Abstract
Background: In the Simcoe, Ontario, Canada, the mental health (MH) system is fragmented with primary care providers reporting being ill equipped to manage MH concerns across the lifespan. This often leads to referrals to tertiary care or emergency departments (EDs) regardless of acuity of symptoms as evidenced by clogged EDs and long waits. This highlights the key role primary care can play in care pathways to first diagnosis before referral to specialist or urgent care. As such, it is imperative to equip primary care with the right tools and guidance to enable those experiencing MH concerns to receive the appropriate level of care at the right time.
Approach: The approach undertaken is to develop an integrated care pathway for MH care; from identification and screening through to collaborative care delivery. Locally, a team has implemented two digital care pathways to support primary care in managing patients presenting with MH concerns; a child/youth pathway and an adult pathway. Each pathway is designed to use the best available evidence to guide conversations with patients and prioritize care coordination in the community. While workflows in each pathway vary, both consist of electronically based tools embedded directly in the electronic health record providing clinicians access to evidence-based screening and assessment tools, treatment guidance, and effective referral to community MH services.
As uptake of both pathways increases, provider feedback has encouraged the integration of the favorable components of each pathway into one comprehensive pathway irrespective of age of patient at time of presentation to primary care. Clinicians can now utilize one newly customized digital pathway to manage care across the lifespan. In parallel, we have co-designed a set of resource guides for individuals and families seeking MH support and embedded these resources in the pathway.
Results: As integration remains underway, the full impact has yet to be realized. However, reviews of beta versions share enthusiasm behind the customized integration better aligning with clinical decision-making creating more efficient workflow for assessing and treating MH. Additionally, the customized workflow allows for electronic referral to local resources and creates a shared care model wherein measurement based care is the backbone. Evaluation of the patient experience remains a central component underway. We would be excited to share implementation results with the conference community if selected for presentation.
Implications: This customized integration will transform patient and provider experience by making it easier for primary care to provide MH care for children, youth and adults, directing patients to the right level of care at the right time. Patients thus receive MH care in less intensive care settings reducing strain on EDs ensuring such resources are available for those who need them most. Concurrently data collection/evaluation will help identify population needs in relation to system capacity and inform future investments and system improvements. Our hope is that this digital pathway will increase uptake, not only across our geographic region, but also across the province, creating a more standardized approach to supporting primary care in identifying and managing MH across the lifespan.