Promising Practice: EPION’s Primary Care Communication Tool for early psychosis intervention programs

What you need to know:

  • EPION developed the Primary Care Communication Tool to facilitate comprehensive care, transitions, and information sharing between primary care and early psychosis intervention programs (EPI).
  • This promising practice piece highlights two EPI programs in Ontario that have been using this tool in their practice.
  • Both programs do not use this tool during intake/initial assessment visit, however they do complete this tool after every client visit following, or when there is a change to report to the client’s general practitioners (GP).   
  • User feedback has highlighted that the tool has a very simple structure to capture all the domains and areas they are working in, as well as next steps. It’s easy to use because it is brief and it can tailored to suit the program and client.
  • This tool provides prompts that allow the user to provide a comprehensive snapshot of the client.
  • Programs have also has seen an increase in the number of primary care teams following up with them after receiving the completed tool.

 

The primary care sector is a critical partner for early psychosis intervention (EPI) programs in supporting mutual clients. To support comprehensive care and transition between services, EPI programs have a responsibility to work collaboratively with primary care providers. Communication is the cornerstone of an effective relationship. 

To facilitate this relationship, the Early Psychosis Intervention Ontario Network (EPION) developed a simple correspondence template. This template, called the EPION Primary Care Communication Tool, is designed to help EPI programs share information about a client with their primary care providers in a concise and timely manner. 

EPION’s Partnerships, Education, Access and Knowledge Translation (PEAK) working group developed the tool based on information gathered through a province-wide survey of primary care providers in November 2017.  It helps EPI staff give primary care providers a comprehensive snapshot of a client’s progress while in EPI care, ideally every six months, as clinically indicated, and when a client is preparing to transition out of EPI services.

This issue of Promising Practice highlights two EPI programs in Ontario that have been using the tool in their practice. Sharing their experiences and tips for using the tool, are:

  • Carlyn McNamara, Mental health & Addictions clinician, Canadian Mental Health Association (CMHA) Cochrane-Timiskaming (CT)
  • Adrian Comeau, Prevention and Early Intervention Program for Psychosis (PEPP) Case Manager and Shannel Butt, PEPP Coordinator & Student Placement Program, CMHA Elgin.

Read it below or download the PDF.

With which clients are you using this tool?

therapist sitting with notes on her lapCarlyn, CMHA CT: As an early intervention clinician, I am currently using this tool with the majority of our clients in Timiskaming region, which is about 13 clients. For the other clients, I will be using the tool when communicating with a primary care team is required. I travel to meet about half of my clients, the clients do not have to travel.

I have a community based program model throughout the District of Timiskaming. Communicating with physicians for the clients only takes place a couple of times a year, unless the client is having their medications revised. There are a couple of clients still waiting to be connected to psychiatrists, so they only have a general practitioner (GP) physician.

Adrian and Shannel, CMHA Elgin: We are using the tool with all clients in our first episode program. We have been using it for the past year with GPs, providing updates pretty often.

How often are you using the tool and how?

Carlyn: We don’t use this as our initial intake tool, since at intake we don't have the information available to complete this tool and we have another letter format for that. Rather, we use this as a follow-up/discharge communication with external primary care teams, ranging from six months to annually, depending on the level of contact the client has with their primary care team. I generally review case notes, then go through the tool and fill in what I know, then go to client chart, fill in medications, symptoms of concern, then fill in prompting chart, complete the blurb and transition statement, then fax to their GP. I have never completed this tool with clients, but I do ask them if there’s anything they would like to address with their GP. I also do not use this with our internal primary care team, as they have access to our charts.

Adrian and Shannel: Using this tool has been a regular practice of ours to communicate client updates with GPs. We use this at the six-month mark, after the client has been accepted into our program, during the post-assessment phase. We also have other communications tools we use with GPs, for example, an initial GP letter introducing our program, informing them that the client has entered our program, who their case manager is, medications, along with psychiatric consultation notes; a transition of care document; and a discharge letter letting them know the client has graduated the program.

We generally draft a completed version of this tool before meeting with the client, and then go over it together with them to fill out unknown fields and see if there is anything they want to change. We have found that some items (for example, substance use), may be of concern to include, as clients may not be too comfortable with sharing with GPs. They are not as close with their GPs as they are with our programs, so this tool is also helpful in getting them to start building a relationship with their GPs.

We do not use this tool during discharge, as we have our own discharge letter, outlining why the client is being discharged, what they received, etc., and encouraging GPs to do regular follow ups. However, using this tool is also a good opportunity to talk about discharge with the client and plan for the long game—what happens after the EPI program, when they only have their GPs to connect with. Once they understand that they won’t need to re-tell their story and start from scratch, most clients are ok with sharing all this information included in the tool so their GP is aware of what took place during their time in the EPI program.    

Was it feasible to implement the tool in your program?

therapist talking with clientCarlyn: Yes, I had to get permission to use this, but it is very easy to use! There are great prompts in the tool! I have also shared with our nurse practitioner and she thought there was just the right amount of information provided. The tool meets the need and highlight all the relevant points. It is only myself using it right now in my program. My hope is we will upload this in our electronic system, so it is even easier to use, as I am currently scanning and adding to clients’ charts.

Adrian and Shannel: Yes very feasible! The tool has a very simple structure to capture all the domains and areas we’re working within and the next steps. It’s easy and feasible to use because it isn't long. This allows us to have a quick process (quicker than before) and provides a quick snapshot. We have found that it is seamless to start using it right away and it doesn't take long to go through with all our caseloads.

Is it onerous to complete?

Carlyn: Not really, it's broken down nicely. There are opportunities to add open fields and I can tweak it to make it individualized.

Adrian and Shannel: No, it’s a great tool to go over with clients and make sure everyone is on the same page. It’s also a good opportunity to have a conversation, keep things on track, and do reflections. We like that you can include additional info as attachments as well. Tip: Make sure to be concise when using tool and don't get too wordy.

What are the benefits of using the tool?

Carlyn: The utility of the tool is nice, especially for sharing information with GPs I don’t know too well. GPs have also noted that they want as much information as possible prior to meeting with the client every time, as they don’t have time to get that background information from them, so this tool meets that need.

Adrian and Shannel: The tool is a really good form of communication, in lieu of meetings/updates every couple of months with GPs. Some GPs have even reached out, after receiving the tool, for follow-up conversation for more information! We have noticed more contact from GPs from using tool. One GP also said that it's really nice to have something typed out and it’s easy to read, providing a more comprehensive summary. She appreciates it! 

The tool also helps us keep on track, sort of like an informal review process of where you are at with the client. It highlights the client’s goals, and when you revisit the tool, it can help you refocus as a clinician and identify areas that still need to be worked on.

What did you do before to communicate with GPs?

Carlyn: Previously, we have used a one-page word document, providing a summary, which is not as easy for doctors to read and pull out the main points.

Adrian and Shannel: We previously used a brief updates, similar to our initial letter, which was sent via fax. It was a bit cumbersome, developing a blurb every time after the meeting with the client, along with the psychiatrist update. This process was more difficult to put together. We found that it was time consuming and didn't cover all the domains that are included in PEAK’s tool.

What is unique about this practice compared to other practices aimed at achieving similar objectives?

Carlyn: The prompting statements in the tool really helps you include all relevant information to share with primary care in an easy way. Some that you might forget if you had to put together an open letter instead. You don’t have to think too much! 

Adrian and Shannel: This tool provides simplicity of use. It is really helpful compared to community action plans, etc. and we don't have to get 10-15 people in the room to talk about this and complete it.

Are there any important things people should consider before using this tool?

Carlyn: Make sure the tool is formatted with your letterhead. (Carlyn, can you send this to me so I can include your program’s version as an image in this piece?)

Adrian and Shannel: Really be mindful what info you're including. If you're not talking to the client before sending the completed tool off to their GP, it's a delicate dance, as you want the client to have as much control with what they want to share. Tip: Add reminders in your calendar to do it every six months, and you don't have to update every section. It’s a straightforward process!

Are there any keys to success that you want to highlight?

Carlyn: Any communication to/from primary care is always a bonus! This tool is great at prompting someone to do a communication—a reminder to work collaboratively whenever possible! This tool can also be used in other case management programs.

Adrian and Shannel: Having GPs reach out and wanting to consult with us really shifts the tone in our relationships with them and it’s a big success. The least fragmented services can be between our program and GPs the better for our clients!

What are the limitations of this tool?

Carlyn: The current format for the tool does not fit with our electronic medical records system, but the hope is that we’ll upload it as part of our forms in the charting system. I also don't think this should be the only form of communication with primary care teams—this is one way, but not only way! Limitations only come when people feel the need to write a strict organizational policy about how and with what frequency to use this.

Adrian and Shannel: One challenge might be that clients don't want to share information with GPs, but it gives you the opportunity to have the conversation on why, and get them to build the relationship with their GP after.

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Note: The EPION PEAK group did not originally envision using the tool with clients, as this is a clinician to clinician tool. However, after interviewing CMHA Elgin, the group decided that this is a great use. Moving forward, PEAK will look at how an updated version of the tool might be used to have a conversation with a client and potentially including prompts in the tool for clinicians. 

If you plan to use this tool and would like to provide feedback to the PEAK group, please contact info [at] epion [dot] ca

For more information about how to use the EPION Primary Care Communication Tool, watch the instructional videos and/or refer to the explanation sheet. For more information about their use of the tool you can also contact Carlyn McNamara at cmcnamara [at] cmhact [dot] ca, Shannel Butt at ShannelB [at] cmhaelgin [dot] ca, or Adrian Comeau at AdrianC [at] cmhaelgin [dot] ca