Wait time well spent

Time can be of the essence in mental health care, something Dr. Leslie Anne Campbell knows well from her days as a mental health nurse.

“I wanted to know how we could ensure that the best evidence available could be used for each patient, and how we would know as soon as possible that care was or wasn’t working,” says Dr. Campbell, the Sobey Family Child & Adolescent Mental Health Outcomes Chair and an assistant professor in the Department of Community Health & Epidemiology at Dalhousie Medical School.

From pen-and-paper to digital

Dr. Campbell is hoping a new pilot project will soon turn time spent in a waiting room into a valuable source of data for informing clinical decisions and improving patient outcomes.

When patients and their families are seen by the IWK’s Community Mental Health and Addictions Program, they complete a standardized, pencil-and-paper questionnaire about their symptoms and how they impact important areas of their lives. This Strengths and Difficulties Questionnaire provides clinical staff a reliable picture of how well the young patient is functioning, and whether treatment being provided is working.

The hand-written questionnaire is slow to process, however, with results unavailable to clinicians until after the patient has left their appointment.

Presenting the questionnaire to patients electronically on an iPad would result in answers being automatically scored, compared to previous encounters or an overall average, and made accessible to a clinician during the same appointment.

“Research has shown that this Routine Outcome Measurement improves the quality of care we deliver,” says Dr. Campbell. “We know that measurement and the use of these measures clinically improves the time to a good outcome, improves youth and family engagement in services, and reduces the amount of time people spend in the system because they’re not left going down the wrong road with a given therapy.”

Real-time info to improve patient care

Dr. Campbell says that having a real-time snapshot of a patient’s progress can improve conversations between patients and their families with clinicians, and make it easier to change course if a particular form of treatment isn’t working. “In mental health and addictions, supporting the engagement of patients and families is so very important. We lose people to follow-up because they feel they’re doing better and no longer need care, or feel they’re not doing well and think, ‘well, this isn’t working.’”

The trial use of iPads will be implemented in the IWK’s Outpatient Community Mental Health and Addictions clinics, located in Halifax, Sackville and Dartmouth, as soon as February 2019. The clinics help children and youth up to the age of 19, and their families, who are experiencing mental health and addictions difficulties.

The project is being funded under the IWK’s Translating Research into Care (TRIC) program, which provides grants to projects that seek to improve patient-reported outcomes and reduce wait times and/or the need for health care. Dr. Campbell is the project’s co-principal investigator, along with Maureen Brennan, the IWK’s Director of Mental Health and Addictions.  

“This project is a partnership between researchers, clinicians and administrators,” says Dr. Campbell, noting that Drs. Debbie Emberly and Susan McWilliam of the IWK’s Research, Evaluation and Outcomes group are co-investigators on the project.

“We’ve done a lot of background work in choosing measures that are most useful to clinicians, to help translate those measures to an electronic format, and now we’re launching this test to inform a more permanent solution.”

Improving outcomes

Aside from helping patients and their families who visit one of the IWK’s community clinics, Dr. Campbell hopes the increased use of technology will shape outcome-based approaches to care delivery.

“I would consider it a success to think that we had information that made every encounter with the health care system an opportunity to learn how we can provide better services.”

“I’m grateful to the Sobey Family for supporting a research vision that creates an opportunity to make an immediate difference to the mental health of young people and their families.”