SIIReN - System Integration & Innovation Research Network

Primary Health Care System
RESEARCH AND KNOWLEDGE TRANSFER

SEED FUNDING REPORTS


Informational Continuity: Communication between Primary Care and Mental Health

Principal investigators: Drs Janet Durbin and Jan Barnsley. Co‐investigators: Drs Whitney Berta, Elizabeth Lin, Liisa Jaakkimainan, Lindsey George. Coordinator: Brenda Finlayson, RN MSW, RSW Other contributors: Drs Paul Kurdyak, Jeff Bloom; Michael Jeavons, Josephine McMurray (PhD candidate)

 

Abstract :

The majority of individuals receive treatment from their family physician, who manages their care either alone or in consultation with mental health professionals. Thus effective communication between primary care (PC) physicians and mental health specialists is important to support continuity of care between providers. The present study reviewed the literature to identify items and processes relevant to three information exchange contexts: primary care referrals/consultation requests to psychiatrists; consultation responses from psychiatrists to primary care physicians; and discharge summaries from inpatient to primary care. Information on content, mode of transfer, timing and formats was summarized. Thirty‐nine studies were identified, mainly quality audits and physician preference surveys. None of the studies assessed importance of the content items to quality of care. Preliminary frameworks of domains and items were developed for each information exchange context and reviewed by a small physician panel for importance to care quality and feasibility to collect. Initial panel results suggested agreement between primary care physicians and psychiatrists on the importance of content but less agreement on the accessibility of content elements. A future research agenda was proposed that will refine the framework, develop indicators of information exchange, and investigate the facilitators and outcome of better quality information exchange. This research will need to include electronic medical records given their increasing role in health care delivery.

Key Messages:

Literature generally supports the view that better patient information transfer between primary care physicians and psychiatrists for mental health consultations and at discharge from hospital leads to more access to information for informed decision making and improves continuity. However, few studies have been done to test this view.

  • Most of the studies identified key content elements, format and transfer options through expert opinion or surveys.
  • Some studies included chart audits to determine whether key content elements are actually included in the referral/consultation letters and discharge summaries.
  • Different content elements were deemed essential for the referral letter, consultation letter, and hospital discharge summary.
  • Initial panel results suggested there is agreement between primary care physicians and psychiatrists on the importance of content elements in the three exchange contexts. However, there was less agreement regarding the accessibility of content elements.
  • Future research will need to include electronic medical records given their increasing role in health care delivery.

 

For further information please contact:
Dr. Janet Durbin Janet_Durbin@camh.net
Dr. Jan Barnsley jan.barnsley@utoronto.ca

 

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