Collaboration Also Gains Momentum North of the Border

Collaboration between psychiatrists and primary care doctors, which is becoming increasingly popular in the United States (see Barriers Slow, But Don't Halt March of Collaborative Care), is also gaining ground throughout Canada.

“It works well in the Canadian system, playing on its strengths and weaknesses,” Randall White, M.D., a clinical assistant professor of psychiatry at St. Paul's Hospital in Vancouver, told Psychiatric News. “We have too few psychiatrists, so this approach allows us to use our time effectively by supporting primary care providers.”

In Quebec, for example, the government is trying to reorganize the health care system so that less-ill psychiatric patients will be cared for by family doctors, not by psychiatrists, Joel Paris, M.D., a professor of psychiatry at McGill University in Montreal, said during an interview. This means that psychiatrists will see only the sickest patients, either at the family doctors' offices or at the hospital where they work. (Most psychiatrists in Quebec work in hospitals, not in private practice.) “So that's how things have evolved here,” he said. “This is pretty typical of Canada.”

In Vancouver, White and Rainer Borkenhagen, M.D., a family physician, set up a collaborative-care program whereby psychiatrists would help family physicians provide better mental health care to their patients. They named the program Urbandoc. Today, not just White, but two other psychiatrists at St. Paul's and two psychiatrists at Vancouver General Hospital are participating in the program.

The family physicians and psychiatrists involved in Urbandoc can communicate with each other through a secure Web site. “We accept any referrals the family practitioners send,” White said. “I have diagnosed mood disorders, anxiety disorders, addictions, personality disorders, and somatoform disorders.” Still another valuable aspect of the program, White explained, is that the public health insurance system in British Columbia has set up special mechanisms to reimburse the family physicians and psychiatrists who participate in the program.

“So I think partnering in Canada is going to increase,” Paris anticipates. “Patients will be treated by family doctors unless there is a reason not to.” ▪