VIHA MHAS Story Board

May 21, 2010

Enhanced Collaborative Care

Service

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 Our Team
Marnie Jones Dr. Miriam Korn
Lynn Hahn Dr. Pushpa Malavi
Aline Ngai Dr. Robert Miller
Pearl Pal-Reid Dr. Lucy Nerenberg
Devin Lynn Dr. Keith Sigmundson
Sharon Ali Dr. Kiri Simms
Paulette Coe Dr. Kate Whitaker
Dr. Helen Campbell Dr. Richard Williams
Dr. Laura Chapman 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 Far
Patient Satisfaction
Survey’s Received:
16 in April and 16 in May

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

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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 we
couldn’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 • How to market this
website better

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Summary of all teams data

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