In this Issue:
- Nurse Practitioner Scope of Practice Changes
- Ontario Cervical Screening Program Recommendations
- Screening Activity Report
- Continuing Professional Development Modules
- Cancer Screening Initiatives in Teams
- Upcoming Webinar
Nurse Practitioner Scope of Practice Changes
Content below developed by Ontario Health
The Ontario Breast Screening Program (OBSP) and the Ontario Lung Screening Program (OLSP) are pleased about amendments to Regulation 543 under the Healing Arts Radiation and Protection Act and Regulation 107/96 under the Regulated Health Professions Act, 1991, which will allow nurse practitioners (NPs) to order computed tomography and magnetic resonance imaging scans as of July 1, 2022.
As of July 1, 2022, NPs will be able to:
- Refer individuals to the High Risk OBSP. The updated referral form will be available on July 1st and can be found here.
- Manage unattached OBSP participants with abnormal results.
- Authorize OBSP sites to arrange all assessment tests required for OBSP participants.
- Refer individuals to the OLSP. The updated referral form can be found here.
NPs are still able to provide colonoscopy referrals for the ColonCancerCheck program. Ontario Health helps people with an abnormal fecal immunochemical test (FIT) result who don’t have a primary care provider find a provider to refer them for a follow up colonoscopy. If an NP would like to put their name on the Ontario Health list to support unattached patients with abnormal FIT results, they can complete the CCC Attachment form found here.
Further information about the OBSP can be found here in English and French.
Further information about the OLSP can be found here in English and French.
Ontario Cervical Screening Program (OCSP) Recommendations
Content below developed by Ontario Health
The OCSP now formally recommends that people with the following cervical screening results repeat their cytology test in 12 months instead of in 6 months:
- A first time low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASCUS) result
- An LSIL or ASCUS result followed by a normal result
The OCSP originally released these evidence-based recommendations to support the gradual resumption of cervical screening services during COVID-19. We are now formalizing the change to our screening recommendations. Please see the fulsome screening recommendation summary that can be found here. For evidence to support this recommendation, please see: www.cancercareontario.ca/repeatcytologyinterval
Ontario Health is working with Ontario labs that provide cervical screening testing to update the relevant cytology result reports, so they reflect this recommendation change. Please reach out to cancerinfo@ontariohealth.ca if you have any questions.
Screening Activity Report
Content below developed by Ontario Health
The Screening Activity Report (SAR) is an electronic audit and feedback tool for patient enrolment model (PEM) physicians. The SAR supports PEM physicians with improving screening participation and follow-up rates for Ontario’s three organized screening programs:
- Ontario Breast Screening Program (OBSP)
- Ontario Cervical Screening Program (OCSP)
- ColonCancerCheck (CCC)
Information and tools to support using the SAR can be found on: cancercareontario.ca/SAR
Continuing Professional Development (CPD) Modules
Content below developed by Ontario Health
The following cancer screening Continuing Professional Development (CPD) modules are available for providers:
- Fecal Immunochemical Test (FIT): A Non-Invasive Test for Colorectal Cancer (CRC) Screening
- Abnormal Fecal Immunochemical Test (FIT) Follow-Up and Surveillance
- Lung Cancer Screening for People at High Risk (for applicable providers)
Each module has been certified by the College of Family Physicians of Canada for 1 Mainpro+ Group Learning credit. If you are interested in a presentation of these new modules, please contact your Regional Cancer Program or your Regional Primary Care Lead. Information about the Regional Cancer Programs can be found here.
Cancer Screening Initiatives in Teams
Preventative Care Text Reminders at Marathon Family Health Team
Content below developed by Marathon Family Health Team
Text reminders have been used for over 2 years at Marathon FHT to remind consenting patients the day before a scheduled clinic appointment. Aside from a small percentage of cell phone numbers being no longer valid when reminders are sent, the process has been going smoothly and reduced the administrative time needed to make reminder calls.
Given the success with general appointment reminders, in 2021 the team looked to expand the text reminder system to preventative care recall. In the fall of 2021, it was used first to notify patients aged 65+ of flu shot clinics. Then in December 2021, the first set of text reminders was sent out to 31 patients due or overdue for Pap testing. While the uptake from flu shot reminders has not been tracked, 7 (22.6%) of the patients receiving Pap reminders contacted the clinic within 2 weeks to book a Pap. Text reminders have also been successful in encouraging patients due for mammograms to book appointments with the Screen for Life Coach; last spring the booking staff for the coach confirmed that several patients called for appointments following the text reminder notifications of upcoming visits of the coach to our rural northern community.
In all cases, the reminders are short and offer the option to opt out of preventative care reminders while retaining the usual clinic appointment reminders. Staff ensure that patient cell phone numbers are recorded in the cell phone field in the EMR (OSCAR) and consent for reminders is recorded in a previously unused demographic field now named “SMS consent”. Patients opting out of specific preventative care reminders have that recorded under the specific prevention as “never remind”.
Sample messages are as follows:
MFHT Pap reminder: Email appointments@mfht.org or call 807-229-3243 to book a Pap. To opt out of Pap reminders CALL the clinic 807-229-3243
MFHT reminder: Screen for Life Coach in Marathon June/Sep call 1-800-461-7031 to book a mammogram. To opt out of mammogram reminders CALL the clinic 807-229-3243
To learn more about this initiative please contact Margaret Cousins at mcousins@mfht.ca.
Portal Messages at West Carleton Family Health Team
Content below developed by West Carleton Family Health Team
West Carleton FHT utilizes population health methods, namely EMR reminders, the newsletter and portal messages (note that 72% of patients at this FHT are registered on the portal) to inform patients that they are (or may be) (over)due and how to book/request the test. For the portal specifically, the health promoter runs a search to pull the list of eligible patients that are due then sends a mass portal message. Here is the response rate by cancer screening program:
- For the FIT, over the last 2 times the portal messages were sent, 20.7% of the patients receiving those messages requested the test (370 requests out of 1,791 messages).
- For Paps, the portal messages are staggered until the pap clinic slots are filled. During the latest pap clinic, 20.8% of the patients that received a message booked an appointment on the portal (49 appointments booked online out of 236 messages).
- For mammography, over the last 2 times the portal messages were sent, the rate of messages read was 78.7% after 3 weeks and 52.4% after 2 weeks respectively (708 and 418 messages sent respectively).
To learn more about this initiative please contact Charles Bruntz at charles.bruntz@esfam.ca.
Email Communications to Engage Patients
Content below developed by Southlake Academic Family Health Team
Southlake Academic Family Health Team has made tremendous strides in the digital era produced by COVID-19. They have seen that email communication has been a very effective strategy to engage patients and provide them with important updates related to their health. Adapting successes from their vaccination clinics, the team is emailing education materials and newsletters to patients who are overdue for cervical cancer screening using resources from CognisantMD Ocean portal, AFHTO, Cancer Care Ontario, clinicians, and peers. These emails include a direct link to book appointments online with their providers for a Pap test. Based on past experiences, the team expects about 50% engagement from the email campaign, with 10-30% of these patients self-initiating an appointment with the team.
To learn more about this initiative please contact Peter Nguyen at pnguyen@southlakeregional.org.
Content below developed by New Vision Family Health Team
New Vision Family Health Team is actively emailing patients who have email addresses that they are due and providing them a link to book online with the NP during NP clinics. During Pap visits the team ensures that patients due for mammograms or FIT/colonoscopies are being provided requisitions or requisitions are being sent at that time. The team is actively tracking these conversations within the Pap stamp and utilizing the patient newsletter to remind patients of these screenings, letting them know they will receive a letter in the mail and need to contact the clinic to set up their appointment.
To learn more about this initiative please contact Desirée DeMelo at desiree@newvisionhealth.ca.
Cancer Screening Queries
To assist teams in pulling a list of up-to-date screening-eligible patients, the QI in PC Council members have put together a few queries. Please note, these queries are designed as a starter point to be customized according to your team’s EMR and needs. They can be found here.
Upcoming Webinar
Advancing Equity in Cancer Screening for Gender-Diverse Clients
June 17 from 12:30-1:30 pm
New, gender-affirming cancer screening guidelines have been developed to support the health and wellbeing of Transgender and Non-Binary clients. Research shows that these populations have lower than average screening rates because outreach efforts often miss eligible clients; screening practices that can trigger gender dysphoria; and many clinicians experience confusion about who is eligible for cervical and breast screening. Join us on Friday, June 17, from 12:30-1:30pm for a special lunch ‘n’ learn webinar with guests from Ontario Health and Alliance member organizations to learn about the new guidelines and how the Alliance is helping to update data standards. Register here.
In Case You Missed It: Check out eBulletin #117 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
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