THE BRITISH COLUMBIA NEUROPSYCHIATRY PROGRAM THE PROVINCIAL CLINICAL-ACADEMIC NEUROPSYCHIATRY PROGRAM BASED IN VANCOUVER, CANADA SEPTEMBER 16, 2016 Dr. Islam Hassan, MBChB, MMedSc, MRCP(UK), MRCPsych, FRANZCP, FRCP(C) Clinical Assistant Professor, Dept. of Psychiatry, University of British Columbia Professor Trevor Hurwitz, MBChB, MRCP(UK), FRCP(C) (Psychiatry & Neurology) Clinical Professor, Dept. of Psychiatry, University of British Columbia
DECLARATION STATEMENT THE PRESENTERS HAVE NO COMPETING INTERESTS TO DECLARE.
LEARNING OBJECTIVES AT THE END OF THIS SEMINAR, PARTICIPANTS WILL HAVE AN UNDERSTANDING OF: 1. THE HISTORY OF THE PROGRAM 2. THE MODEL OF CLINICAL SERVICE DELIVERY 3. THE LEVEL OF CLINICAL-ACADEMIC SUBSPECIALIZATION WITHIN THE PROGRAM 4. THE CLINICAL EDUCATION ROLE INCLUDING THE TWO-YEAR FELLOWSHIP
OUTLINE SETTING: DEMOGRAPHICS AND HEALTHCARE SYSTEM ORIGINS OF THE PROGRAM PROGRAM FLOWCHART CLINICAL-ACADEMIC SPECIALIZATION WITHIN THE PROGRAM CLINICAL EDUCATION ROLE
OUTLINE SETTING: DEMOGRAPHICS AND HEALTHCARE SYSTEM ORIGINS OF THE PROGRAM PROGRAM FLOWCHART CLINICAL-ACADEMIC SPECIALIZATION WITHIN THE PROGRAM CLINICAL EDUCATION ROLE
SETTING: DEMOGRAPHICS AREA 944,735 KM 2 POPULATION 4,720,932 POPULATION (METRO VANCOUVER) 2,313,328 CANADA Sta%s%cs Canada 2011
SETTING: DEMOGRAPHICS AREA 944,735 KM2 POPULATION 4,720,932 POPULATION (METRO VANCOUVER) 2,313,328 PROVINCE OF BRITISH COLUMBIA Sta%s%cs Canada 2011; Google Maps 2016
SETTING: DEMOGRAPHICS AREA 944,735 KM2 POPULATION 4,720,932 POPULATION (METRO VANCOUVER) 2,313,328 PROVINCE OF BRITISH COLUMBIA CITY OF VANCOUVER Sta%s%cs Canada 2011; Google Maps 2016
SETTING: DEMOGRAPHICS AREA 944,735 KM 2 POPULATION 4,720,932 POPULATION (METRO VANCOUVER) 2,313,328 Sta%s%cs Canada 2011
SETTING: DEMOGRAPHICS POPULATION DENSITY Sta%s%cs Canada 2006
SETTING: DEMOGRAPHICS POPULATION PYRAMID BC Stats 2016
SETTING: DEMOGRAPHICS POPULATION GROWTH KnowBC.com 2016
SETTING: DEMOGRAPHICS CULTURAL DIVERSITY IN METRO VANCOUVER MIDDLE EAST 2% SOUTH AMERICA 1% AFRICA 1% INDIA/ SUBCONTINENT 11% CHINA/SE ASIA 28% EUROPE 57% Sta%s%cs Canada 2011
SETTING: HEALTHCARE SYSTEM PRACTICALLY A SINGLE-TIER SYSTEM PUBLIC HEALTH INSURANCE FUNDS HOSPITAL STAYS AND CLINICIAN FEE-FOR-SERVICE MOST CLINICIANS ARE INCORPORATED SERVICE PROVIDERS
SETTING: HEALTHCARE SYSTEM REGIONAL HEALTH AUTHORITIES www2.gov.bc.ca 2016
OUTLINE SETTING: DEMOGRAPHICS AND HEALTHCARE SYSTEM ORIGINS OF THE PROGRAM PROGRAM FLOWCHART CLINICAL-ACADEMIC SPECIALIZATION WITHIN THE PROGRAM CLINICAL EDUCATION ROLE
ORIGINS OF THE PROGRAM 1987: DE-INSTITUTIONALIZATION (DRAFT PLAN TO REPLACE RIVERVIEW HOSPITAL) 2002: TRANSITION FROM 800 BEDS AT RIVERVIEW TO 920 MENTAL HEALTH BEDS THROUGHOUT GENERAL HOSPITALS
ORIGINS OF THE PROGRAM 2000: BC NEUROPSYCHIATRY PROGRAM CREATED PARTNERSHIP BETWEEN RIVERVIEW HOSPITAL AND UBC HOSPITAL TERTIARY CARE PRIMARY CARE (FAMILY PHYSICIAN) SECONDARY CARE (GENERAL PSYCHIATRIST) TERTIARY CARE (NEUROPSYCHIATRIST)
ORIGINS OF THE PROGRAM GOALS COORDINATE PROVINCIAL NEUROPSYCHIATRY SERVICES DEVELOP COST-EFFECTIVE SERVICES THAT MEET THE NEEDS OF THE PROVINCE IMPROVE NEUROPSYCHIATRY CARE THROUGH RESEARCH & EDUCATION, INCLUDING A FELLOWSHIP PROGRAM, SPECIALIZED ROUNDS & CONFERENCES SUPPORT & PROMOTE THE CONTINUUM OF CARE FOR NEUROPSYCHIATRY PATIENTS
ORIGINS OF THE PROGRAM MEMBERS OF THE TERTIARY NEUROPSYCHIATRY PROGRAM 10 PHYSICIANS (ALL FRCP(C) & CLINICAL FACULTY AT UBC): 7 FELLOWSHIP-TRAINED NEUROPSYCHIATRISTS 2 PHYSICIANS DOUBLE-CERTIFIED IN BOTH PSYCHIATRY & NEUROLOGY 1 BEHAVIOURAL NEUROLOGIST NEUROPSYCHOLOGIST & PSYCHOMETRIST NURSING STAFF, SOCIAL WORKER, OCCUPATIONAL THERAPIST, PHYSIOTHERAPIST PROGRAM COORDINATOR & ADMINISTRATIVE ASSISTANT RESEARCH COORDINATOR
ORIGINS OF THE PROGRAM COMPONENTS OF THE TERTIARY NEUROPSYCHIATRY PROGRAM ACUTE DIAGNOSTIC ASSESSMENT & TREATMENT (INPATIENT UNIT) AMBULATORY ASSESSMENT, TREATMENT & OUTREACH (OUTPATIENTS) NEUROBEHAVIORAL STABILIZATION (HILLSIDE CENTRE)
ORIGINS OF THE PROGRAM ACUTE DIAGNOSTIC ASSESSMENT & TREATMENT (INPATIENT UNIT) UBC HOSPITAL 10-BED OPEN UNIT MOSTLY VOLUNTARY AVG 74 DISCHARGES PER YEAR AVG LENGTH OF STAY 49 DAYS
ORIGINS OF THE PROGRAM AMBULATORY ASSESSMENT, TREATMENT & OUTREACH (OUTPATIENTS) Ø UBC HOSPITAL, VANCOUVER GENERAL HOSPITAL & OUTREACH Ø SUBSPECIALTY FOCUS AREAS: EPILEPSY (CO-LOCATED) MOVEMENT DISORDERS (CO-LOCATED) MULTIPLE SCLEROSIS & DEMYELINATING DISORDERS (CO-LOCATED) NEURODEGENERATIVE DISORDERS & HUNTINGTON S DISEASE (CO-LOCATED) LIMBIC SURGERY & DBS FOR NEUROPSYCHIATRIC DISORDERS NEUROPSYCHIATRIC GENETICS & NEUROMETABOLIC DISORDERS TRAUMATIC BRAIN INJURY NEUROVASCULITIDES TIC DISORDERS SOMATOFORM DISORDERS PAIN
ORIGINS OF THE PROGRAM NEUROBEHAVIORAL STABILIZATION (HILLSIDE CENTRE) KAMLOOPS, BRITISH COLUMBIA 10-BED SECURE UNIT MOSTLY UNDER CERTIFICATE DISINHIBITION AND AGGRESSION LENGTH OF STAY UP TO 1 YEAR
ORIGINS OF THE PROGRAM COMPONENTS OF THE TERTIARY NEUROPSYCHIATRY PROGRAM ACUTE DIAGNOSTIC ASSESSMENT & TREATMENT (INPATIENT UNIT) AMBULATORY ASSESSMENT, TREATMENT & OUTREACH (OUTPATIENTS) NEUROBEHAVIORAL STABILIZATION (HILLSIDE CENTRE)
ORIGINS OF THE PROGRAM COMPONENTS OF THE TERTIARY NEUROPSYCHIATRY PROGRAM ACUTE DIAGNOSTIC ASSESSMENT & TREATMENT (INPATIENT UNIT) AMBULATORY ASSESSMENT, TREATMENT & OUTREACH (OUTPATIENTS) NEUROBEHAVIORAL STABILIZATION (HILLSIDE CENTRE) CENTRALIZED TRIAGE WITH SINGLE POINT OF ENTRY
ORIGINS OF THE PROGRAM COMPONENTS OF THE TERTIARY NEUROPSYCHIATRY PROGRAM OUTPATIENTS TRIAGE INPATIENT UNIT STABILIZATION UNIT
OUTLINE SETTING: DEMOGRAPHICS AND HEALTHCARE SYSTEM ORIGINS OF THE PROGRAM PROGRAM FLOWCHART CLINICAL-ACADEMIC SPECIALIZATION WITHIN THE PROGRAM CLINICAL EDUCATION ROLE
PROGRAM FLOWCHART REFERRAL SOURCES (2015; N=423) OUTPATIENTS TRIAGE INPATIENT UNIT STABILIZATION UNIT
PROGRAM FLOWCHART REFERRAL SOURCES (2015; N=423) OUTPATIENTS HOME 58% HOSPITAL 40% 1% TRIAGE INPATIENT UNIT RESIDENTIAL FACILITY STABILIZATION UNIT
PROGRAM FLOWCHART REFERRAL SOURCES (BY SETTING, 2015) RESIDENTIAL FACILITY 1% HILLSIDE 1% HOSPITAL 40% HOME 58%
PROGRAM FLOWCHART REFERRAL SOURCES (BY SPECIALTY, 2015) NEUROLOGIST 11% FAMILY PHYSICIAN 17% PSYCHIATRIST 72%
PROGRAM FLOWCHART REFERRAL SOURCES (BY REGION, 2015) VANCOUVER COASTAL 35% FRASER 43%
PROGRAM FLOWCHART REFERRAL SOURCES (BY REGION, 2015) VANCOUVER COASTAL 35% FRASER 43%
PROGRAM FLOWCHART REFERRAL SOURCES (BY REGION, 2015) VANCOUVER COASTAL 35% FRASER 43%
PROGRAM FLOWCHART TRIAGE OUTCOMES (2015; N=423) OUTPATIENTS HOME 58% HOSPITAL 40% 1% TRIAGE INPATIENT UNIT RESIDENTIAL FACILITY STABILIZATION UNIT
PROGRAM FLOWCHART CENTRALIZED TRIAGE WITH SINGLE POINT OF ENTRY DEFINE APPROPRIATE PRESENTATIONS: Ø KNOWN NEUROLOGIC DISEASE WITH PSYCHIATRIC COMORBIDITY Ø COMPLEX PRESENTATIONS WITH BOTH NEUROLOGIC AND PSYCHIATRIC SYMPTOMS, FOR DIAGNOSTIC CLARIFICATION Ø CHALLENGING SOMATOFORM, FOR DIAGNOSTIC CLARIFICATION MUST MEET A THRESHOLD OF COMPLEXITY (TERTIARY PROGRAM) LIMITED RESOURCES - WAITLIST
PROGRAM FLOWCHART TRIAGE OUTCOMES (2015; N=423) OUTPATIENTS HOME 58% HOSPITAL 40% 1% TRIAGE INPATIENT UNIT RESIDENTIAL FACILITY STABILIZATION UNIT
PROGRAM FLOWCHART TRIAGE OUTCOMES (2015; N=423) OUTPATIENTS HOME 58% 55% HOSPITAL 40% 1% TRIAGE 11% INPATIENT UNIT 6% RESIDENTIAL FACILITY 28% DID NOT MEET CRITERIA STABILIZATION UNIT
PROGRAM FLOWCHART DIAGNOSES INPATIENT DATA (2006-2015; N=782) SOMATOFORM DISORDERS 20% NEUROLOGICAL DIAGNOSES WITH PSYCHIATRIC SYMPTOMS 80%
PROGRAM FLOWCHART DIAGNOSES SUBCLASSIFICATION BY NEUROLOGIC DIAGNOSIS - INPATIENTS (2006-2015) PERCENTAGE 0 5 10 15 20 25 30 DEMENTIAS/NEURODEGENERATIVE MOVEMENT DISORDERS EPILEPSY MS AND OTHER DEMYELINATING NEURODEVELOPMENTAL OTHER (INCLUDING TBI)
PROGRAM FLOWCHART DIAGNOSES SUBCLASSIFICATION BY PSYCHIATRIC DIAGNOSIS - INPATIENTS (2006-2015) (EXCLUDING SOMATOFORM) PERCENTAGE 0 5 10 15 20 25 30 35 40 45 DEPRESSIVE DISORDERS PSYCHOTIC DISORDERS BIPOLAR AFFECTIVE DISORDER ANXIETY DISORDERS SUBSTANCE USE DISORDERS OTHER
PROGRAM FLOWCHART DISCHARGE DISPOSITION (2015; N=423) OUTPATIENTS HOME 58% 55% HOSPITAL 40% 1% TRIAGE 11% INPATIENT UNIT 6% RESIDENTIAL FACILITY 28% DID NOT MEET CRITERIA STABILIZATION UNIT
PROGRAM FLOWCHART DISCHARGE DISPOSITION (2015; N=423) OUTPATIENTS HOME 58% 55% 78% HOME HOSPITAL 40% 1% TRIAGE 11% INPATIENT UNIT 16% 4% HOSPITAL 6% RESIDENTIAL FACILITY 28% RESIDENTIAL FACILITY DID NOT MEET CRITERIA STABILIZATION UNIT
OUTLINE SETTING: DEMOGRAPHICS AND HEALTHCARE SYSTEM ORIGINS OF THE PROGRAM PROGRAM FLOWCHART CLINICAL-ACADEMIC SPECIALIZATION WITHIN THE PROGRAM CLINICAL EDUCATION ROLE
CLINICAL-ACADEMIC SPECIALIZATION NUMBER OF CLINICIANS FACILITATES (SUB-)SUBSPECIALIZATION CLINICAL RESEARCH: EXTENSION OF WELL-CHARACTERIZED PATIENT POPULATION COLLABORATION WITH UBC BASIC SCIENCE RESEARCHERS
CLINICAL-ACADEMIC SPECIALIZATION ACTIVE RESEARCH AREAS BEDSIDE NEUROCOGNITIVE ASSESSMENT INSTRUMENTS BNCA, RAM-T, PROSPEE, GAUTENG LIMBIC SURGERY PROGRAM OUTCOMES & DTI POST-ANT. CAPSULOTOMY NEUROGENETICS MAGERS MILD TBI OUTCOMES AND ADVANCED IMAGING POST-MTBI
CLINICAL-ACADEMIC SPECIALIZATION ACTIVE RESEARCH AREAS (CONT D) MOVEMENT DISORDERS PSYCHIATRIC ASPECTS OF PHARMACOTHERAPY & DBS SOMATOFORM DISORDERS OUTCOMES OF THERAPY MULTIPLE SCLEROSIS IMAGING CORRELATES OF NEUROCOGNITIVE DEFICITS
CLINICAL-ACADEMIC SPECIALIZATION ACTIVE RESEARCH AREAS (CONT D) EPILEPSY PROSPECTIVE DB (EMU ASSESSMENTS; COLOCATED CLINIC); COMORBIDITES; SURGERY; PNES TREATMENT CASEBOOK OF NEUROPSYCHIATRY
OUTLINE SETTING: DEMOGRAPHICS AND HEALTHCARE SYSTEM ORIGINS OF THE PROGRAM PROGRAM FLOWCHART CLINICAL-ACADEMIC SPECIALIZATION WITHIN THE PROGRAM CLINICAL EDUCATION ROLE
CLINICAL EDUCATION ROLE WEEKLY NEUROPSYCHIATRY GRAND ROUNDS Ø LOCAL, NATIONAL AND INTERNATIONAL INVITED SPEAKERS Ø BROADCAST VIA TELECONFERENCING TO 20 SITES IN BRITISH COLUMBIA AND ALBERTA WEEKLY NEURORADIOLOGY ROUNDS ONE HOUR DEDICATED TO NEUROPSYCHIATRY CASES WEEKLY NEUROSCIENCES GRAND ROUNDS NEUROPSYCHIATRY ROUNDS VIA TELECONFERENCING WITH SOUTH AFRICAN NEUROPSYCHIATRY GROUP
CLINICAL EDUCATION ROLE UBC FACULTY OF MEDICINE TEACHING 3 RD YEAR NEUROLOGY RESIDENTS (CORE ROTATION) 4 TH AND 5 TH YEAR PSYCHIATRY RESIDENTS (ELECTIVE) MEDICAL STUDENTS (ELECTIVE) HOSTING VISITING TRAINEES AND CLINICIANS INTERPROVINCIALLY AND INTERNATIONALLY
CLINICAL EDUCATION ROLE TWO YEAR NEUROPSYCHIATRY FELLOWSHIP ACCREDITED BY UCNS ucns.org 2016
CLINICAL EDUCATION ROLE TWO YEAR NEUROPSYCHIATRY FELLOWSHIP Ø CLINICAL FELLOWSHIP Ø OPEN TO PSYCHIATRISTS AND NEUROLOGISTS Ø CLINICAL SUPERVISION & DIDACTIC PROGRAM OF LECTURES EVERY OTHER WEEK COVERING UCNS CURRICULUM
CLINICAL EDUCATION ROLE TWO YEAR NEUROPSYCHIATRY FELLOWSHIP Ø FIRST YEAR (NEUROLOGY) GENERAL NEUROLOGY WARD (+ CALL DUTIES) STROKE UNIT (+ CALL DUTIES) NEUROLOGY CONSULTATION SERVICE (+ CALL DUTIES) SEIZURE INVESTIGATION UNIT NEUROLOGY AMBULATORY CLINICS NEURORADIOLOGY NEUROLOGICAL REHABILITATION NEUROANATOMY TEACHING ASSISTANT
CLINICAL EDUCATION ROLE TWO YEAR NEUROPSYCHIATRY FELLOWSHIP Ø SECOND YEAR INPATIENT NEUROPSYCHIATRY WARD OUTPATIENT NEUROPSYCHIATRY CLINICS
CLINICAL EDUCATION ROLE TWO YEAR NEUROPSYCHIATRY FELLOWSHIP Ø ALUMNI INCLUDE 7 NEUROPSYCHIATRISTS RETAINED AS CONSULTANTS 2 NEUROPSYCHIATRISTS IN CALGARY, ALBERTA 1 NEUROPSYCHIATRIST IN SINGAPORE
THE BRITISH COLUMBIA NEUROPSYCHIATRY PROGRAM www.bcnp.ca Professor Trevor Hurwitz t.hurwitz@ubc.ca Dr. Islam Hassan islam.hassan@vch.ca