Canada Life Identity Research

1
Collaborative Mental Health Care Network
Mentoring family practitioners utilizing email

Jon Hunter MD FRCPC Nadine Gingrich pHD Patricia
Rockman MD,CCFP,FCFP Jose Silveira MD,FRCPC Lena
Salach Ma

2
Family Physician Needs

• Needs assessment 1999 (n 50)
• Access to specialist support
• Knowledge in mental health care
• Access to psychiatry/community resources
• Clinical issues addictions, schizophrenia,
  personality disorders, eating disorders
• Pharmacotherapy antipsychotics / mood
  stabilizers
• Overwhelming support for mentoring program
• (telephone/email/face-face)

3
Objectives and Goals

• Goals
• Enhance quality of mental health care delivery
• Support family physicians in service provision
• Improve family physician/specialist collaboration
• Objectives
• Reduce time to optimal treatment
• Reduce time to consultation
• Improve accessibility to specialist
• Improve physician satisfaction with consultations

4
Organizational Framework

• Steering Committee
• (FPs, GPPs, Psychiatrists, OCFP staff)
• ?
• 2 Mentors (gt44 mentors)
• (1 GPP 1 Psychiatrist)
• 10-20 Community FPs GPP Mentees (gt370 FPs)
• ?
• 15 Mentor/Mentee Groups (matched geography
  interests/communication phone/email)

5
Helpfulness Of CMHC Network

• Percent of MDs stating CMHCN has helped
• Patient care 88
• Knowledge base 75
• Collegial satisfaction 75
• Time to optimal treatment 68
• Amelioration of symptoms 64

6
Distribution of average change in
pharmacotherapeutic intervention ability
8 deteriorated 6 stable 86 improved
7
Distribution of average change in
psychotherapeutic intervention ability
13 deteriorated 5 stable 82 improved
8
Qualitative analysis of email communication

• Email use 20 ? gt 40 (2004-2006)
• Aim to understand the process of email
  communication between mentor and mentee
• Method Qualitative examination of email
  exchanges (8 mentors, 26 mentees), after informed
  consent, for emergent and recurrent themes

9
Results Mentees

• (1)Mentees demonstrate concern and need
• HELP PLEASE!
• Your needed help
• I am VERY worried

10
Results Mentees

• (2) Mentees are deferential to the experts
• Apologize for bothering mentor
• Use self-deprecating humour
• State ignorance

11
Results Mentees

• (3)Mentees are grateful
• thanks a million!
• The solution you suggested worked like a charm
• We are both very happy

12
Results Mentors

• (1) Mentors transfer knowledge directly and
  indirectly
• Direct Start at 25 mg bid and increase weekly
• Indirect Take a look at this article
• We need to ask J. to figure
  out what to do
• about the etoh

13
Results Mentors

• (2) Mentors demonstrate expertise
• I usually start Effexor XR 75 mg and increase
  weekly until I reach 225 mg
• What I have come to learn over the years is
  that it is better to continue the patient on a
  tried, tested and true combination then to watch
  them crumble before your eyes

14
Results Mentors

• (3) Mentors promote generalization
• I usually
• In cases like this
• This is certainly a good screening tool to have
  in your back pocket when looking for ADD

15
Results Mentors

• (4) Mentors encourage and support
• You were absolutely right that the case was
  worth asking about
• This is a challenging case
• Holy smackers what a case!

16
Results Mentors

• (5) Mentors emphasize equality
• Reduce formality in communication
• Make face-saving comments
• Display their own fallibility or uncertainty

17
Results Summary

• Mentees need, gratitude, elevating discourse
• Mentors expert knowledge, encouragement,
• equalization
• Information immediate, clinically applicable,
• reiterative over time

18
Learning Relationship

• Knowledge hierarchy valued and maintained by
  mentees
• Power hierarchy diminished by mentors- Humble
  experts
• ?
• Safe and secure interpersonal space created for
  revealing needs and concerns without shame
• Educational transfer contextualized in trusting
  relationship

19
Email communication

• Pros
• Rapid response
• Informal, conversational
• Allows for reflection, reference checking
• Immediate hard copy
• Reply to all includes whole group
• Oversight of students

• Cons
• Privacy
• Security
• Lack of prosody, paralinguistic features
• Tech. glitches

20
Future directions

• Limited generalizability non-representative
  sample
• Require focus groups, surveys to test general
  applicability of themes
• No information on change of practice
• Impact on mentor training
• Relevance for education of FP and Psychiatry
  residents