Site and app connect primary care to psychiatric expertise

TORONTO – The Centre for Addiction and Mental Health (CAMH) has launched an interactive website, called Portico (www.porticonetwork.ca), which provides a platform for primary care physicians and allied healthcare professionals to better diagnose and treat patients and clients with psychiatric issues and substance abuse problems.

At the same time, CAMH released an app, called Psychiatry in Primary Care, which provides easy-to-use tools for primary care providers at the point-of-care. It also links back to the more comprehensive web platform.

“Primary care is the backbone of our healthcare system,” said Dr. Peter Selby, director of medical education at CAMH, who explained that primary care physicians are often the first place patients go for help with their problems. “It’s best if we can prepare primary care practitioners for the people who walk in with mental issues.”

Dr. Selby noted that Portico and the new app offer screening tools and access to advice from mental health professionals – backed by evidence: “No offence to Dr. Oz, but you want to make sure the information you give out is curated. Portico is curated.”

Importantly, Portico also offers primary care professionals the ability to interact with communities of care, and to join these communities, as a way of discussing psychiatric issues and ways of dealing with addictions, including alcoholism and opioid dependencies. “It’s not just a static website,” said Dr. Selby. “It’s a meeting place for knowledge to be spread.”

Already, there are 30 communities of practice up and running, with 2,000 care providers active. “And it’s just at the beginning, it’s going to grow,” said Dr. Selby.

The launch of Portico and the app were made possible by resources from CAMH, as well as funding from Bell Canada. Recently, Bell made a $10 million donation to CAMH, and a portion of the funding was used to produce the online system.

Bell has been actively involved in mental health issues. “So that people can get the care they need, and so they can reach their full potential,” said Mary Deacon, chair of Bell Let’s Talk, at the launch announcement, which was held at CAMH in January.

Dr. David Goldbloom demonstrated the use of the app with Nancy McNaughton, a senior simulation specialist at CAMH. With Dr. Goldbloom playing the role of a family doctor using the app on his tablet computer, they showed how a primary care provider could quickly screen a person with substance abuse issues, determining the degree of severity and whether the help of a specialist is needed.

The app, he said, answers the need for “a concise and rapid guide for the diagnosis and treatment” of psychiatric problems.

It makes use of more than 135 screening questions, which can be added to or customized by the user. As well, it connects to a variety of tools and resources on the Portico site. The app is based on Dr. Goldbloom’s book, Psychiatry in Primary Care, which was published in 2011. “The app version is evidence-based, customizable and updatable,” said Dr. Goldbloom.

A copy of the screening questions and answers can be emailed to the patient; moreover, it doesn’t remain on the tablet or point-of-care computer, but rather resides on a secure server. In this way the patient’s privacy is protected.

The Portico website has extensive resources about treatment options and best practices for topics such as suicide risk, depression, psychosis and personality disorders. It also offers a place for primary care doctors and social workers to ask questions and interact with their peers.

Amy Restoule, a social worker with the Sudbury East Community Health Centre, spoke about her experience with the app and web site. “On any given day, I’ll see people with depression, substance abuse problems, or anxiety, often coupled with physical problems. I have to know when to refer them to specialists.”

For many of them, expert help requires a one-hour car trip to Sudbury. “If possible, I don’t want to add to their stress with travel and wait times,” said Restoule. Using the online systems, she has been able to access tools helping her to diagnose and treat her clients, and to better determine if they need the care of a specialist.

“We can connect with other professionals, including experts in Toronto,” said Restoule. She noted the app and website, by connecting her to others, “reduces her sense of isolation.”

Dr. David Wiljer, senior director, transformational education and academic advancement, observed that “there is a void out there when it comes to mental health apps, especially those that are connected to the care delivery system.” Portico and the Psychiatry in Primary Care app may be unique, he said, in providing care-givers with access to evidence-based knowledge and to whole communities of practice.