collaborative care of psychiatrists and family doctors: pit consultation appointments
TRANSCRIPT
A Race Against Time
Dr. Marilyn Thorpe, Psychiatrist
No conflicts of interest to declare
• 122 patients with mental health needs seen per week by family doctors
• Survey of staff – 100% dissatisfied
• Chief complaint – Average wait to see a psychiatrist was 43 days (up to 272 days)
And the Psychiatrist Survey Says…
• 50% of psychiatric consultations could have been treated with less time
• 40 patients on the waiting list
• Team reviewed and allotted 36/40 for “pit spots”
• May 14, 2014 began four 30 minute spots 3 days a week
• Proved successful
Pit Appointments at UVic
A Pit Appointment
5
25
30
UCL
LCL
0
10
20
30
40
50
60
70
befo
re
Ma
y-1
4
Jun
-14
Jul-
14
Au
g-1
4
Se
p-1
4
Oct-
14
No
v-1
4
De
c-1
4
Jan
-15
Fe
b-1
5
Ma
r-1
5
Ap
r-15
Ma
y-1
5
Jun
-15
Jul-
15
Au
g-1
5
Se
p-1
5
Oct-
15
No
v-1
5
De
c-1
5
Jan
-16
Fe
b-1
6
Ma
r-1
6
Ap
r-16
Ma
y-1
6
Jun
-16
Jul-
16
Au
g-1
6
Se
p-1
6
Oct-
16
No
v-1
6
De
c-1
6
Avera
ge W
ait
(d
ays)
Pit Appointments Reduced Wait Times to See a Psychiatrist
Before Pit
Pit Starts
UCL
LCL
0
10
20
30
40
50
60
701
/1/1
3
2/1
/13
3/1
/13
4/1
/13
5/1
/13
6/1
/13
7/1
/13
8/1
/13
9/1
/13
10/1
/13
11/1
/13
12/1
/13
1/1
/14
2/1
/14
3/1
/14
4/1
/14
5/1
/14
6/1
/14
7/1
/14
8/1
/14
9/1
/14
10/1
/14
11/1
/14
12/1
/14
1/1
/15
2/1
/15
3/1
/15
4/1
/15
5/1
/15
6/1
/15
7/1
/15
8/1
/15
9/1
/15
10/1
/15
11/1
/15
12/1
/15
1/1
/16
2/1
/16
3/1
/16
4/1
/16
5/1
/16
6/1
/16
7/1
/16
8/1
/16
9/1
/16
10/1
/16
11/1
/16
12/1
/16
Wait Times for Psychiatric Consultations Also Fell After Pit Appointments
Da
ys W
ait
Pit Starts
27 26
7
24
0
5
10
15
20
25
30
35
January 20131.4 FTE
January 20141.4 FTE
January 20160.9 FTE
Nu
mb
er
of
Pati
en
ts S
een
More Patients are seen by Fewer Psychiatrists
Pit Appointments
Psychiatric Consultations
Benefits From the Psychiatry Perspective
• Less paperwork for psychiatrists
• Increased team work and support in crisis
• 50% less psychiatry cost than a traditional psychiatric consultation
Benefits From the Patient Perspective
Most Patients Find Pit Appointments Helpful
4 12 8
-10 -5 0 5 10 15 20 25
Number of Respondents
Not Helpul Mildly Helpful Very Helpful
Pit Appointments
Because I was in a crisis … [I had a
pit] instead of waiting for [a]
consultation. I'm glad that they
realized how important it was for me
to start seeing someone immediately.
Benefits From the Family Doctors’ Perspective
• Interviews with family doctors revealed pit appointments:
• Improve their competence and confidence
• Teach them about • Medications and treatment options
• How to decipher coping and complicating personality factors
What Makes a Pit Good?
1. An established relationship between the family doctor and the patient (mandatory)
2. Starting on time (changed times)
3. Ending with a definitive plan (contingency)
Patient Information Sheet
Psychiatry Referral Form
(included in your handouts)
Lessons learned
• Pits appointments decrease wait times to see a psychiatrist
• Psychiatrists, family doctors, and patients like pit appointments
• Certain factors are required for successful pit appointments
Pit appointments have the potential to transform care delivery…
1. Decrease wait times to see a psychiatrist
2. Fewer psychiatric consultations necessary and decreased wait times for them
3. Help patients get well faster
4. Improve knowledge of family doctors
5. Decrease emergency room visits
Work smarter, not harder
Challenges with Spread…
• Funding for family doctors
• Is this transferable in older (hence more complicated) populations?
Future Directions
• Webinars (coming this summer)
• Publications (in progress)
Project Team (Pit Crew) Members
Funding for this initiative was provided for by the Specialist Services Committee (SSC), a joint
collaborative committee of Doctors of BC and the BC Ministry of Health.
SECONDARY
Dr. Andre Kushniruk – Co-Investigator
Dr. Elizabeth Borycki – Co-Investigator
Dr. Judy Burgess – Clinic Director
Dr. Leigh Greiner – Data Analyst
CORE
Dr. Marilyn Thorpe – Project Lead
Helen Monkman – Project Manager
Dr. Oona Hayes – GP Mental Health Lead
Dr. James Felix – GP Mental Health Lead
Theresa Brown – MOA for Mental Health
Geraldine Kiss – MOA for Family Doctors
FAMILY DOCTORS Dr. S. Baskerville-Bridges
Dr. J. Bowles
Dr. M. Brydon
Dr. W. Dyson
Dr. B. Fraser
Dr. K. Foster
Dr. J. Fry
Dr. C. Gray
Dr. T. Garnett
Dr. K. John
Dr. C. Levia
Dr. S. Martin
Dr. B. Meeker
Dr. S. Stewart
PSYCHIATRISTS Dr. M. Cooper
Dr. J. Cheek
Dr. C. Duncalf
Dr. M. Ganzer (Resident)
Dr. I. Lorincz
Dr. P. Singh (Resident)
MH NURSE Cathy Buchan
Thank you!
Questions and Suggestions?
Come to see us during the poster session!
