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  • Patient Story: Stephen

    Watch this video to see an example of the benefits of interprofessional team-based care for Stephen, a patient with rheumatoid arthritis. Courtesy of Dufferin Area FHT

  • Annual AFHTO Leadership Session Reports

    Every year, leaders from AFHTO member teams (board members, EDs/Admin Leads, and lead MDs/NPs) meet in advance of the annual conference. Below are links to past leadership session reports, along with the leadership themes from each year’s conference.

    2018 – Addressing Mental Health and Addictions Needs in Primary Care

    • In this year we partnered with the Canadian Mental Health Association, Ontario, and co-designed a session to focus on mental health and primary care integration. Leaders from the CMHA chapters across the province  joined us  –  leaders in primary care – to discuss how both sectors can work more closely together to ensure patients receive timely access to care. The session was kicked off by our CEO, Kavita Mehta, and Camille Quenneville, CEO of the CMHA, Ontario. There were group discussions, followed by break-outs by region. We addressed the question “How do we ensure that we provide seamless care for our patients and create a well integrated system of care.” From this discussion, we took away action items to help teams be leaders in local change, as well as a set of recommendations to provide policy makers. Ministry officials also joined the discussion.

    2017- The Way Forward: Care Coordination Being Led by Primary Care

    • This year’s focus for the Leadership Triad Session was on care coordination and building primary care as the foundation of the health care system, such that more Ontarians have access to comprehensive primary care and coordination of care through primary care teams. Given the Minister’s LHIN mandate letter from May 1 2017 “to develop and implement a plan with input from primary care providers, patients, caregivers and partners that embeds care coordinators and system navigators in primary care to ensure smooth transitions of care between home and community care and other health and social services as required”, we believe care coordination to be a relevant and timely topic for both LHIN and AFHTO leaders.

    2016: Tackling the big issues: relationship and accountability questions in Ministry contracts

    • The objective of this leadership session was to find common ground and guide AFHTO’s position on particularly challenging issues related to the FHT contract, as informed by membership consultation over the preceding summer. Major themes were: standardizing FHT contracts; fostering teamwork and defining the”team”; defining the “population” for which governors are accountable, defining minimum standards of governance/addressing conflict of interest; and accountability and dispute resolution.

    2015: Leading Primary Care through the Next Stage

    • This Leadership Session was designed to identify issues and shape the direction to be taken by this sector, supported by the advocacy, networking and knowledge-sharing made possible through AFHTO. This year, the session focused on the question of a population-based approach to primary care.

    2014: Toward the Next Ministry Contract

    • This Leadership Session was part of a comprehensive process of working with AFHTO membership to identify the key principles to guide the journey toward more mature relationships, including contracts that support high-quality comprehensive interprofessional primary care. The report summarizes the outcomes of the entire process, including the leadership session.

    2013: Leadership in Health Care for Ontarians

    • Summarizes the key messages and insights into primary care leadership gleaned from the AFHTO 2013 Conference – including the Leadership Session, concurrent sessions within the leadership theme, and plenary sessions.

    2012: Priorities, Goals, and Actions

    • Leaders delved into the question of “How do we continue to build a stronger primary care foundation and work in a more integrated manner within the LHIN to ensure coordinated and seamless care for our patients?” The resulting Priorities, Goals and Actions report  lists the priorities and cross-cutting themes that emerged across all LHIN groups and documents the priorities, goals and short-term actions identified by the leaders from each LHIN.

  • Evaluation of the McMaster Family Health Team: results and practical implications for quality improvement

    By Laila Nasser, Alix Stosic, David Price; McMaster FHT Abstract Purpose: To evaluate the McMaster Family Health Team (MFHT) as part of a Continuous Quality Improvement initiative using a set of provincial performance metrics to demonstrate which measures of assessment are actually clinically meaningful in context and where system-level changes might be implemented to improve operational practice. Methods: Measures were selected from the Primary Care Performance Measurement Framework based on data availability for the MFHT and provincial comparators. The measures explored in this paper are those that were deemed to have actionable properties. Data were extracted from billing reports, electronic medical records and information collated for the Association of Family Health Teams of Ontario Data to Decisions database. Metrics were then examined to demonstrate the importance of interpretation in clinical context. Conclusions: Quantitative assessment of performance based on standardized measures is a suitable starting point when evaluating a practice, however it is not appropriate as a stand-alone report card of practice performance. Rather, quantitative measures must be of clinical relevance and applicable to the patient populations of interest in order to create conversation and impact change. Thus, the focus of quality improvement should not be to improve numbers relating to efficiency, patient satisfaction and continuity of care, but rather to determine what drives those numbers and how changes might be made at a system or practice level that will optimize clinician buy-in. Click here for access to full article (PDF)

  • CBC profiles Marathon FHT’s Bright Lights Award for Safer Opioid Prescription (HARMS) Program

    CBC News article published on November 27, 2018 By CBC News A clinic in a small northwestern Ontario town is enjoying some recognition after taking a chance on an unusual approach to opioid prescription. For the past several years, the Marathon Family Health Team, located in Marathon, Ont., has required urine drug tests of every patient prescribed opioids for chronic pain. The tests are used to better understand whether patients will be helped, or harmed by a prescription, said Dr. Ryan Patchett-Marble, a family doctor at the clinic and lead on the HARMS (or High-yield Approach to Risk Mitigation and Safety) program. “There’s no perfect test to show someone’s in pain and there’s no perfect test to show that somebody’s addicted,” he said. “There is something that can help us know, and that’s urine drug testing.” If the tests reveal traces of other concerning drugs — cocaine, for example, or opioids that were not prescribed — then doctors take note. “Those things suggest the person’s at higher risk of opioid addiction, overdose and death,” he explained, “and so urine drug tests can help us know who we’re harming, and affect [whether] we prescribe opioids at all, and if we do, how.” While there was some initial pushback from patients worried that the drug testing may turn out to be punitive, over time that concern dissipated, Patchett-Marble said, as people came to understand that the tests were being applied across-the-board as a safety measure.

    Drug test results changed care for one in five

    The urine drug testing system was implemented about four years ago, but it was studied in 2016 and 2017 when a group of patients, considered to be low-risk, were followed over a 12-month period. The study revealed that the system was having an even bigger impact than expected. It found that one in five patients had a drug test result that “directly changed management,” meaning doctors altered the patient’s care by starting the patient on addiction treatment, weaning them off medication or taking other measures. “I assumed it would have a high detection rate, but one in five is actually quite astounding because we’d already weeded out the people that were considered high-risk,” said Patchett-Marble. “So we were quite surprised.”

    Provincial recognition

    Others are now starting to pay attention to the HARMS system, and its potential, said Patchett-Marble, who recently gave a talk on the program at a family medicine forum in Toronto. This year it received an award from the Association of Family Health Teams of Ontario. The Bright Lights scalable pilot program award recognizes a project with potential for expansion. Expansion to other clinics is the next step, said Patchett-Marble, adding that they also plan to more thoroughly study the program and its impacts. “Up to this point, drug testing hasn’t been studied very well, as it’s used for chronic pain, and we’d like to, during this expansion, also evaluate and say ‘hey, does this actually work?’ “Does a clinic that does drug testing as a safety measure with opioids, do they have lower rates of addiction? Or higher rates of detection of addiction? Do they have lower rates of overdose? Lower rates of death?” Patchett-Marble said the recognition for a program run by a small team in a small town with minimal resources, has been gratifying. “So we’re kind of getting on the map a little bit, I guess. But our whole team has worked really hard to do this.” Click here to access the CBC News article

  • Espanola & Area FHT Implements New Addictions Service

    Access to PDF Flyer for Espanola & Area FHT RAAM Clinic Espanola & Area Family Health Team has implemented a new program to enhance services offered at their clinic. The Rapid Access Addiction Medicine (RAAM) Clinic serves those with substance abuse issues, primarily addictions to opioids and alcohol.  The purpose of the clinic is to provide quick access to care for addiction issues, including assessments, counselling and prescriptions for medications that may help with lessening cravings and withdrawal symptoms. The RAAM Clinic will also help patients to navigate access to other addiction services in our community and provide support through transitions. How this Program helps… The RAAM Clinic helps those with alcohol and substance use disorders in a timely way by:

    • Offering rapid assessment:  Patients will be seen by an Addiction Worker within 24-48 hours after referral. Patients will be screened and assessed for substance use disorder. They will then be seen by the Addiction Specialist to create and implement a treatment and medication plan.
    • Offering pharmacological treatment:  While not everyone with addictions requires pharmacological treatment, some may benefit from prescription medications that may help with lessening cravings and withdrawal symptoms.  Additionally, the RAAM Clinic will support family physicians to ensure they are able to help with pharmacological treatment for addictions. An example of a pharmacological treatment for addiction is the prescribing of anti-craving or abstinence medications.
    • Offering connections to community treatment programs: The RAAM Clinic will help patients successfully connect with community-based mental health and addiction services. The clinic addiction worker will help the patient navigate through the transitioning to community programs.

    Contact Phone: (705) 862-7991 ext. 4245 (Monday to Friday, 8:30 am – 4:30 pm) Click here to view the My Espanola Now Article

  • Bits & Pieces: Longwoods call for abstracts, Bill 47, complex patient management & more

    Your Weekly News & Updates
    Building Effective Primary Care Systems- call for abstracts Longwoods’ Healthcare Quarterly will have a special edition that will focus on building effective primary care systems. Given the amazing work our members do, think about submitting an abstract in the following themes: – Collaborative models of care including discussion of benefits and challenges. – Innovative examples of care delivery in long-term and palliative care. –  Implementation of a successful medical home – with outcomes analyses. –  How to implement and use supports for patients, such as electronic medical records, email, etc. – Examples of how to keep older people out of hospital. – What should be included in a full-service family practice and why? Abstracts are due December 4th – for more information please click here.     In this Issue: Building Effective Primary Care Systems- call for abstracts What Bill 47- changes to the Ontario Employment Standards Act, 2000 mean for your team ECHO Ontario complex patient management Opioid tapering and tools slides and video Making the case for nutrition screening in team-based primary care to meet the needs of your frail clients Patient story: Dufferin Area FHT Hypertension Canada adds clinical-grade BPM to recommended list Opioids Clinical Primer Speak Up Ontario website updated Upcoming events regarding board orientation and more
    What Bill 47- changes to the Ontario Employment Standards Act, 2000 mean for your team What do the Ontario Government’s changes to the Ontario Employment Standards Act, 2000 mean for your team, especially your leave of absence policies? Maria McDonald of McDonald HR Law fills us in.
    ECHO Ontario complex patient management Are you looking for support managing your most complex patients? You can apply for ECHO Ontario Complex Patient Management. FREE and virtual interactive sessions will take place on Fridays from 12:00-1:00 PM EST from January 18 – March 22, 2019. Identifying the most effective mental and physical health interventions can be challenging.  The program connects you virtually with the expertise of leading clinicians and a panel of your peers to review your most complex patients. By learning together, you won’t be alone in finding the best path ahead for your patients. Spots are limited. Apply now.
    Opioid tapering and tools slides and video On Nov. 19, Dr. Andrea Furlan, co-chair of ECHO Ontario Chronic Pain and Opioid Stewardship, spoke to our members about opioid tapering and tools for use in clinical practice. You can see the presentation and recording here. Making the case for nutrition screening in team-based primary care to meet the needs of your frail clients On Nov. 21, Dr. Heather Keller focused on nutrition screening as a means of shifting primary care to ‘upstream’ prevention of undernutrition and eventual frailty. You can see the recording she presented with members here.
    Patient story: Dufferin Area FHT Watch this video to see an example of the benefits of interprofessional team-based care for Stephen, a patient with rheumatoid arthritis. We’ll also share this on social media this week. Have similar stories? Share them with us, your MPP and the public to highlight the great work you do!  
    Patient story: Stephen
     Patient story: Stephen
    Hypertension Canada adds clinical-grade BPM to recommended list Hypertension Canada has added clinical-grade choices to Recommended Blood Pressure Measurement (BPM) Devices List, to assist you in your purchasing decisions. They’re confirmed as having met prevailing BPM accuracy standards, to support diagnosis and in monitoring how patients’ blood pressure responds to lifestyle changes and medications. You can view the full list at hypertension.ca.     Opioids Clinical Primer Machealth has launched the Opioids Clinical Primer, a free, certified online program to educate health professionals in Ontario about safe opioid risk reduction and addressing opioid use disorder by reducing harm including overdose and dependence by recognizing and treating opioid use disorder. Two of the six courses are currently available: Primary Care: Principles of Assessing and Managing Opioid Use Disorder; and Managing Patients with Opioid Use Disorder in Primary Care with Buprenorphine. The primer is integrated with the suite of programs collectively described as Ontario Pain Management Resources: a partnership to help clinicians support their patients. You can learn more at opioids.machealth.ca
    Speak Up Ontario website updated
    Speak Up Ontario is an initiative of Hospice Palliative Care Ontario (HPCO) to improve awareness and understanding of Health Care Consent (HCC), Advance Care Planning (ACP) and Goals of Care (GoC) in the Province of Ontario. HPCO updated their site to provide easier access to resources such as their workbook, resource guide, videos, posters and post cards You can learn more here or visit their website.
    Reflections on Using Data for Improvement, Dec. 6, 2018 This webinar will discuss how data and listening to patients support QI. Learn more here. ACLS Courses for 2019 The Sunnybrook ALS Educator Program has released their 2019 course schedule. For more information, see here.
    Governance Webcast Series: Board Orientation and Education, Dec. 6, 2018 Learn why board orientation and education is important. Register now! IPAC-CEO and PHO Education Day 2018, November 29, 2018 Learn the steps and implications for IPAC in this session held in Whitby. Learn more here.

     

  • Fall 2018 Highlights: AFHTO Leadership Councils

    Below are the highlights from the fall 2018 joint meeting of AFHTO’s Executive Director Advisory Council (EDAC), Physician Leadership Council (PLC), Board Chair Leadership Council (BCLC), NPLC Leadership Council (NPLC LC), and IHP Advisory Council.

    Governance tools are now here!
    Based on the needs identified by the Board Chair Leadership Council, the following governance tools are now available:

    Governing Through Healthcare Transformation – Workshop

    • The “Governing Through Healthcare Transformation: Leading Practices in Effective Governance and Collaborative Governance” workshop was well attended at the conference. Missed the workshop? The workbook and presentation are here.

    Leadership training continues

    • Dates for the 2019 LeaderShift programs have been announced. Registration for the spring LEADS Learning Series cohorts open in January.
    • The third LEADS LITE online learning series starts in January. The deadline for applications is December 7. Register here.
    • New applied leadership e-learning opportunities are available! The first webinar – “How to Give Better Feedback” – is now open for registration. More information is here.

    Members’ priorities for improvement

    • Based on member input, a focus on 7-day discharge follow-up after hospitalization is a priority. Members can track their team’s work on follow-up by using the team-based definition of follow-up developed by AFHTO members.
    • D2D 6.0 showed high participation in measurement. Moderate contribution of “team characteristics” data to make it possible to answer the question: what are the characteristics of teams that tend to improve and/or have high performance? Contact AFHTO staff to complete the “team characteristics” survey.
    • AFHTO is looking at aggregate data to give to the group at Queen’s University to help with the research agenda to show team-based care does improve patient outcomes. Interested teams can contact the QIDS team at improve@afhto.ca
    • The IHP council will work on measuring outcomes and the value of IHPs. Encourage your IHPs to connect with their IHP council to participate in an ongoing research project that will help demonstrate the value of IHPs in team-based care.

    Advocacy with your MPP

    • AFHTO is working with H&K Strategies to develop materials that align with the new government’s priorities. Final material is expected by early January.
    • Members are encouraged to schedule meetings with their MPPs.
    • It is important to build a relationship. MPPs want to hear from their constituents, particularly front-line providers and patients.
    • Start to collect good news patient stories to share with MPPs. Please also share these with AFHTO to assist with central communications in demonstrating the value of team-based care.
    • High-level support is here. More information and guidelines will be ready soon. Stay tuned!

    The patient enrollment model (PEM) and story telling

    • The current narrative from government is that there are challenges with the PEM model. It is important we ensure that the government sees its benefit.
    • We need to change the narrative, so that government understands what PEMs do, the value they bring, and how they result in better outcomes for patients.
    • The OMA is encouraging teams to write their stories to the ministry. If you do so, please forward a copy to AFHTO so we can share it with the OMA negotiations team. Please do not copy AFHTO directly.

    Communication with the ministry and LHIN

    • AFHTO is working to ensure the committed 3-year recruitment and retention dollars are protected.
    • With the line-by-line audit underway, the future of ministry funding for AFHTO’s programs (Governance and Leadership, and Quality Improvement Decision Support) remains unknown.
    • AFHTO has been working to develop a Primary Care Multi-Sector Accountability Agreement (M-SAA), so teams can receive one-time or project funding directly from the LHINs. This is on hold as the LHINs focus on getting approved funding out.
    • Timing for further conversation with the LHINs is unknown.
    • AFHTO will continue to keep members updated as we learn more.

    2018 conference wrapped up!

    • Thanks to all members who completed the feedback form to help AFHTO prepare for the 2019 conference. Preparation will begin early next year!

    Any questions or comments, please contact Bryn Hamilton, Provincial Lead for the Governance & Leadership program.

  • Save the Date: Panel Discussion with Primary Care Featuring Helen Bevan

    Mark your calendars for a virtual lunch and learn on Primary Care and Health System Change facilitated by internationally renown change agent Helen Bevan. Helen Bevan, the Chief Transformation Officer for the National Health Service (NHS), will be joined by a panel of esteemed primary care practitioners from the UK and Ontario who will share their insight on system transformation, leading and responding to change, building relationships and maintaining momentum. Within this interactive webinar, participants will have the opportunity to learn about how to overcome obstacles and address challenges based on lessons learned in the UK and how they might apply to primary care in Ontario. Details: When: Thursday November 22nd, 2018 Time: 12:00pm-1:00pm Register here

  • Webinar event: “Making the case for nutrition screening in team-based primary care to meet the needs of your frail clients”

    “Making the case for nutrition screening in team-based primary care to meet the needs of your frail clients”, presented by Dr. Heather Keller.

    Did you know that ….

    • Malnourished patients cost $2000 more per hospital stay and cost an addition 2 billion dollars per year in health care costs?
    • Malnourished seniors are three times more likely to fall?
    • Malnutrition = fragility?

    Primary care is the optimal place for the identification and treatment of malnutrition by team-based care. Primary care providers play a key role in treatment of this preventable disease (diagnostic code 263.)  Nutrition screening in FHTs started in 2016 and now over a hundred teams are screening. This webinar will make the case for nutrition screening as a means of shifting primary care to ‘upstream’ prevention of undernutrition and eventual frailty. Come learn how team-based primary care teams can improve health care for pre-frail and frail clients.

    Click here to access the webinar.  

  • Bits & Pieces: LEADS LITE, OCFP recognises members, measuring up & more

    Your Weekly News & Updates

    LEADS LITE: Apply now to become a better leader in five 90-minute webinars!

    Current and emerging community and primary health care leaders need practical leadership capability. That’s what LeaderShift’s new LEADS LITE five-part, interactive, online workshop series is all about. This workshop series starts in January 2019. Space is limited. Apply by Dec. 7. More information and the link to the application form are here.              

    In this Issue:

    • LEADS LITE: Apply now to become a better leader in five 90-minute webinars!
    • Members in the media and journals
    • AFHTO members recognised in 2018 OCFP Awards Change Day ON- pledge by Nov 22
    • Measuring Up 2018
    • Digital Storytelling webinar Nov 22 2018
    • Cancer System Performance Report
    • Internal Responsibility System (IRS) and Workplace Violence Prevention Initiative 2018/2019
    • Free opioid addiction treatment guide
    • Advanced clinical practice fellowship request for proposals
    • OCD education needs assessment
    • Upcoming events including a webinar featuring Helen Bevan and more

    Members in the media and journals

    City of Kawartha Lakes FHT– City of Kawartha Lakes FHT helps keep Woodville Medical open

     

    Peterborough FHT– Peterborough FHT adds third ultrasound machine

     

    St. Michael’s Hospital Academic FHT – the most effective outreach for patients overdue for cancer screening

    AFHTO members recognised in 2018 OCFP Awards

    AFHTO congratulates Medical Associates of Port Perry, North Durham FHT and physicians in our member family health teams who were recognized on Wednesday, November 14, 2018 at the Ontario College of Family Physicians (OCFP) 2018 Awards Ceremony. See the full list here.  

    Change Day ON- pledge by Nov 22

    Thousands of pledges have been made so far and you can still participate. Please ensure that your team and all involved post their pledges to the website by Nov. 22 to officially count towards the Celebration Day 2018 tally. Join Celebration Day from 12-1 p.m. on Facebook LIVE. They’ll be featuring changemakers and your stories from across the province.

    Measuring Up 2018

    Health Quality Ontario has released their yearly report on the performance of Ontario’s health care system. Key findings include emergency department visits are on the rise, especially among patients with serious conditions. But fewer children and youths are having their first care for a mental health condition occur in the emergency department. Read the report here.    

    Digital Storytelling webinar Nov 22

    This free webinar from 12:00pm – 1:00pm by Techsoup Canada will share tools and successful campaigns that can help teams tell their own stories even with limited resources. Register here.
    2018 Cancer System Performance Report Canadian Partnership Against Cancer has released the 2018 Cancer System Performance Report. Highlights include that more Canadians are surviving cancer than ever before, too many Canadians are still being diagnosed with preventable cancers, and wait times for diagnostic tests are still too long. Read more here.  

    Internal Responsibility System (IRS) and Workplace Violence Prevention Initiative 2018/2019

    On Nov. 14, 2018, the Ministry of Labour and Public Services Health and Safety Association (PSHSA) reviewed the Ontario Internal Responsibility System (IRS) and Workplace Violence Prevention Initiative. This initiative is to promote compliance with the Occupational Health and Safety Act (OHSA) and its regulations. The webcast and presentation can be seen here.
    making the choice camh

    Free opioid addiction treatment guide

    Free from the Centre for Addiction and Mental Health, for a limited time and within Ontario only, Making the Choice, Making It Work: Treatment for Opioid Addiction is an easy-to-read guide for people in treatment for opioid addiction. Formerly known as the Methadone Maintenance Treatment: Client Handbook, the updated guide describes how treatment works, side-effects, drug interactions, counselling, pregnancy and more. To receive your free copy, use the code “MAKING THE CHOICE” and order directly by phone or e-mail. Complimentary copies are not available through the on-line store. Organizations may be eligible for up to 208 copies. Order by e-mail: publications@camh.ca Order by phone: 1 800 661-1111 (toll-free) or 416 595-6059

    Advanced clinical practice fellowship request for proposals

    The Advanced Clinical Practice Fellowship (ACPF) program provides RNs and NPs the opportunity to have a focused, self-directed learning experience to develop clinical, leadership or best practice guideline implementation knowledge and skills, with support from a mentor(s), the organization where the RN/NP is employed, and RNAO. A new request for proposals has been issued for a new round of fellowships that can occur any time during the period of April 15, 2019 – February 1, 2020. Find out more here.

    • Information Session Webinar:  Nov. 27, 2018 at 12pm. Register here.
    • Deadline to notify RNAO of intention to submit a proposal Jan. 7, 2019.

    OCD education needs assessment

    The Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook Health Sciences in Toronto provides residential and outpatient treatment for patients with Obsessive Compulsive (OCD) and related disorders, as well as an education program for healthcare professionals to increase their knowledge and capacity in this field. As they plan for next year’s education and training activities, they’re seeking your input to ensure their educational program meets the needs of those providing care and treatment to those with OCD. Here’s the link to the short survey.

    Helen Bevan webinar, Nov. 22, 2018

    Helen Bevan, the Chief Transformation Officer for the National Health Service (NHS) will facilitate a virtual lunch and learn on Primary Care and Health System Change on Nov. 22, hosted by The Change Foundation and offered to AFHTO and OCFP members. Register here.

    NPAO MaiD Conference, Nov. 30, 2018

    This free workshop is for those interested in or already providing MAiD. Learn more here.  

    Governance Webcast Series: Board Orientation and Education, Dec. 6, 2018

    Learn why board orientation and education is important. Register now!

    Young-Onset Dementia: The Experience of Spousal Carers- Baycrest GeMH, Nov. 23, 2018

    Gain a better understanding of the experiences and needs of young-onset dementia spousal caregivers. Learn more here.