Mental health case conferences in primary care: content and treatment decision making

Case conferences are multidisciplinary meetings of health professionals to plan treatment for specific people with chronic and complex care needs. The value of multidisciplinary teamwork in mental health care is well recognized.

This study aimed to explore the process of decision making in mental health case conferences involving community pharmacists and primary care physicians.

Case conferences were conducted for 44 people receiving one or more medicines for a mental illness. Before participating in the case conferences, pharmacists conducted home visits and produced written reports that detailed Home Medicines Review findings and recommendations. The case conferences were audio taped and transcribed verbatim. A framework, based on the 3 components of decision making (derived from the Model of Shared Decision Making), was used to code statements made at the case conferences. These components were (1) information exchange, (2) deliberation, and (3) decision making.

Pharmacists and physicians exchanged personal and medical information. Pharmacists presented their treatment findings and recommendations, and generally a brief discussion about treatment options followed (deliberation). The responsibility for deciding which treatments to implement (decision) typically remained with the physicians.

The case conferences provided an opportunity for pharmacists and physicians to share information and discuss treatment options. Responsibility for deciding which treatment to implement generally remained with the primary care physicians.