2011 AFHTO conference presentation PRESENTER (S): Dave Sellers, Director of Operations; Dr. Mark Fraser, Lead Physician FHT/ORG: West Carleton FHT ABSTRACT: This presentation will describe how innovative approaches within the FHT IT infrastructure have been used to solve process issues and improve efficiencies and data quality. The quality of the data in your EMR has a direct impact on quality of care and your ability to identify care issues, promote self care and identify population care needs. The presenter will demonstrate approaches that have been used and the impact that they have made in the FHT using tools that you may already have and did not know it. This is a highly technical presentation; therefore you should have a good understanding of your current Information Technology Infrastructure and processes to glean the most from this presentation. This presentation is not specific to single vendors EMR. Click here to view presentation.
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Realizing Patient Goals
2011 AFHTO conference presentation PRESENTER (S): Andrea Petroff, BA Honours. Psych, M.I.R. (Masters of Industrial Relations), Executive Director; Claudia Mariano, NP-PHC, MSc Primary Health FHT/ORG: West Durham FHT ABSTRACT: Our commitment to our patients, our community, and to ourselves, to provide the best possible care for chronically ill patients, meant that we needed to take a cold, hard look at how we currently manage versus how we need to be managing this vulnerable patient population. Focusing first on patients with diabetes; we took a strategic approach to establishing FHT procedures and policies that can be easily applied in managing other chronic illness. These are the tactics we employed:
- Developed outcome and monitoring goals for all Type Two diabetic patients >18yrs
- EMR review of baseline patient statistics measured against goals set
- In-depth analysis of current resources, practice design, interprofessional collaboration and office efficiencies to identify gaps that jeopardized our goals
- Prioritized actions to address areas of concern and assigned personnel to lead change for improvement
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Walk to Wellness
2011 AFHTO conference presentation
PRESENTER (S): Heather Hadden, BSc Phm
FHT/ORG: Credit Valley FHT
ABSTRACT: The Credit Valley Family Health team works with many patients who have chronic disease states. These include but are not limited to Diabetes, COPD, Asthma, Hypertension, Obesity, Arthritis and Osteoporosis. Many of these patients do not lead an active lifestyle and do not meet the Canadian recommended requirements for daily activity. It was felt that having a weekly walking group would help to educate and motivate these patients to increase their daily activity. The “Walk to Wellness” program started with a selected group of patients with Diabetes. Our goals were not only to provide a 2-hour orientation on active lifestyle and then a weekly 1-hour activity session but also to help motivate the patient to do expand on their own. Goals included weight loss, decrease in BMI, decrease in waist circumference and also changes in FBS, HBA1C, Triglycerides, Cholesterol, LDL, HDL, and cholesterol ratio. To date the program has opened up to patients with COPD, Asthma, Obesity, Arthritis, Osteoporosis, CVD and addictions.
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Using Spirometry in Clinical Practice
2011 AFHTO conference presentation PRESENTER (S): Angie Shaw, RRT,CRE Respiratory Educator; Amy Massie, RRT, CRE Respiratory Educator FHT/ORG: New Vision FHT ABSTRACT: This workshop will assist Family Health Team members in utilizing spirometry as a valuable tool in various clinical settings. Case studies will be presented, worked and reviewed. There will be a brief review of spirometry interpretation principles. Participants will then have the opportunity to practice interpretations, and consider recommendations based on the case presentations. Upon completion of the workshop participants will be better able to use spirometry results as a valuable tool in diagnosis and treatment of obstructive/restrictive lung conditions, and have an improved understanding of what recommendations to make based on results from spirometry testing. Click here to view presentation.
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Self Management for Chronic Pain Patients
2011 AFHTO conference presentation PRESENTER (S): Shellie Buckley, RN FHT/ORG: Stratford FHT ABSTRACT: Self management is a fairly new, vogue term used in healthcare but does it really work for patients with chronic pain? The data collected at the Stratford Family Health Team over the past two years shows chronic pain patients will attend six week group sessions and will benefit not only at the time but continue to demonstrate positive effects weeks and months later. Following the standardized model of the Stanford Chronic Pain Self Management Program patients are supported and guided through a six week structured program. Each week patients learn and develop skills or tools to help them be competent and successful self managers. A collection of real patient case studies will be reviewed to demonstrate the benefit of self management for the patient with chronic pain. Click here to view presentation.
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Medical Directives and Team Development
2011 AFHTO conference presentation PRESENTER (S): Dr. Kimberly Wintemute, Medical Director; Dr. Jon Hunchuck, PharmD, Pharmacist FHT/ORG: North York FHT ABSTRACT: Maximizing access to care is an important primary care goal. Medical Directives are one tool for improving access. The workshop objectives will be: to become familiar with essential structural elements of medical directives; to identify clinical opportunities within your organization for the development of meaningful directives; to consider factors within your organization to assist with directive implementation; to write a sample directive that can be brought back to your organization; to leave with a number of sample directives that could be polished for your FHT. Click here to view presentation.
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From a Basic Hypertension Clinic to a Complex CV Clinic
2011 AFHTO conference presentation
PRESENTER (S): Shellie Buckley, RN; Jenny Carter, RN
FHT/ORG: Stratford FHT
ABSTRACT: Two years ago a basic hypertension clinic was designed and launched as a pilot, with two physician partners at the Stratford Family Health Team. Now, in 2011, we have a complex CV risk program that services over 3000 patients. Gradually, over the past 2 years we have partnered with several doctors and their office staff, we have been through the QIIP learning community for HTN, have added more equipment and grown to welcome another RN. Progress has been slow at times; data extraction and organization is sometimes painful. We are now past the point of basic BP checks and offer patients tools to prevent CV events, screening for hypertension and hyperlipidemia, management of blood pressure and cholesterol plus ongoing monitoring and support. We are continually looking for new ideas and strategies to reach and benefit our patients. The outcome data remains positive as do the patient comment
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FHTs in the Intelligent Community
2011 AFHTO conference presentation PRESENTER (S): Tim Iredale, Stratford Family Health Team; Paul West, Rhyzome Networks FHT/ORG: Stratford FHT ABSTRACT: The Stratford FHT is located in a city that is one of the Top 7 Intelligent Communities of 2011. The Stratford FHT has partnered with Rhyzome Networks to improve its IT infrastructure which has resulted in better access to our EMR and improved FHT collaboration. Rhyzome Networks offers 60 kms of fiber optics which supports a city wide mesh WiFi. This improved IT infrastructure has provided consistent and redundant connectivity and capacity for IP based voice and data communications between offices. The Stratford FHT receives results electronically into our EMR within minutes of them being posted at our local Hospital as a result of this intrastructure. Physicians can access our EMR securely from a WiFi enabled device anywhere within the City of Stratford. The next step is a patient portal made available through the city wide WiFi to any Stratford FHT patient regardless of economics. Click here to view presentation.
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Coaching Health Self-Management
2011 AFHTO conference presentation PRESENTER (S): Durhane Wong-Rieger, PhD FHT/ORG: Institute for Optimizing Health Outcomes ABSTRACT: This workshop provides an introduction to Health Coaching for Patient Self-Management. Case studies and brief demonstrations/role plays will be used. After participating in this program, participants will be able to:
- Define the role of self-management in promoting treatment adherence and health behaviour change
- Identify the knowledge and skills patients learn as self-managers
- Know five-stage model of health coaching and concepts that support self-management
- Know principles of motivational interviewing and stages of change
- Identify the roles of healthcare professionals in facilitating patient self- management
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Summerville Arthritis Program
2011 AFHTO conference presentation PRESENTER (S): Lucy Bonanno, Executive Director; Nadya Zukowski, Health Promotion Specialist FHT/ORG: Summerville FHT ABSTRACT: The Summerville Arthritis Program is a novel, collaborative approach to community Osteoarthritis care. Our interdisciplinary team partnered with The Arthritis Society and Pfizer to map out the delivery of a comprehensive yet flexible program. The program guides the patient through in-house services including a group education session, one-on-one counseling, a joint injection clinic and the ‘Maximize Your Health’ Stanford Chronic Disease Self-Management Program. It also identifies a pathway for Rheumatoid Arthritis care. The program was piloted winter 2011 and is now being offered Summerville-wide starting fall 2011, thus optimizing patient-centered care. Click here to view presentation.