Patients seem very appreciative of the program.

• In April, 4/4 of available slots were filled. I am not certain if patients were informed of what service they would receive.

• Can this questionnaire be done electronically?

• Consults very slow to be typed. I believe Val has discussed this with Aline and Rivian. 11

Changes we tested to improve multi-professional communication

• Developed a cheat sheet for signoff including relevant information-

• This is an Enhanced Collaborative Care Service. I am available for any ongoing questions on this patient, as an integral part of the Enhanced Collaborative Care one time consultation. For further information, please have your staff call (insert your telephone #) and leave the patient's name, date of birth and the best way for me to contact you.

 

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• Developing a website to include in the signoff to give more information about this service. To be integrated into the VIHA website. Still in progress

• Changed GP question to indicate improvement in “what”

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Changes we tested to improve the initial assessment process• Ensure the GP knows this is part of the

ECC one time consult with telephone consultation availability by faxing this info on receipt of his/her referral. This was done but was confirmed to be done

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Changes we tested to improving the Plan of Care

• Some psychiatrists included the GP in the last part of the assessment. Wonderful idea. May want to copy

• Make sure the psychiatrist calls the GP personally when there is a no show- to discuss and request GP discuss commitment with patient and refer through INTAKE again

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Other changes wecouldn’t resist testing

• Creating a website

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From all this testing, we have learned

• This is a wonderful skilled group of psychiatrists

• GPs have very complex patients

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We are surprised by • The tremendous patient response

• The low number of telephone calls so far. Still early in process

• The positive response by GPs taking the time to write a response and have it faxed in

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We worry about…• No shows

• GPs knowing about this program and using it as a first request

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Next, we are thinking about…• Completing the

website• How to market this

better

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Summary of all teams data

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