Ultimate Blogging Championship

Year: 2011

  • Atikokan FHT and the Falls Prevention Team

    Atikokan — Two years in, the Atikokan Falls Prevention Team has proven its value – so much so, the team plans to stay together, and continue helping seniors maintain the quality of their lives. “There isn’t another program in the region like this,” said occupational therapist Amanda Dickson, the team leader. “It would be pretty rare to get the professionals we have to be able to work so closely together on a team. In a small town, we are able to do that.” Originally, the group was one of 33 community-based fall prevention teams funded for two years by the Northwest LHIN and St. Joseph’s Care Group. They were formed to address falls in long term care homes. But here, that model quickly expanded to include community members through in-home assessments, with the goal of helping seniors stay in their own homes as long as possible. That mobile team component, combined with the seamless approach of sharing information and resources made Atikokan unique in the NW LHIN region. When the team’s two-year funding wrapped up last month, members decided to keep it going. The team includes Cathe Hoszowski, counsellor Bob Botham, RN Keira Lacosse, dietician Kira Schan, (all from the Family Health Team), seniors’ counsellor Patricia Dunnett, Home Support coordinator Brenda Wood, pharmacist Earle Arnold, ComCare’s Phyllis Mosley, and Extended Care Wing (ECW) program coordinator Tanis Hampshire. Home visits The team looks at a broad range of health and environmental issues which can contribute to frailty and falls, with the goal of supporting independent living. That can mean relatively simple measures such as providing special footwear, eye wear, or double-sided tape to secure rugs and carpets, to improving lighting and installing hand rails. The group also addresses more complex matters: identifying balance issues caused by improper medication use, lack of balance or muscle tone, poor nutrition, or even depression. Doing all of that is fairly easy in an extended care facility, where many health professionals work in close proximity. But it has been reaching out to the community – seeing seniors in their homes, where half of all serious falls occur – that has proven valuable here. Reaching out makes sense: 50% of falls occur in the home, and seniors now make up almost a third of Atikokan’s population. Family Health Team RN Keira Lacosse said without the home visits, critical health issues may otherwise go undetected until a fall actually occurs. The visits have also been eye-opening for physicians, who may not be aware of contributing factors that can affect the overall health picture of their patient. “A lot of older people in town don’t have supports and they may have some depression or are just very isolated [and not taking proper care of their health], so it’s good for them to have someone checking in.” Adds counsellor Bob Botham: “You’re there to identify fall risks but because of your profession, you’re also noticing [other health risks], and that’s where referrals come from.” (Clients sign a form that allows the team to share information and referrals among health professionals). Lacosse will provide some preventative materials on the first visit (such as double-sided tape and nightlights) and provides information on other in-town services (such as Home Support for meals or grocery shopping services, emergency response bracelets, and blister packs to keep medications organized and easy to open). Typically, she then refers clients to Dickson, who conducts a home assessment and recommends equipment or exercises to improve safety. If necessary, the client may also be referred to a dietitian, counsellor and physician, or encouraged to sign up for home care services. Botham conducts follow-up visits to see how effectively those measures are being implemented, and if the situation is improving. These visits suggest risk factors have been reduced by 41%. Many seniors living in their homes have some fear that admitting a fall to a health professional or family member can mean ending up being put in long-term care; in fact, that is the opposite of the team’s goal, said Botham. “The goal is to keep them in their homes, and as healthy as possible,” he said. And there are many inspiring examples of seniors living in their homes in their later years, with a little help, noted Hoszowski, who cited the example of a 92-year-old friend who has used the recommendations of the team to reduce risks of falls in her home. Brenda Wood (Home Support) estimates the number of seniors using the emergency response bracelets has doubled since the team began doing assessments. Patricia Dunnett (Community Counselling) said that while some may initially feel embarrassed to need certain devices as they age, “if they see their friend [has an emergency response bracelet] then it becomes okay to do this.” The team has compiled a wealth of information on accessing services and assistive devices including coupons and reduced payment plans available for low-income seniors. Botham added that they are also working on a list of contractors who are available for home upgrades and equipment installations. Dunnett said that while seniors on fixed incomes may be reluctant to pay for certain items, it helps to realize that with an initial, and usually affordable, cost, they might be able to keep their independence much longer. With some funds from Northwest LHIN, and a donation from the seniors’ forum, the team has been able to make night lights, mats, special tape and other devices available free to clients. The team anticipates keeping their services going indefinitely; basically, communication is free, and just practical. Botham credits the “openness of our employers and the community, who realized that this would a benefit to everybody because we’re doing [these functions] anyways, so sharing our expertise and sharing the workload between us all just really made sense.” SAGES An example of pooling resources was the recent eight-week SAGES (Safe and Gentle Exercises for Seniors) program the team hosted in February which brought both ECW and community residents together four weekly sessions held each at the ECW or the Pioneer Centre. Up to a dozen seniors learned strengthening and balancing exercises from ANFC fitness instructor Shanna Brewster. (“They were doing sitting Tai Chi at the start and by the end of four weeks they were doing modified aerobics,” said Dunnett.), and heard special presentations on a range of health topics such as nutrition (by Schan) and safe medication use by Arnold. The program reunited some old friends from both ECW and the community, “and had a secondary benefit of getting them out and socializing with members of their community, especially for the higher functioning seniors,” noted Dickson. The team plans to run the SAGES program again, soon. By Jessica Smith, Atikokan Progress, May 3, 2011

  • Doctor from The Ottawa Hospital FHT uses web to cut wait-times to see specialists

    OTTAWA — An Ottawa family doctor has pioneered a simple way to bypass the lengthy delays that patients often face when they are referred to medical specialists. Using a web-based tool to make contact with high-demand specialists such as dermatologists and endocrinologists, Dr. Clare Liddy said she is able to get her patients faster access to medical advice. In many cases, her system of electronic consultations eliminates the need for patients to visit the specialist in person. In cases requiring follow-up, specialists either request more patient information, order diagnostic tests, or determine that the patient needs to be seen. Since she started using e-consultations 16 months ago, Liddy said she has cut her patients’ waits for specialists from as long as 12 months to one week. The web-based tool is secure enough to safeguard patient information and is accessible to all physicians through a website hosted by the Champlain Local Health Integration Network, eastern Ontario’s health authority. The tool is available provincewide through other regional LHINs, meaning family physicians across the province could easily set up similar e-consultation networks, said Liddy. Family physicians simply log on to the system, fill out an electronic form outlining their patients’ complaints, then send the document to a specialist who belongs to the e-consultation network. The specialists usually respond within a week. Liddy, who works at The Ottawa Hospital’s Riverside Family Health Team, described the case of a recent patient who showed up at her clinic with a mysterious rash. Instead of making a traditional referral to a dermatologist, which would have resulted in a 12-month wait, Liddy sought a specialist’s advice using e-consult. She even took a digital photo of the rash and included it in her documentation. The tool is particularly useful for patients who live in remote areas with few specialists. “Many of those patients have to make a trip to Ottawa. If you can avoid unnecessary specialist visits, that is beneficial to the patient,” Liddy told a meeting Wednesday of the Champlain LHIN. The test project was started with a $110,000 grant from The Ottawa Hospital Academic Medical Organization, which covered consultation fees for the specialists who participated. To date, 40 physicians, including some in Deep River and Winchester, have participated in Liddy’s project. She hopes that as more family physicians use the tool, changes will be made to the Ontario Health Insurance Plan to allow specialists to bill for the services they provide through e-consultations. By Pauline Tam, The Ottawa Citizen April 28, 2011 3:45 PM

    © Copyright (c) The Ottawa Citizen

  • FHT Funding Agreements: MOHLTC to distribute revised documents this week

    AFHTO has been working with the Ministry of Health and Long-Term Care and the Ontario Medical Association (OMA) to address concerns regarding the new FHT Funding Agreement templates. FHT Leads should be receiving from the Ministry, prior to the April 29 sign-back date, a revised agreement that addresses our key concerns with these templates. For those FHTs that requested an exemption to the requirement that “all positions funded pursuant to this Agreement shall be employees of the Recipient unless the Ministry has provided its written consent”, you will receive a separate exemption agreement. The Ministry continues to encourage all FHTs to strive to meet this goal; however, the exemption agreement gives greater flexibility regarding FHT staffing arrangements while upholding the Government of Ontario’s risk management needs. Note that the exemption agreement lists a few “as applicable” requirements. If your FHT has a concern with any of these “as applicable” requirements, you may wish to seek clarification from your Ministry consultant to determine whether they are in fact “applicable” in your case. The template agreements for all Physician-Sponsored and Mixed Governance FHTs have been revised to address the concerns regarding governance, liability and communications. AFHTO and the OMA would like to recognize the Ministry’s willingness to make these revisions to address the concerns raised by FHTs. As with any contract, each FHT is advised to carefully review the new agreement and to discuss any ongoing concerns with appropriate legal counsel and their Ministry consultant.

  • FHT Funding Agreements: deadline extended to April 29, 2011

    Ministry staff are distributing today (April 15) a memo from Phil Graham announcing the sign-back deadline is extended to April 29, 2011.   The memo reads:
     
    I would like to thank all those Family Health Teams who have reviewed the new FA and articulated their issues and concerns to the ministry and those who have signed back. The ministry has reviewed the issues raised and is working with the Ontario Medical Association (OMA), Association of Family Health Teams of Ontario (AFHTO) and the Association of Ontario Health Centres (AOHC) in an effort to address the issues that are common across FHTs.
    In light of this on-going work and in an effort to arrive at optimal solutions to the issues identified, the ministry is extending the deadline for sign-back from the previous extension date of April 15, 2011 to April 29, 2011. Although the ministry will consider a further extension should further review and discussion be required, all FHTs are encouraged to expedite the process of review and sign-back once the ministry provides responses to the issues identified, expected shortly. Any changes or amendments made will also be shared with FHTs that have already signed back their FA.
    Thank you for your attention to this and I look forward to addressing these issues cooperatively so we can continue to support the delivery of quality, interdisciplinary care to Ontarians.

  • FHT Funding Agreements: update on the “employee requirement”

    AFHTO has learned the Ministry is working on a framework for granting exceptions to the “employee requirement” that appears in all Funding Agreements. They expect the draft to be completed in the next few weeks. AFHTO was told that, at minimum, we would get advance notice of the content of this framework. AFHTO continues to request the opportunity to review and give feedback on the draft framework for exceptions so that problems can be identified and solved before the Agreements move into implementation. AFHTO has a very successful track record in this regard, given past work in pulling together working groups from member FHTs to give constructive feedback and attempt to solve problems with the Ministry on such issues as the move to 5-year funding, NP-SERT and the new smoking cessation program. AFHTO first notified FHTs about the potential problem with the “employee requirement” clause on March 25, and survey results indicated this would pose significant implementation challenges for many FHTs. As noted in that March 25 e-mail, the “employee requirement” was introduced with the intent to meet a government-wide directive from Ministry of Government Services (MGS) implemented last September for all transfer payment agencies. In the last few days AFHTO has discussed these concerns with the Minister’s Office (MO) and the Ontario Medical Association (OMA). We welcomed news that the MO is working with the FHT Unit and MGS to find reasonable and workable solutions to fulfil the intended purpose of the directive while minimizing the risk of destabilizing staffing arrangements and service delivery in FHTs. The OMA shares AFHTO’s concerns, and our two organizations are working collaboratively in seeking solutions. In the meantime AFHTO has learned that some FHTs have yet to receive an extension date for signing their Agreement.  Other FHTs have received a response to their specific problems in implementing the “employee requirement” with a message that says, “The Ministry realizes that there may be isolated circumstances where exemptions will require consideration. … The ministry is not encouraging exceptions and very rarely will approve unless extreme circumstances.” AFHTO continues to recommend to those FHTs who have not yet signed the Agreement:

    • Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation.
    • If the “employee requirement” poses problems for your FHT, wait to see the Ministry’s framework for granting exceptions.
    • Continue to work with your Ministry consultant to seek clarification on other issues affecting your FHT.
    • Seek legal advice as needed to deal with your FHT’s unique situation.
    • Please continue to keep AFHTO in the loop. AFHTO remains ready to gather FHT opinions, coordinate discussion, and facilitate resolution of issues that are common among FHTs.

  • FHT Funding Agreements: update on Ministry’s new deadline

    AFHTO has learned that all FHTs who requested an extended deadline to sign their Funding Agreement have received it. For some FHTs the new deadline is Friday, April 8, and others have until Friday, April 15. The FHT Unit has told AFHTO it will work with each FHT individually to resolve the issues the FHT has raised.  While the common issues were reiterated, the Ministry’s view is that each FHT’s needs and issues are unique, and each FHT has been given funding in their budget for legal assistance to help them with this. Each FHT does have unique circumstances. Some are sufficiently satisfied and have signed the agreement. Others have copied AFHTO on their letters to the Ministry specifying their FHT’s concerns. For those FHTs who have not yet signed, AFHTO suggests you:

    • Continue to work with your Ministry consultant to seek clarification.
    • Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation.
    • Seek legal advice as needed to deal with your FHT’s unique situation.

    AFHTO is continuing to monitor progress and to seek advice on the unresolved issues. We sincerely hope that all FHTs will find workable solutions; however, if your FHT should find itself reaching an impasse, please keep us informed. AFHTO remains ready to gather FHT opinions, coordinate discussion, and facilitate resolution of issues that are common among FHTs.

  • South East Toronto FHT’s Virtual Ward

    Virtual wards are a model pioneered in England. They use the systems, staffing and daily routine of a hospital ward to provide case management to patients in the community but without the walls of the hospital. Patients who are admitted to the SETFHT Virtual Ward receive post-hospital discharge follow-up and interventions by a team of health care professional under the supervision of a physician. Interventions include daily phone calls to provide medical management in consultation with the family physician along with educating the patient on their specific chronic disease management and self-management. As well, there will be coordination of additional health care services as required within both the SETFHT team and to community supports. Electronic monitoring of vital signs may also be included for those with COPD, CHF or Diabetes. Target Population Virtual wards are an appropriate form of post-discharge care for patients who are considered to be at high risk of readmission, according to the LACE index. The patients in SETFHT’s virtual ward are highly complex seniors – average age is 82.1 years old with an average LACE score of 12.5. The SETFHT Virtual Ward uses remote monitoring technology provided by Ontario Telemedicine Network (OTN). They are helping lay the groundwork for a new model of primary care in Ontario, one that ensures both quality and value and results in the best possible outcomes for patients. Evaluation data is being collected, and the patients are very happy with the care. Click here to view SETFHT’s virtual ward patient brochure.

  • FHT Funding Agreements: OMA’s legal review / up dates

    AFHTO has just received a copy of a review by OMA legal counsel of the FHT Funding Agreement – Physician Sponsored template.  This is posted on the OMA’s members-only website or click here to view. Some comments in the review apply to the Mixed Governance and Community Sponsored templates as well, and so this is being forwarded as a service to all FHT leaders.  The assessment of risk and liability issues may be the most pertinent for other models. AFHTO’s ED has followed up with the Ministry regarding the “employee” and the “governance” issues outlined in the March 28 e-mail below. The fact that these are issues for a large number of FHTs has been acknowledged, as has the need for a collective approach to finding workable solutions in the best interest of all. Thank you to the 62 FHTs who responded to the survey – the results were instrumental in getting the Ministry’s attention.   Please remember to e-mail a copy of your response letter to the Ministry to angie.heydon@afhto.ca , and thank you the FHTs who have done so already. These are very valuable to have for reference in our follow-up with the Ministry on the Funding Agreement.

  • Provincial budget stays the course for FHT funding for 2011-12

    This is a review of the what the Ontario provincial budget means for FHTs, prepared for the benefit of AFHTO members. The good news for FHTs is government’s commitment to “protect education and health care”. In documenting its record in office, creation of 200 FHTs are once again mentioned as one of the key achievements in “Better Access to Primary Care” (pages 97-98). New investments are announced to invest in a Mental Health and Addiction Strategy – starting with children and youth, enhancing the MedsCheck program, expanding breast screening for high-risk women aged 30-49, increasing funding for long-term care and community-based support to free up hospital beds, and a 1.5% increase to hospital base funding. There was no announcement of additional funding for delivery of primary care services.  There is simply the statement “More than $300 million is invested annually to support Ontario’s FHTs” (page 98). The “Managing Responsibly” section of the budget lists measures to reduce waste, eliminate duplication, strengthen oversight and find more savings. While the measures mostly focus on the public service and government agencies, as transfer payment agencies, FHTs could expect to see tightening of controls. (FHTs are already beginning to experience this with the current Funding Agreement templates.) Pages 107 – 110 point to action to manage health care costs. It states, “The government’s focus now is to manage the rate of growth in health spending to a sustainable level, while protecting front-line service delivery of quality care. In the 2010 Budget, the government set a goal of holding annual health sector spending increases to three per cent by 2012–13.The government is on track to meet this target and to maintain this rate of growth into 2013–14 after accounting for time-limited investments. It is doing so by introducing reforms that focus on providing services supported by evidence, improving quality and accountability in the sector, and increasing the value of investments in the health care system.” Government will also establish the Commission on Broader Public Sector Reform, chaired by economist Don Drummond, to examine long-term, fundamental changes to the way government works. The Commission is to report “in time to inform the development of the 2012 Budget. The Commission will not make recommendations that would increase taxes or lead to the privatization of health care or education”. Given that Mr. Drummond was co-author of a highly-publicized report called “Charting A Path To Sustainable Health Care In Ontario”, the recommendations could touch on how publicly-funded health care is organized. Full text of the budget is available at – http://www.fin.gov.on.ca/en/budget/ontariobudgets/2011/papers_all.pdf

  • FHT Funding Agreements: recommendations for your FHT’s consideration

    The Ministry template for FHT Funding Agreements has serious implications for FHTs, therefore this message is being sent to all FHT leaders, AFHTO members and non-members alike.  This message follows up on an e-mail sent to all AFHTO members on March 25 and a related message sent to non-members on March 26. The AFHTO board of directors met this evening (March 27) to review the results of the membership survey on the Funding Agreement (53 responses since Saturday) and outcome of discussions today with Phil Graham, with two different lawyers working with FHTs on this issue, and with various FHT leaders. The key messages for all FHT leaders are: 1. Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation. Our survey results tell us over 60% of responding FHTs cannot meet the deadline. The Ministry’s FHT Unit has said it is looking for “best efforts for sign-back” and will consider requests for extensions, as long as the FHT is specific in identifying the additional issues that need to be addressed. 2. Review the problems with the template agreements listed below, and seek legal advice as needed to deal with your FHT’s unique situation. Our survey results show that the “all funded positions shall be employees” clause will create significant hardship for the majority of FHTs. Additional issues identified to date in the three template agreements (one for each of the three governance models) are identified below. 3. In a letter to your Ministry consultant, indicate very clearly the clauses in the Agreement that are of concern. In sending the letter, your FHT could append the signed Agreement, having first struck out and initialled all of the problematic clauses in the agreement. 4. E-mail a copy of your cover letter to AFHTO — angie.heydon@afhto.ca. AFHTO is ready to gather FHT opinions and coordinate discussion. Our goal is to facilitate resolution of issues that are common among FHTs. Concerns with the template agreements ·         “All funded positions shall be employees” clause: From the survey response, this is a problem affecting pharmacists in about 1/3 of responding FHTs, admin staff and social workers in about 1/4 of these FHTs, RNs and dieticians in 15% of these FHTS, and NPs in just under 10%. Among the 19 FHTs who reporting having psychologists, 11 FHTs would be challenged in converting them to employees.  Twenty-eight FHTs reported having mental health workers; 9 of these FHTs would have the same conversion challenge. AFHTO acknowledges that a government-wide directive on “transfer payment accountability” has led to inclusion of this clause, and that the clause allows for exceptions. From discussions Friday and today, it is clear that each requesting FHT will have to go to inordinate lengths to prove they cannot fill these positions with employees, and very few exceptions would be granted in the end.  While AFHTO believes it will be possible to find solutions that uphold government’s principles for transfer payment accountability, without jeopardizing patient care, the FHT Unit has indicated they are not prepared to discuss it further. ·         Governance problems in “Mixed Governance” and “Provider-led” templates: For Mixed Governance FHTs:  the requirements are highly prescriptive (and include some errors, e.g. a FHT cannot be a member of itself) and will generate costs to amend and implement the resulting bylaw changes. For Provider-led FHTs: their governance is undermined by the lack of any reference to the FHT board as the governors, and gives authority for the contract to the “Lead Physician and Associate Lead Physician as designated or redesignated under its Physician Services Contract”. ·         Other concerns to note: AFHTO members have also flagged concerns about: –          the process by which payment could be reduced or suspended –          the restrictive bands on compensation levels –          liabilities for the physician group if the FHT is wound up –          the requirement to consult with the Ministry before participating in media communications and publications. AFHTO will continue to work on behalf of members to identify and work to resolve common issues.  We will provide updates and share solutions with AFHTO members as they emerge. For those who are not yet members of AFHTO, this is an excellent time to join. Go to www.afhto.ca for more information.