BMJ Open Quality最新文献

{"title":"Transforming improvement training at scale with essential digital training skills.","authors":"Margaret Herbert, Iain M Smith, Cheryl Guest","doi":"10.1136/bmjoq-2024-003224","DOIUrl":"10.1136/bmjoq-2024-003224","url":null,"abstract":"<p><strong>Background: </strong>Internationally, healthcare systems are facing global issues due to rising costs and an ageing population. System-wide improvement is needed to help address these issues. Therefore, large-scale training of staff in improvement skills is required.An established method of training at scale is digitally delivered training, including Massive-Open-Online-Courses (MOOCs). Within the National Health Service in England, wide-scale variation exists in digital education and training standards. This study evaluates an education programme, known as MOOC School, that sought to address educational skills shortfalls by training subject matter experts and trainers in interactive, online learning techniques.</p><p><strong>Methods: </strong>This evaluation assessed the MOOC School training programme's impact on participants' ability to design, develop and deliver online learning. A mixed-methods approach was used, with data collected from existing application and attendance records, surveys and interviews with volunteers who self-identified as having put the learning into practice. The study aimed to identify key success factors of a health educator digital upskilling programme.</p><p><strong>Results: </strong>The MOOC School programme ran seven formal cohorts over 3 years with 96 participants and 2 informal, coaching style cohorts with 14 participants the following year. The programme was well received with 97% rating the course as good or very good. MOOC School helped participants to reach over 30 000 enrolments through courses they created with their teams after undertaking the training, filling a significant gap. Participants reported gaining important skills and insights into the art of what is possible in delivering training in new ways.</p><p><strong>Conclusions: </strong>The experience and plans of the participants support the need for more creative training practices and digitally literate health educators to deliver the training that is required. The findings of the evaluation highlight a way forward in defining the essential skills and knowledge needed to create high-quality digital learning at scale.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying facilitators, barriers and areas of opportunity in diabetic retinopathy screening: quality improvement through qualitative methods.","authors":"Senxi Du, Matthew Freeby, Maria Han, Sylvia Lambrechts","doi":"10.1136/bmjoq-2025-003310","DOIUrl":"10.1136/bmjoq-2025-003310","url":null,"abstract":"<p><strong>Objective: </strong>Quality improvement efforts have aimed to improve annual diabetic retinopathy screening at our institution, but rates remain well below goal. To better understand facilitators, barriers and operational issues unique to our health system and to develop a comprehensive understanding of the care pathway, the Patient Voice toolkit was applied.</p><p><strong>Methods: </strong>In-depth interviews were conducted individually with patients and care team members in a large urban academic medical centre with multiple satellite community clinics. Interviews with patients focused on facilitators and barriers to annual diabetic retinopathy screening. These interviews were transcribed and organised into discrete codes to identify initial themes. We interviewed clinic staff involved in diabetic retinopathy examination scheduling, execution or quality assurance. Interviews with care team members focused on training materials, camera operations and workflow.</p><p><strong>Results: </strong>Through analysis of 15 patient interviews, we found that facilitators included internal motivation, automated examination reminders, reminders from providers and utilisation of local optometry offices. Barriers included competing demands, distant retinal camera locations, limited appointment access and financial and insurance issues. Interviews with 13 care team members resulted in the creation of a process map, and areas of opportunity were identified in the training and operational workflows.</p><p><strong>Conclusions: </strong>The inclusion of different stakeholder perspectives provides in-depth insight into facilitators and barriers to completing annual diabetic retinopathy screening, allowing for recommendations tailored to our specific health system and operations. Suggested operational improvements include expanding clinics that can perform this examination, increasing appointment flexibility, partnering with local optometry clinics and enhancing annual examination reminders to include more details about the examination. Recommendations suggested by staff include increasing patient education, setting expectations around the examination and implementing real-time feedback on image quality.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring health confidence: benefits to patients, clinicians and healthcare providers.","authors":"Tim Benson, Alex Benson","doi":"10.1136/bmjoq-2024-003134","DOIUrl":"10.1136/bmjoq-2024-003134","url":null,"abstract":"<p><strong>Background: </strong>Patients need a high level of health confidence to manage their own care with success. However, health confidence is complex and changes throughout life.</p><p><strong>Methods: </strong>The Health Confidence Score (HCS) is a measure of a patient's confidence and has four items covering their opinion of their health knowledge, ability to self-care, get help and participate in shared decision-making, plus an aggregate summary score. It is a short, easy-to-use measure with a low reading age.Data from about 5000 ratings are analysed, coming from anonymised patients living out of hospital.</p><p><strong>Results: </strong>Findings show a highly significant improvement in health confidence between referral and follow-up after care and treatment. Health confidence is inversely related to the number of medications taken. The highest health confidence is in patients aged between 30 and 49. The lowest health confidence is in patients aged between 50 and 69. No significant difference in health confidence between male and female patients. Health confidence is a different concept from health status and personal well-being.</p><p><strong>Conclusion: </strong>Integrating HCS into routine care fosters patient-centred healthcare, promotes self-care and can reduce cost of care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing equity and efficiency in cervical screening uptake: a multidisciplinary quality improvement initiative.","authors":"Carlos Santos, Julie Roye, Joyce Tucker, Christina Guevara","doi":"10.1136/bmjoq-2024-003111","DOIUrl":"10.1136/bmjoq-2024-003111","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer screening is vital for early detection and prevention, yet uptake remains suboptimal in diverse communities.</p><p><strong>Local problem: </strong>Cauldwell Medical Centre reported cervical screening uptake rates of 54% (ages 25-49) and 62% (ages 50-64) by June 2022, both significantly below the national target of 80%, with a concerning 8 percentage point disparity between age groups.</p><p><strong>Methods: </strong>Using quality improvement (QI) methodologies, including Plan-Do-Study-Act cycles and statistical process control charts, the team tested eight cycles of change grouped into three high-impact actions designed to improve accessibility, trust and personalisation of cervical screening services. Tests of change included culturally sensitive outreach, extended clinic hours and a self-booking system to enhance accessibility and engagement.</p><p><strong>Results: </strong>This QI initiative achieved a marked reduction in age-related inequalities in cervical screening uptake. By the end of the intervention period (March 2023), screening rates increased from 54% to 69% among women aged 25-49 and from 62% to 72% among women aged 50-64, narrowing the gap from 8 to 3 percentage points-a 60% reduction in disparity. By the final monitoring week, uptake further increased to 73% (ages 25-49) and 82% (ages 50-64), demonstrating how structured QI approaches can amplify the effectiveness of existing healthcare processes.</p><p><strong>Conclusions: </strong>This project highlights that systematically applying QI methodologies can effectively address healthcare inequalities, providing a scalable model for improving cervical screening uptake among under-represented populations.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a learning collaborative on team-based care: qualitative analysis of coaching calls using normalisation process theory.","authors":"Kathleen Thies, Meaghan Angers, Amanda Schiessl, Nashwa Khalid, Kasey Harding, Deborah Ward","doi":"10.1136/bmjoq-2024-002972","DOIUrl":"10.1136/bmjoq-2024-002972","url":null,"abstract":"<p><p>Evaluation of learning collaboratives (LC) needs to account for not just outcomes and context, but also the mechanisms participating teams use to implement and normalise new practices. Normalisation process theory (NPT) mechanisms-<i>coherence</i>, <i>cognitive participation</i>, <i>collective action</i> and <i>reflexive monitoring</i>-were used to do a constant comparison coding of transcripts of weekly calls between team coaches and mentors during a 9-month LC to implement team-based primary care in 13 health centres. Both the positive and negative (eg, lack of <i>coherence</i>) use of normalising mechanisms, as well as when they occurred over time, were noted. Findings suggest that normalising mechanisms are not linear, but work concurrently in real time, in a recursive fashion and in negative and positive ways. Clarity of purpose (<i>coherence</i>) became clearer as teams met regularly, and optimised team relational work and commitment to using a shared quality improvement process (<i>cognitive participation</i>). Similarly, the concurrence of <i>cognitive participation</i> and <i>collective action</i> likely refined each other. It took 3-4 months for most teams to establish sufficient <i>coherence</i> and <i>cognitive participation</i>, and to access actionable data. Nine months was not enough time for some teams to both implement and <i>reflexively monitor</i> change using data. A separate analysis indicated that prominent topics of discussion were interactions within the team, its relationship with the larger organisation, and difficulties accessing data and determining its reliability. Teams which experience sufficient positive aspects of normalising mechanisms are able to tolerate the unevenness and negative aspects of normalising change to succeed.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of validated, context-specific patient-reported experience measures (PREMs) tools to enhance quality and patient safety in India.","authors":"Lallu Joseph, Rahul Deshmukh, Malathi Murugesan, Neesha Ajit Nair, Ebinesh Antony, Premkumar Ramasubramani, Reka Karuppusami, Pratheesh Ravindran","doi":"10.1136/bmjoq-2025-003345","DOIUrl":"10.1136/bmjoq-2025-003345","url":null,"abstract":"<p><strong>Objectives: </strong>Patient-reported experience measures (PREMs) offer unique insights into patient perceptions of care. However, their implementation at the micro level with regards to patient safety remains limited. This study aimed to repurpose PREMs to co-produce validated, context-specific PREMs tools aimed at improving patient safety.</p><p><strong>Methods: </strong>A prospective mixed method approach was used to design PREMs-based tools. This multiphase study was conducted from September 2023 to April 2024. In phase 1, a core group identified 17 key processes to devise the PREMs tools. In phase 2, focus group discussions were conducted by the multidisciplinary principal teams to finalise the standard operating procedures for each key process and prepare the respective PREMs questionnaires. Patient safety was the primary construct. Relevant stakeholders, including patients, participated in the face and content validation of each PREMs tool during phase 3. Content Validity Index (CVI) was calculated using three indices, namely, item level CVI (I-CVI), scale-level CVI (S-CVI) and content validity ratio (CVR). The reliability of the questionnaires was checked using Kuder-Richardson Formula 20 (KR-20) values with pilot tests on patients.</p><p><strong>Results: </strong>17 checklist format PREMs tools were developed. The I-CVI values for all the items in the questionnaires ranged from 0.73 to 1.00 and the CVR values ranged from 0.46 to 1.00. The S-CVI/AVG ranged from 0.89 to 1.00. These indicated strong content validity for all items and questionnaires. The reliability analysis for the 17 studies, based on the KR-20 values, ranged from 0.4324 to 0.9455. Except for 'fall prevention', all tools showed good internal consistency.</p><p><strong>Conclusions: </strong>We offer a battery of patient safety oriented PREMs tools. Co-production of PREMs tools across an extensive range of patient care processes offers significant potential in patient safety implementation in addition to patient engagement.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot study evaluating frailty-focused care for hospitalised patients with chronic obstructive pulmonary disease.","authors":"Sunita Mulpuru, Melanie Chin, Delvina Hasimja, Jacqueline Sandoz, Nha Voduc, Smita Pakhale, Jiro Inoue, Joanne Cassidy, Caroline Tessier, Barbara d'Entremont, Julie Lawson, Julia Shaw, Wendy Laframboise, Tim Benson, Alan J Forster","doi":"10.1136/bmjoq-2025-003366","DOIUrl":"10.1136/bmjoq-2025-003366","url":null,"abstract":"<p><strong>Background: </strong>Frailty is associated with morbidity and mortality among people with chronic obstructive pulmonary disease (COPD), yet there are no established care pathways to manage frail patients with COPD. To address this gap, we developed, implemented and assessed the feasibility of a new frailty-focused care model for patients hospitalised with exacerbations of COPD.</p><p><strong>Methods: </strong>We conducted a prospective cohort study among hospitalised patients with acute exacerbations of COPD in an academic hospital in Canada over 18 months. We developed and implemented a frailty-focused care model using the degree of frailty to guide personalised assessments, education, and care interventions during and after hospital discharge. We assessed the feasibility of using frailty-focused care in a real-world setting with prespecified targets for recruitment rate, care model completion and collection of patient-reported outcomes including symptom burden, health confidence, health status and self-management scores. Patients were followed up at 3 months after hospitalisation to reassess patient-reported outcomes.</p><p><strong>Results: </strong>87 patients used the frailty-focused care model during hospitalisation, 58 consented to participate in this study and 45 (78%) completed 3-month postdischarge follow-up. 47% (n=21) were at least mildly frail at baseline, with 35% (n=20) at risk of frailty. Target recruitment of 50 patients was achieved, and all participants completed core elements of frailty-focused care, including frailty assessment, personalised education and discharge planning. Patient-reported outcomes were measured in all participants in hospital, and in 78% (n=45) patients at 3-month follow-up. 23% (n=13) of patients initially reported feeling confident to manage their health condition. This improved to 62% (n=28) at 3-month follow-up.</p><p><strong>Conclusions: </strong>This study provides a foundation to build innovative care models for frail individuals with COPD and shows it is feasible to use frailty-focused care in a real-world hospital setting. Future work requires strong patient engagement to better align frailty-focused care with patient-centred goals.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying diagnostic errors in the emergency department using trigger-based strategies.","authors":"Mahsa Khalili, Moein Enayati, Shrinath Patel, Todd Huschka, Daniel Cabrera, Sarah J Parker, Kalyan Pasupathy, Prashant Mahajan, Fernanda Bellolio","doi":"10.1136/bmjoq-2025-003389","DOIUrl":"10.1136/bmjoq-2025-003389","url":null,"abstract":"<p><strong>Importance: </strong>Diagnostic errors represent a major patient safety concern, with the potential to significantly impact patient outcomes. To address this, various trigger-based strategies have been developed to identify diagnostic errors, aiming to enhance clinical decision-making and improve patient safety.</p><p><strong>Objective: </strong>To evaluate the performance of three pre-established triggers (T) in the emergency department (ED) setting and assess their effectiveness in detecting diagnostic errors.</p><p><strong>Design: </strong>Consecutive cohort, retrospective observational design.</p><p><strong>Setting: </strong>Academic ED with 80 000 annual visits.</p><p><strong>Participants: </strong>Adults and children presenting to a single ED in the USA between 1 May 2018 and 1 January 2020.</p><p><strong>Intervention/outcomes: </strong>Electronic health records (EHRs) were retrieved and categorised into trigger-positive and trigger-negative cases using the following criteria: T1-unscheduled returnvisits to the ED with admission within 7-10 days of theinitial visit; T2-care escalation from the inpatient unitto the intensive care unit (ICU) within 6, 12 or 24 hoursof ED admission; and T3-all deaths in the ED or within24 hours of ED admission, excluding palliative care. A random sample of trigger-positive cases was reviewed using the SaferDx tool to determine the presence or absence of a diagnostic error.</p><p><strong>Results: </strong>A total of 5791 trigger-positive and 118262 trigger-negative cases were identified. Among trigger-positive cases, 4159 (72%) were associated with T1, 1415 (24%) with T2, and 217 (4%) with T3. A preliminary chart review of 462 trigger-positive and 251 trigger-negative cases showed most were error-negative (279 and 217, respectively). Detailed reviews found 32 diagnostic errors among 183 trigger-positive cases, yielding PPVs of 5.4% (T1), 8.9% (T2), and 6.9% (T3). No errors were found in 34 reviewed trigger-negative cases, resulting in a 100% NPV. Sepsis was the most common diagnosis among error-positive cases (n=11, 34.4%). Those with non-specific chief complaints like altered mental status or shortness of breath had higher diagnostic error risk.</p><p><strong>Conclusion and relevance: </strong>While previously proposed EHR-based triggers can identify some diagnostic errors, they are insufficient for detecting all cases. To improve error detection performance, we recommend exploring data-driven strategies, such as machine learning techniques, to more effectively identify underlying contributing factors to diagnostic errors and enhance detection accuracy in the ED.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic monitoring among patients with psychotic disorders taking antipsychotics: results of a quality improvement project to address this challenging guideline-practice gap.","authors":"Yomen Al-Saati, Ethiraj Vijayakumar, Eefa Khan, Christine Leong, Jennifer Hensel, Nina Kuzenko","doi":"10.1136/bmjoq-2025-003400","DOIUrl":"10.1136/bmjoq-2025-003400","url":null,"abstract":"<p><strong>Background: </strong>Metabolic adverse effects of antipsychotic medications pose significant health risks for patients with psychotic disorders. Despite clinical practice guidelines recommending regular metabolic monitoring, adherence to these recommendations remains suboptimal in psychiatric settings.</p><p><strong>Objective: </strong>This quality improvement project aimed to assess the impact of an organisational paper-based metabolic monitoring form (MMF) on monitoring practices for patients with psychotic disorders receiving antipsychotic medications at an outpatient psychiatric clinic in a large Canadian city.</p><p><strong>Methods: </strong>A pre-post intervention study was carried out to assess the impact of the MMF on annual monitoring among 75 randomly selected eligible patients. Metabolic monitoring parameters (blood pressure, weight, waist circumference and glucose and lipid profiles) were reviewed 1 year before and after the introduction of the form.</p><p><strong>Results: </strong>The MMF was missing from 10 charts, and despite its presence in the remainder, no improvement was observed in metabolic parameter documentation, and overall guideline adherence remained low. Fasting glucose and HbA1c measurements were most frequently ordered, while blood pressure and weight measurements remained consistently low across both periods.</p><p><strong>Conclusions: </strong>The implementation of a paper-based MMF alone was insufficient to bridge the guideline-practice gap in metabolic monitoring, highlighting the need for other or concurrent strategies to achieve improvement.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap: monthly telephone calls to enhance collaboration between primary care physicians and psychiatrists.","authors":"Kamini Vasudev, Stephanie Fernando","doi":"10.1136/bmjoq-2025-003328","DOIUrl":"10.1136/bmjoq-2025-003328","url":null,"abstract":"<p><strong>Background: </strong>The integration of mental health services within primary care settings is a growing priority in Canada, driven by the need to improve access and ensure comprehensive patient-centred care. This year-long pilot quality improvement (QI) project was conducted to examine the feasibility and impact of introducing monthly telephone consultations between primary care physicians (PCPs) and psychiatrists working at a secondary care regional hospital in Ontario, Canada.</p><p><strong>Methods: </strong>PCPs were connected with a team of psychiatrists via email on a voluntary basis. Once connected, PCPs were encouraged to contact psychiatrists by text or email to book monthly telephone consultation for patient care.</p><p><strong>Results: </strong>A total of seven PCPs and five psychiatrists participated in this project. A total of 66 patients were discussed via telephone consultations between PCPs and psychiatrists and 11 of these patients were referred to psychiatry for further assessment. The number of referrals to psychiatry O-P service from the seven PCPs involved in this pilot decreased from 83 for the period of November 2021 to October 2022 to 53 for the period of this project, that is, November 2022 to October 2023.There were initial challenges in scheduling consultations due to busy practices. After the first few months of regular monthly contact, three psychiatrists reported fewer ongoing contacts with PCPs and that PCPs email them on an as needed basis. Two psychiatrists continued to have ongoing 4-6 weeks contact with their assigned PCP, discussing on average 3-4 patients, after 1 year.Psychiatrists found the telephone meetings productive and the PCPs were appreciative of the support provided and were willing to take over the primary care of some patients under the care of the psychiatrists, who had medical needs but no PCP.</p><p><strong>Conclusion: </strong>This pilot QI project confirms the feasibility and successful collaborations between PCPs and psychiatrists through monthly phone calls.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}