First Frontline Forum | Family physicians and specialists seek solutions to streamline communication

Frontline Forum
Presenters at the Frontline Medical Services Forum, from left, Sébastien Blin, Director of Frontline Integrated Services; Francine Dupuis, Associate CEO and Dr. Lawrence Rosenberg, President and CEO.

Even as our CIUSSS embraces the digital age, integrating innovative communication tools into health and social-service practices, sometimes there’s simply no substitute for personal contact.

Frontline Forum panel
Dr. François Loubert, Chief of the Montreal Direction regionale de médecine générale, facilitates a panel discussion between family physicians and CIUSSS specialists. From left, Dr. Samer Daher, family physician at the GMF La cité médicale de Montréal; Dr. Renée Fournier, family physician at the GMF-R Queen Elizabeth; Dr. Fanny Hersson-Edery, family physician at the Clinique VMS; Dr. Heather Rubenstein, family physician at the GMF-U Village-Santé; Dr. Ernesto Schiffrin, Physician-in-Chief at the Jewish General Hospital; Dr. Elizabeth MacNamara, JGH Chief of Medical Biochemistry and Chair of the Council of Physicians, Dentists and Pharmacists.

That’s what over 60 of our network’s family physicians and medical specialists discovered as they gathered at the Jewish General Hospital for the inaugural Frontline Medical Services Forum. Many had communicated with one another for years via electronic channels or paper referral slips—but had never actually met face-to-face.

Enhanced cooperation was indeed part of the vision when the CIUSSSs formed in 2015, uniting healthcare teams that worked across the continuum of care. In daily practice, though, many of the communication lapses between the groups persisted.

Frontline Forum was a first step in bridging the gap between family physicians working in the CIUSSS West-Central Montreal territory and the network’s specialists, an initiative of President and CEO Dr. Lawrence Rosenberg.

For family physician Dr. Renée Fournier, the Frontline Forum revealed a consensus on services that were ripe for improvement.

“My colleagues from other offices, clinics and family medicine groups (FMGs) face many of the same obstacles as me,” she reported at the December event. “Our goal as family physicians is to offer the best possible care to our patients. To accomplish that, the referral process that gives our clients access to tests has to be seamless. That’s why it’s essential to maintain good communication with specialists. It is important to act together to solve our problems instead of simply complaining.”

Participants took part in panel discussions and workshops at the Frontline Forum, which was organized by the Frontline Integrated Services Directorate in collaboration with the de la Montagne and Cavendish local physician roundtables of the Direction regionale de médecine générale.  

“For them, it was a time to stop and assess their needs,” remarked Sébastien Blin, Director of Frontline Integrated Services. “Family physicians, specialists, managers and partners brought their heads together to reflect, ‘how can we improve the continuity of care for our clients?’ Then they went one step further, proposing solutions to some of the most intractable bottlenecks. These can be enacted at two levels, both within the CIUSSS, and by the Ministry of Health and Social Services.”

Examples of some of the challenges identified and suggested courses of action:

Return of information and access to the patient’s clinical information

Family physicians would like to be updated when their patient is hospitalized or has visited the Emergency Department

CIUSSS action: 
Send a copy of the ED consult to the family doctor;
With the patient’s consent, send a summary of the consultation to the family physician

MSSS action: 
Give the institutions access to RAMQ’s database to identify the family physician;
The Québec Health Record must contain the name and coordinates of the client’s family physician

Access to specialists

Access to specific specialties are delayed, notably neurology, pediatrics and gastroenterology

CIUSSS action:
Develop a closer link between the network’s Clinical Access Service and super-clinics;
Make greater use of nurse practitioners

MSSS action: 
Coordinate the Clinical Access Service with hospitals in the catchment area that do not belong to CIUSSS West-Central Montreal, for instance the McGill University Health Centre  and St. Mary’s Hospital

On hand to present physicians an overview of services available to patients in the CIUSSS territory was Associate CEO Francine Dupuis, while Associate Director of Nursing Valérie Pelletier introduced participants to the Clinical Access Service at the JGH, which provides users with more timely access to a medical specialist for a consultation.

Following up after the Frontline Forum

The Frontline Forum opened a door to improved collaboration between family physicians and specialists. So what are the next steps?

In February, a summary of preoccupations and recommendations raised at the Forum was presented to Dr. Lucie Opatrny, Assistant Deputy Minister for Local Services, Emergency and Prehospital Services.  

Dr. Opatrny congratulated CIUSSS West-Central Montreal’s leadership on their initiative. She indicated that the summary would be analyzed to improve and expand on MSSS strategies.

Meanwhile, managers at the CIUSSS will examine the recommendations that can be acted upon locally. Certain items will be addressed with medical clinics in the community during an upcoming meeting of the Local Table Coordinating Medical Services and Frontline Professionals.  

Mélanie Lapointe, a Planning, Programming and Research Officer and member of the Frontline Medical Services Forum organizing committee, notes that organizers would like to host a second edition of the Frontline Medical Services Forum within the year.

Dr. Fournier says she will urge to her colleagues to take part. “We must all get involved, because in the end we are all here to offer the best possible care to our patients.”