The Anatomy of Primary Care and Mental Health Clinician Communication: A Quality Improvement Case St

Authors, Primary Chang,Evelyn;Wells,Kenneth;Young,Alexander;Stockdale,Susan;Johnson,Megan;Fickel,Jacqueline;Jou,Kevin;Rubenstein,Lisa
Title Primary The Anatomy of Primary Care and Mental Health Clinician Communication: A Quality Improvement Case Study
Periodical Full Inflammopharmacology
Pub Year 2014
Volume 29
issue Not Available
Start Page 598-606
Abstract BACKGROUND: The high prevalence of comorbid physical and mental illnesses among veterans is well known. Therefore, ensuring effective communication between primary care (PC) and mental health (MH) clinicians in the Veterans Affairs (VA) health care system is essential. The VA's Patient Aligned Care Teams (PACT) initiative has further raised awareness of the need for communication between PC and MH. Improving such communication, however, has proven challenging. OBJECTIVE: To qualitatively understand barriers to PC-MH communication in an academic community-based clinic by using continuous quality improvement (CQI) tools and then initiate a change strategy. DESIGN, PARTICIPANTS, AND APPROACH: An interdisciplinary quality improvement (QI) work group composed of 11 on-site PC and MH providers, administrators, and researchers identified communication barriers and facilitators using fishbone diagrams and process flow maps. The work group then verified and provided context for the diagram and flow maps through medical record review (32 patients who received both PC and MH care), interviews (6 stakeholders), and reports from four previously completed focus groups. Based on these findings and a previous systematic review of interventions to improve interspecialty communication, the team initiated plans for improvement. KEY RESULTS: Key communication barriers included lack of effective standardized communication processes, practice style differences, and inadequate PC training in MH. Clinicians often accessed advice or formal consultation based on pre-existing across-discipline personal relationships. The work group identified collocated collaborative care, joint care planning, and joint case conferences as feasible, evidence-based interventions for improving communication. CONCLUSIONS: CQI tools enabled providers to systematically assess local communication barriers and facilitators and engaged stakeholders in developing possible solutions. A locally tailored CQI process focusing on communication helped initiate change strategies and ongoing improvement efforts.
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Reference Type(s) Journal Article
Topic Tag(s) Comprehensive Care;System Approach to Quality and Safety;Implementation;Team Based Health Care
Special Population(s) People with Mental and Behavioral Health Issues
Case Study No
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
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