H10 – Physician-led Cognitive Behaviour Therapy Groups Rapidly Increase Accessibility to Skills Training in Primary Care and are Successfully Delivered through Telehealth

Summary

Family physicians were trained by psychiatrists to deliver manualized 8-week Cognitive Behaviour Therapy-based skills groups, addressing the unmet need for an early intervention for people with depression and anxiety. This innovation was made possible by group medical visit fee codes, partnerships, and funding by the Doctors of BC and Ministry of Health that brought family physicians and psychiatrists together to develop materials, plan evaluation, and design a training system. The program served over 5100 patients with in-person groups from 2015-2019 in large urban centres in BC, Canada, with up to 34 groups running in a given month, by 19 physicians. A centralized referral centre was the key to a lean, economically sustainable administrative structure. It increased participant acceptability as they could choose between an array of group offerings. In 2018, a non-profit society was formed to administrate the program, financially sustained through physician overhead payments, no-show fees, and the Health Authority funding an administrative assistant. When the COVID19 pandemic began in 2020, the team pivoted to telehealth. Virtual groups were offered within a week, and a comparable-sized program resumed within 3 months. Quality improvement data indicated patient improvements and satisfaction ratings comparable to those obtained with in-person groups. Many patients reported that the telehealth format was preferred or made the groups accessible for the first time. Key drivers that enabled the adaptation were political will to create telehealth fee codes, brief technological skills training for facilitators and patients, and slight modification of materials. Virtual groups have vastly extended accessibility and contribute to equitability, as patients from across BC can now attend groups with an established facilitator. Physician facilitators can be trained across the province. Virtual groups will now be sustained as part of the ongoing program, post-pandemic.