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Better understanding of philosophical differences and collaborative planning and service delivery may foster shared approaches in CAMHS and AMHS to better meet the needs of transitioning youth.

Youth shifting to adult mental health services often report experiencing frustrations with accessing care that adequately replaces the youth services they had received. This systematic review assesses the peer reviewed evidence on services/programs aimed at addressing youth to adult transitions in mental health services. Findings suggest little data exists on the effectiveness of transition services/programs. While the available evidence supports meetings between youth and youth caseworkers prior to transitions occurring, it also verifies that this is not common practice. Other identified barriers to effective transitions were categorized as logistical (ineffective system communication), organizational (negative incentives), and related to clinical governance.

Objectives Information and communication technology is often lauded as the key to enhancing communication among health care providers. However, its impact on interprofessional collaboration is unclear. The objective of this study was to determine the extent to which it improves communication and, subsequently, enhances interprofessional collaboration in chronic disease management. Methods A systematic review of academic literature using two electronic platforms: HealthSTAR and Web of Science (core collection and MEDLINE). To be eligible for inclusion in the review, articles needed to be peer-reviewed; accessible in English and focused on how technology supports, or might support, collaboration (through enhanced communication) in chronic disease management. Studies were assessed for quality and a narrative synthesis conducted. Results The searches identified 289 articles of which six were included in the final analysis (three used qualitative methods, two were descriptive and one used mixed methods). Various forms of information and communication technology were described including electronic health records, online communities/learning resources and telehealth/telecare. Three themes emerged from the studies that may provide insights into how communication that facilitates collaboration in chronic disease management might be enhanced: professional conflict, collective engagement and continuous learning. Conclusions The success of technology in enhancing collaboration for chronic disease management depends upon supporting the social relationships and organization in which the technology will be placed. Decision-makers should take into account and work toward balancing the impact of technology together with the professional and cultural characteristics of health care teams.

BackgroundReducing monies spent on unnecessary medical care is one possible target to improve value in healthcare systems. Regional variation in the provision of medical care suggests physician behaviour and patient demands influence the provision of unnecessary medical care. Recently, Choosing Wisely campaigns began using ‘top 5 do-not-do’ lists to target unnecessary medical care by encouraging greater physician and patient dialogue at the point of care. The present study aims to examine the rationale for Choosing Wisely Canada’s (CWC) design and to analyse physician perceptions regarding the features of CWC aimed to reduce unnecessary medical care.MethodsThe study involved semi-structured interviews with 19 key informant physicians with CWC experience and the application of procedures of grounded theory to analyse interview transcripts and develop explanations addressing the objectives.ResultsParticipants reported that the CWC was the medical community’s response to three pressures, namely (1) demand for unnecessary medical care from patients during the clinical encounter; (2) public perception that physicians do not always prioritise patients’ needs; and (3) ‘blunt’ government tools aimed to reduce costs rather than improving patient care. Respondents stated that involving the patient in decision-making would help alleviate these pressures by promoting the clinical encounter as the paramount decision-point in achieving necessary care. However, CWC does not address several of the key reasons, from a physician perspective, for providing unnecessary medical care, including time pressures in the clinical encounter, uncertainty about the optimal care pathway and fear of litigation.ConclusionThis study contributes to our understanding of the perceptions of physicians regarding the CWC campaign. Specifically, physicians believe that CWC does little to address the clinical reasons for unnecessary medical care. Ultimately, because CWC has limited impact on physician behaviour or patient expectations, it is unlikely to have a major influence on unnecessary medical care.