Helena Kadlec

Mental Health Practice and Attitudes of Family Physicians Can Be Changed

OBJECTIVES An adult mental health module was developed in British Columbia to increase the use of evidence-based screening and cognitive behavioral self-management tools as well as medications that fit within busy family physician time constraints and payment systems. Aims were to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression; to improve patient experience and partnership; to increase use of action or care plans; and to increase mental health literacy and comfort of medical office assistants. METHODS The British Columbia Practice Support Program delivered the module using the Plan-Do-Study-Act cycle for learning improvement. Family physicians were trained in adult mental health, and medical office assistants were trained in mental health first aid. Following initial testing, the adult mental health module was implemented across the province. RESULTS More than 1400 of the provinces 3300 full-service family physicians have completed or started training. Family physicians reported high to very high success implementing self-management tools into their practices and the overall positive impact this approach had on patients. These measures were sustained or improved at 3 to 6 months after completion of the module. An Opening Minds Survey for health care professionals showed a decrease in stigmatizing attitudes of family physicians. CONCLUSIONS The adult mental health module is changing the way participants practice. Office-based primary mental health care can be improved through reimbursed training and support for physicians to implement practical, time-efficient tools that conform to payment schemes. The module provided behavior-changing tools that seem to be changing stigmatizing attitudes towards this patient population. This unexpected discovery has piqued the interest of stigma experts at the Mental Health Commission of Canada.

Improving primary care in British Columbia, Canada: evaluation of a peer-to-peer continuing education program for family physicians

BackgroundAn innovative program, the Practice Support Program (PSP), for full-service family physicians and their medical office assistants in primary care practices was recently introduced in British Columbia, Canada. The PSP was jointly approved by both government and physician groups, and is a dynamic, interactive, educational and supportive program that offers peer-to-peer training to physicians and their office staff. Topic areas range from clinical tools/skills to office management relevant to General Practitioner (GP) practices and “doable in real GP time”. PSP learning modules consist of three half-day learning sessions interspersed with 6–8 week action periods. At the end of the third learning session, all participants were asked to complete a pen-and-paper survey that asked them to rate (a) their satisfaction with the learning module components, including the content and (b) the perceived impact the learning has had on their practices and patients.MethodsA total of 887 GPs (response rates ranging from 26.0% to 60.2% across three years) and 405 MOAs (response rates from 21.3% to 49.8%) provided responses on a pen-and-paper survey administered at the last learning session of the learning module. The survey asked respondents to rate (a) their satisfaction with the learning module components, including the content and (b) the perceived impact the learning has had on their practices and patients. The psychometric properties (Chronbach’s alphas) of the satisfaction and impact scales ranged from .82 to .94.ResultsEvaluation findings from the first three years of the PSP indicated consistently high satisfaction ratings and perceived impact on GP practices and patients, regardless of physician characteristics (gender, age group) or work-related variables (e.g., time worked in family practice). The Advanced Access Learning Module, which offers tools to improve office efficiencies, decreased wait times for urgent, regular and third next available appointments by an average of 1.2, 3.3, and by 3.4 days across all physicians. For the Chronic Disease Management module, over 87% of all GP respondents developed a CDM patient registry and reported being able to take better care of their patients. After attending the Adult Mental Health module: 94.1% of GPs agreed that they felt more comfortable helping patients who required mental health care; over 82% agreed that their skills and their confidence in diagnosing and treating mental health conditions had improved; and 41.0% agreed that their frequency of prescribing medications, if appropriate, had decreased. Additionally for the Adult Mental Health module, a 3–6 month follow-up survey of the GPs indicated that the implemented changes were sustained over time.ConclusionGP and medical office assistant participant ratings show that the PSP learning modules were consistently successful in providing GPs and their staff with new learning that was relevant and could be implemented and used in “real-GP-time”.

Change and Predictors of Change in Social Skills of Nursing Home Residents With Dementia

Background Social skills are of primary importance for those with dementia and their care providers, yet we know little about the extent to which basic social skills can be maintained over time and the predictors of change. Methods A total of 18 nursing homes with 149 newly admitted residents with moderate to severe dementia, 195 direct care staff, and 135 family members, in British Columbia, Canada, contributed data on change in social skills from admission to 6 months and 1 year later. Results Three-quarters of residents maintained or improved their basic social skills during both the time periods. Decline was explained primarily by cognitive status at the time of admission, notably present orientation. However, staff-to-resident communication becomes more important over time. Conclusions Social skills appear to present an opportunity to maintain interaction with these residents. The findings also suggest that a focus on the present orientation before and following admission and on staff-to-resident communication may be beneficial.