Alternate model of care improves patient access to psychiatric treatment

An innovative initiative funded by the joint BCMA/Ministry of Health Shared Care Committee is improving access to psy­chiatric care for patients with mood disorders. The Rapid Access to Psy­chiatry initiative has accelerated the wait time for psychiatric consultation and care from 5 to 6 months[1] from GP referral to within 4 to 6 weeks.

Using an alternate model of care that includes group medical visits and e-mail communication between psychiatrists and patients, the initiative expands the treatment options that family physicians can offer to patients who are suffering from a range of conditions, including depression, anxiety, and bipolar disorder, as well as pa­tients with substance abuse issues and comorbid psychiatric conditions.

The initiative began when psychiatrists Drs Ron Remick, Chris Gorman, and Judy Allen established the Mood Disorders Association of Bri­tish Columbia (MDABC) Psychiatric Urgent Care Program at the MDABC premises in Vancouver, offering group medical visits to patients on a part-time basis. With funding from the Shared Care Committee, they were able to recruit additional psychiatrists and secure administrative support and space to hold additional group visits at the MDABC site. 

Patients referred to the program re­ceive a 50-minute one-on-one consultation by a psychiatrist, who within a week provides them and the referring family physician with a written consultation that includes a diagnosis and treatment recommendation. Patients can then choose either to have their family doctor initiate psychiatric treatment or to attend the drop-in group medical visits and have program psychiatrists direct their medical care. They can also choose to receive follow-up treatment through future drop-in group medical visits or e-mail communication with program psychiatrists. Funding from the Specialist Services Committee supports specialist fees for the group medical visits and e-mail communication.

Psychiatrists encourage patients to maintain treatment through weekly attendance at group sessions, but the in­itiative does enable patients to choose both the mode and frequency of their treatment, as well as provide them and their family physicians with ongoing, indefinite access to program psychiatrists via e-mail.

This model of care enables one full-time equivalent psychiatrist to assess 6.7 times as many new patients and conduct 553 more follow-up visits per annum than a psychiatrist providing traditional outpatient psychiatric care. It is also almost three times less costly per annum for moderate cases and more than four times less costly for severe cases than traditional psychiatric outpatient care.[2]

Feedback on the initiative has been positive. Family physicians surveyed reported a high level of satisfaction with timely patient access to care. Pa­tients surveyed reported a high level of satisfaction with wait times, quality of care, and quality of information, and were satisfied with the wait time for referrals—67% said they attended the group medical visits because of faster access to psychiatric care. Additionally, patients reported that participation in the initiative had enhanced their self-management skills.[3]

Due to proximity, the majority of patients who have participated in the group medical visits held in Vancouver reside in the Lower Mainland, but there are no geographical restrictions to participation. 

Development of a similar system of care in Victoria is under discussion, with proposed plans to link group medi­cal visits with community services, including evidence-based, supported self-management programs like Bound Back and Living Life to the Full. 

Expansion of the initiative to sites including Vancouver’s Langara College campus, Abbotsford, Whistler, Vernon, Penticton, and sites servicing the South Asian community in Surrey, is also under discussion, and some Kamloops physicians have initiated group medical visits for patients with psychiatric conditions in their community. 

Rapid Access to Psychiatry is one of a suite of Shared Care initiatives that aim to improve health outcomes and the patient journey through the health care system by improving coordination of care between family and specialist physicians and access to specialist consultation and care.
For group medical visit schedules and to learn more about referrals to the MDABC Psychiatric Urgent Care Program, visit www.mdabc.net/psychiatric-urgent-care-program.

For more information on the Rapid Access to Psychiatry initiative, visit www.bcma.org/rapid-access-psychiatry-program-psychiatric-urgent-care-ini...
—Gordon Hoag, MD
—Kelly McQuillen
Co-chairs, Shared Care Committee

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This article is the opinion of the Shared Care Committee and has not been peer reviewed by the BCMJ Editorial Board.


References

1.    Goldner E, Jones W, Fung W. Access to and waiting times for psychiatric services in a Canadian urban area: A study in real time. Can J Psychiatry 2011;56:474-480.
2.    Brawner D. Mood disorders: Overview of treatment models and initial costing analysis. Presentation. 21 September 2011.
3.    Araki Y, Bruce R, Lear S. Program evaluation of the MDABC psychiatric clinic on demand. British Columbia Alliance on Telehealth Policy and Research. October 2011.

Gordon Hoag, MD, Kelly McQuillen,. Alternate model of care improves patient access to psychiatric treatment. BCMJ, Vol. 55, No. 7, September, 2013, Page(s) 338 - Shared Care.



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