Supported by funds from the Shared Care Committee, many family and specialist physicians across BC are working together to improve health outcomes and the patient journey through the health care system. Two Shared Care programs highlighted be­low illustrate some of the new ap­proaches being used to improve the coordination of care between family and specialist physicians and access to specialist consultation and care. 

Coordinating patient care 
Family and specialist physicians in communities across BC are teaming up to find locally appropriate solutions to challenges they face in the shared care of patients. 

As part of the Partners in Care program, these physicians are developing, testing, and implementing new processes and systems to improve the coordination of patient care between them, especially for patients with chronic diseases. Current efforts are focused on:

•    Referral and consult processes.
•    Shared care planning and re-referral criteria.
•    Diagnostic standards and communications.
•    Telephone advice protocols and more. 

Solutions range from telephone hotlines that provide rapid access to specialist consults (often within the span of a patient visit), such as Rapid Access to Consultative Experience (RACE), to standardized referral and diagnostic requisition forms, to implementing e-communication of diagnostics and clinical notes for physicians, registered nurses,  and allied health professionals.

More than 1500 GPs and 125 specialists are involved in the Partners in Care program, with work underway at numerous sites across BC, including Providence Health Care, Central Okanagan, Fraser Northwest, Kootenay Boundary, Salmon Arm, South Okanagan/Similkameen, and South Vancouver Island.

Providing a new psychiatric referral option for family physicians 
Lengthy wait times for psychiatric assessments are common, but a program underway in the Lower Mainland enables family physicians to offer patients a treatment option that provides psychiatric care within 4 to 6 weeks of referral.

Using group medical visits for treatment of patients with mood disorders, the Rapid Access to Psychiatry program provides psychiatric as­sessment, effective intervention, and follow-up for patients who might otherwise have waited much longer for one-on-one treatment by a psychiatrist.

Program founder Dr Ron Remick and colleagues assess and care for patients with a range of conditions, including depression, anxiety, and bi­polar disorder, as well as patients with concurrent substance abuse issues and/or comorbid psychiatric conditions. 

While no appointment is necessary for the group sessions, all patients must undergo an initial 45-minute assessment by one of the psychiatrists for which referral from a family physician is required.

Following the assessment, the psy­chiatrist provides a consultation letter to both the patient and the referring family physician that includes a psychiatric diagnosis and treatment recommendation. 

Patients can then choose either to have their family doctor initiate psychiatric treatment, or to attend the group sessions and have the program psychiatrists direct their medical care.

Follow-up treatment is provided through future drop-in group medical visits or via e-mail communication between psychiatrists and patients in lieu of traditional face-to-face consultation.

There are five 1-hour drop-in sessions per week held at the Mood Disorders Association of BC Vancouver premises (the Mood Disorders Association of BC also provides administrative support); group sizes vary from eight to 12 patients.

Patient feedback has been positive, with participants reporting a high level of satisfaction with wait times, quality of care, and quality of information,[1] and demand is growing (there are plans to add a sixth weekly session).

Dr Remick and his colleagues are meeting with psychiatrists across BC to talk about their work, and plans are underway to expand the program to Abbotsford, Whistler, Vernon, and sites servicing the Surrey South Asian community. Physicians from Nanai­mo and the Kootenay Boundary and Central Okanagan regions have also expressed interest in this alternate model of care.

For more information on Shared Care programs, visit www.bcma.org/partners-patients [9].

The Shared Care Committee is a joint committee of the BC Medical Association and the BC Ministry of Health, formed as part of the 2006 Physician Master Agreement.
—Clare O’Callaghan
BCMA Communications