Improving Chronic Pain Management in a Family Medicine Residency.

BACKGROUND AND OBJECTIVE: Although the opioid epidemic continues to affect millions of Americans, many family physicians feel underprepared to perform chronic pain management (CPM) and treat opioid use disorder (OUD). To address this gap, we created organizational policy changes and implemented a didactic curriculum to help improve patient care, including medication-assisted treatment (MAT) into our residency. We investigated whether the educational program improved the comfort and ability of family physicians to prescribe opioids and utilize MAT. METHOD: Clinic policies and protocols were updated to align with the 2016 Centers for Disease Control and Prevention Guidelines for Prescribing Opioids. A didactic curriculum was created to improve resident and faculty comfort with CPM and introduce MAT. An online survey was completed pre- and postintervention between December 2019 and February 2020, utilizing paired sample t test and percentage effective (z test) to assess for change in provider comfort with opioid prescribing. Assessments were made using clinical metrics to monitor compliance with the new policy. RESULTS: Following the interventions, providers reported improved comfort with CPM (P=.001) and perception of MAT (P<.0001). Within the clinical setting there was significant improvement in the number of CPM patients who had a pain management agreement on file (P<.001) and completed a urine drug screen within the past year (P<.001). CONCLUSION: Provider comfort with CPM and OUD increased over the course of the intervention. We were also able to introduce MAT, adding a tool to the toolbox to help our residents and graduates treat OUD.

Impact of Interprofessional Care Conferences Across Primary Care and Mental Health Organizations on Family Medicine Resident Learning.

BACKGROUND AND OBJECTIVES: Patients with severe mental illness often lack care coordination between primary care and mental health providers which can negatively impact patient outcomes. Team-based care is integral in the effective management of patients with multiple comorbidities, with the family physician central in coordinating holistic care. Family medicine residency programs must provide models of effective interprofessional collaboration and mental health treatment to prepare residents to navigate an evolving health care landscape. The objective of this study was to evaluate family medicine residents' learning about providing holistic care with an interprofessional team and medication safety monitoring from the interprofessional cross-organizational care conference experience. METHODS: To bridge care and cultivate the necessary skills, a family medicine clinic and mental health clinic implemented monthly interprofessional care conferences to coordinate care for their shared patients during 2019. Residents who participated in the care conference each (n=11) completed a retrospective pre/postsurvey (11/11=100% response rate) to gather perceptions of what they learned from the interprofessional care conference experience. RESULTS: After participating in the care conference, all residents agreed they understood the elements that must be considered to provide holistic patient care, were confident conducting medication safety monitoring for their patients taking second-generation antipsychotics (eg, lipids, A1C, ECG), and agreed the care conference helped them develop a more comprehensive patient-centered care plan. Additionally, they all intend to work collaboratively across professions in the future. CONCLUSIONS: Interprofessional and cross-organizational care conferences create an authentic learning environment that enhances family medicine residents' understanding and confidence in providing collaborative and holistic care for patients with severe and persistent mental illness.

Just Culture Is Not "Just" Culture-It's Shifting Mindset.

Health care and the Veterans Health Administration have adopted many initiatives to improve patient care, including efforts to create a "Just Culture" environment for patient safety and quality outcomes. Despite significant resources and efforts on these initiatives and some temporary improvements, we continue to struggle to make significant and sustainable improvements. At the Veterans Administration North Texas Health Care System, we see that our efforts have addressed the wrong thing. By focusing our efforts to shift the underlying mindset that drives behavior, we expect to create the foundation that will help us truly achieve a High Reliability and Just Culture organization that provides the care and outcomes our patients and staff deserve.

Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics-HDC/DFMC Bridge Project, Phase 1: Group Concept Mapping.

OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

A formalized teaching, practice, and research partnership with the Veterans Affairs North Texas Health Care System: a model for advancing academic partnerships.

In 1999, the Texas Tech University Health Sciences Center School of Pharmacy expanded its Dallas/Fort Worth presence by creating a regional campus for pharmacy students in their third and fourth years (P3 and P4 years) of the program. This expansion was driven by the need for additional practice sites. The VANTHCS was an obvious choice for the school due to the similarity of missions for clinical practice, education, and research. The VANTHCS and pharmacy school renovated a 4,000 square foot building, which includes classrooms, conference rooms, a student lounge, and faculty offices (expanded to 8,000 square feet in 2003). To date, the school has invested $1 million in the building. From a practice perspective, VANTHCS purchases faculty professional services from the school to augment its clinical specialist staff. These professional practice contracts provide VANTHCS with 12 additional clinical pharmacy specialists serving 50% of their time in multiple specialty areas. The collaboration has also allowed for expansion of clinical teaching, benefitting both institutions. In addition to the pharmacy student interns on P3 and P4 practice experiences, the collaboration allows for 8 to 10 postgraduate pharmacy residents to train with VANTHCS clinical specialists and school faculty members each year. The VANTHCS/pharmacy school collaboration has clearly enhanced the ability of both institutions to exceed their teaching, research, and practice goals in a cost-effective manner.