Hager Keri, Kading Margarette, O'Donnell Carolyn, Yapel Ann, MacDonald Danielle, Albee Jennifer Nelson, Nash Cynthia, Renier Colleen, Dean Katherine, Schneiderhan Mark
Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 211 Life Science, 1110 Kirby Dr, Duluth, MN 55812.
Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, Minnesota, USA.
Prim Care Companion CNS Disord. 2019 Aug 8;21(4):19m02452. doi: 10.4088/PCC.19m02452.
Patients with severe mental illness often lack care coordination between primary care and mental health providers. Siloed patient care across separate health care systems can negatively impact quality and safety of patient care. The purpose of the project discussed in this article is to effectively engage stakeholders from separate primary care and mental health organizations to develop an ideal cross-organization communication system to improve metabolic monitoring for their comanaged patients prescribed second-generation antipsychotics (SGAs).
The mixed method approach of group concept mapping was used to engage stakeholders across a nonaffiliated primary care clinic and a community mental health organization over the time period of March 2018 through May 2018.
Three important domains in communication were identified: (1) process/workflow, (2) advocacy, and (3) a patient-centered focus. Seven high priority/easier to implement brainstormed items were identified and resulted in practice changes across both organizations, including developing a standard release of information, identifying a point person from each clinic focused on cross-organization care coordination, endorsing an SGA monitoring protocol across organizations, agreeing that metabolic monitoring of SGAs will be the responsibility of the primary care clinicians, beginning monthly medication reconciliation and cross-organization care conferences, developing standard electronic health record documentation, and providing education.
Care coordination across all health systems is critical to optimize patient care for chronic medical and psychiatric conditions. Group concept mapping provides a strategic process to allow shared decision-making among stakeholders to take steps toward solving more complex systematic problems such as poor electronic health record interoperability across health systems.
患有严重精神疾病的患者在初级保健和心理健康服务提供者之间常常缺乏护理协调。不同医疗保健系统之间孤立的患者护理可能会对患者护理的质量和安全产生负面影响。本文所讨论项目的目的是有效地促使来自独立的初级保健和心理健康组织的利益相关者参与进来，以开发一个理想的跨组织沟通系统，从而改善对共同管理的、正在服用第二代抗精神病药物（SGA）的患者的代谢监测。
采用小组概念图绘制的混合方法，在2018年3月至2018年5月期间促使一个非附属初级保健诊所和一个社区心理健康组织的利益相关者参与进来。
确定了沟通中的三个重要领域：（1）流程/工作流程，（2）宣传，以及（3）以患者为中心。确定了七个高度优先/更易于实施的头脑风暴项目，并在两个组织中都带来了实践变革，包括制定标准的信息发布流程、从每个诊所确定一名专注于跨组织护理协调的关键人员、认可跨组织的SGA监测方案、同意SGA的代谢监测将由初级保健临床医生负责、开始每月进行药物核对和跨组织护理会议、制定标准的电子健康记录文档以及提供教育。
所有医疗系统之间的护理协调对于优化慢性医疗和精神疾病患者的护理至关重要。小组概念图绘制提供了一个战略过程，使利益相关者能够共同决策，朝着解决更复杂系统问题（如医疗系统间电子健康记录互操作性差）的方向采取措施。
