Theme 5. Optimizing use of resources

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session D
• Time: 9:30am-10:15am
• Room:
• Style: Presentation (information provided to audience, with opportunity for audience to ask question)
• Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
• Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff

Learning Objectives By the end of this session participants will:

1. Gain skills necessary for using process flowcharts to streamline clinical administration roles/functions
2. Understand both the positive and negative outcomes of increased role specialization among medical administration professionals.
3. Gain knowledge of some practical approaches to supporting the administration of a growing Primary Care practice, without a growing budget.

Summary/Abstract The traditional role of the administrator sitting at the front desk in a Primary Care setting has been that of a shape shifter. Most medical administrators and secretaries preform duties that would equally qualify them as medical records managers, communications specialists, database administrators, and customer service agents. Many other medical admin roles also extend even further beyond the already-large scope. In other words, all medical administrators do it all. As the province’s strategic goals trend toward increased complexity and shared care in the Primary Health Care setting, the effect of this demand is uniquely felt by the front desk. As many health care providers are aware, an efficient and highly functioning front desk is necessary for the existence of an efficient and highly functioning clinic. The Bridgepoint Family Health Team has re-structured the way that its administrative tasks are shared between roles, and aims to share its outcomes, challenges, and lessons learned. Presenters

• Jessica Neverson, Program & Administrative Coordinator, Bridgepoint Family Health Team
• Alice McDermott, Medical Administrative Assistant, Bridgepoint Family Health Team

Authors & Contributors

• Diane Farrell, Medical Administrative Assistant, Bridgepoint Family Health Team
• Noor Zaidi, Medical Assistant, Bridgepoint Family Health Team

Theme 4. Strengthening partnerships

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session D
• Time: 9:30am-10:15am
• Room:
• Style: Presentation (information provided to audience, with opportunity for audience to ask question)
• Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
• Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Representatives of stakeholder/partner organizations

Learning Objectives

1. Participants will get an overview of the evolution of Community Palliative Care Rounds in the Barrie area.  Through this overview participants will see how the evolution became more patient care/patient needs focused.  Participants will be able to have a framework to adopt a similar model for their community.
2. Participants will learn how primary care works collaboratively with other community providers/ health agencies as partners with the Palliative patient to facilitate effective and seamless transitions of care (hospital to home/primary care to hospice, for example), the Health Care Professional’s (HCP’s) at the table participating as consultants for patients and the expert role they play on the consulting team.

Summary/Abstract This presentation will provide a brief history of the Barrie area Community Palliative Care rounds and focus on how the recent evolution of this group concentrated on improving quality of patient care for our Palliative patients in hospital, hospice, and in the community (own home, Retirement Home or LTC). We will outline the members of our community committee and their role in the Palliative Care community, the process the interdisciplinary group followed to develop a formal terms of reference that outlines the goals that drive our meetings, the benefits we as a community group wish to achieve as well as agreed upon meeting structure for team based interaction, peer support and debriefing within the meetings limited one hour time frame. The presentation will include some examples of challenging patient cases where the team provided valuable input for collaborative care plans based on best practice guidelines and patient outcomes achieved.  We will also provide examples of the palliative learning needs and gaps in community support identified by the group.

Presenters

• Lynn Augustino, Registered Dietitian, Barrie & Community Family Health Team
• Bob Armstrong, Pharmacist, Barrie & Community Family Health Team

Author & Contributor

• Elizabeth Forde, Quality Improvement Co-ordinator, Barrie & Community Family Health Team

Theme 3. Employing and empowering the patient and caregiver perspective

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session D
• Time: 9:30am-10:15am
• Room:
• Style: Workshop (session is structure for interaction and/or hands-on learning opportunities)
• Focus: Workshop (session is structure for interaction and/or hands-on learning opportunities)
• Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff, Representatives of stakeholder/partner organizations

Learning Objectives

1. Participants will understand the primary care guidelines (Sullivan 2011)  for adults with intellectual and developmental disabilities (IDD) as they relate to the completion of the annual health check by an interprofessional team. Self-advocates (patients with IDD from our FHT) will co-present focus group feedback on a patient-centred model of providing primary care.
2. Participants will learn about the co-construction of the roles of interprofessional disciplines and clinic support staff incorporating both guidelines and patient feedback.
3. Participants will learn how to implement a patient-centred, interprofessional model to complete the annual health check with checklists using EMR tools and links to interprofessional tools adapted for use with adults with IDD.

Summary/Abstract Adults with intellectual and developmental disabilities (IDD) are more likely to live in poorer neighbourhoods, visit emergency departments more often, have more preventable hospitalizations and are less likely to undergo preventative care screening.  It has been shown that the completion of the annual health check in this population has a positive impact on a number of health measures (Durbin 2017). The current 2011 guidelines for the Primary Care of Adults with Intellectual and Developmental Disabilities (IDD) recommend annual health checks for all adults with IDD as well as access to interprofessional care. However, in 2010, only 22% of adults with IDD had an annual health check completed. This workshop will present the results of patient and caregiver focus groups, a patient-informed consultation and the co-construction of an interprofessional model to complete the annual health check. It will outline the steps to identify adults with IDD within a practice population, and outreach methods to engage these patients/ caregivers/family.  Patients/self-advocates from the practice will present the results of the focus groups and their experience in presenting to interprofessional teams. Power point presentations to these teams (by discipline) which include both relevant guidelines and focus group feedback will be reviewed. The presentation will include EMR templates created to determine interprofessional consultations needed as well as the specific interprofessional templates incorporating both feedback and relevant primary care guidelines. The templates created from this consultation will be made available in addition to adapted tools appropriate for this population. These tools would be available for use across the province in family health team settings. Presenters

• Laurie Green, MD, CCFP-EM, FCFP, Staff Physician, St. Michael’s Hospital Family Health Team
• Andrea Perry, OT, Baycrest Hospital
• Donna McCormick, patient in the St. Michael’s FHT/adult with IDD, Patient in the St. Michael’s FHT
• Paul Cochrane, Patient in the St. Michael’s FHT/adult with IDD, Patient in the St. Michael’s FHT
• Barbara Anderson, RN, St. Michael’s FHT

Theme 2. Planning programs for equitable access to care

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session D
• Time: 9:30am-10:15am
• Room:
• Style: Presentation (information provided to audience, with opportunity for audience to ask question)
• Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
• Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff, Representatives of stakeholder/partner organizations

Learning Objectives

1. Understand how to triage patient waiting for a primary care provider
2. Understand how to develop a program to manage patients with no primary care provider
3. Understand how to mitigate clinical, organizaitonal and legal risk associated with caring for patient with no provider

Summary/Abstract The Unattached Patient Program (UPP) is intended to provide residents in the greater Owen Sound Area, who do not have a primary care provider with access to a general assessment, screening investigations, and referral as indicated to local specialists and community programs. If available and agreed upon, clients may be referred to a primary care practitioner for enrollment with the OSFHT. The UPP supports early detection and management of asymptomatic disease and risk factors. The emphasis is not to provide comprehensive primary care; rather the emphasis is on assessment, screening, preventive health care interventions (eg: immunization), health education and required follow up and referrals. The available information will inform health care management for both the patient and future providers. Presenters

• Caroline Rafferty, Executive Director, Owen Sound Family Health Team
• Betty Barber, Nurse Practitioner, Owen Sound Family Health Team

Authors & Contributors

• Betty Barber, Nurse Practitioner
• Caroline Rafferty, Executive Director
• Kaitlin Low, Registered Nurse

Theme 7. Clinical innovations for specific populations

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session C & D
• Time: 8:30am-10:15am
• Room:
• Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)

1. Gender Affirming Surgical Assessments/ Referrals in an Interprofessional Primary Care Context: Sherbourne Health Centre’s Journey

Style: Presentation (information provided to audience, with opportunity for audience to ask question) Target Audience: Clinical providers Learning Objectives

1. Increase awareness about legislative changes allowing primary care providers to carry out assessments and referrals for OHIP funded gender confirming surgeries
2. Conceptualize the implications of the legislative change for surgery referrals in primary and integrated care settings
3. Review and reference the World Professional Association for Transgender Health (WPATH) standards of care related to gender confirming surgeries
4. Explore assessment and readiness components of the surgical referral process from primary and mental health care perspectives
5. Identify resources needed/available to support FHTs to begin or refine assessments and referrals for trans clients
6. Examine what facilitators and barriers currently exist to carrying out referrals in FHTs through panel-audience discussion

Summary/Abstract On March 1, 2016, the Minister of Health announced that people who are seeking OHIP approval for transition related surgeries (TRS) no longer needed to go through The Centre for Addiction and Mental Health (CAMH).  Instead, people now have the additional option to get approval from “qualified” primary care providers (Family Physicians, Nurse Practitioners, Registered Nurses, Psychologists and Social Workers with Masters level education).  This is a great change for trans people, removing an unnecessary and highly challenging barrier to access.  To ensure that providers are prepared and comfortable with the assessment and referral process, the Ministry requires providers to take training in accordance with the WPATH Standards of Care.    After the Minister’s announcement, Sherbourne Health Centre began working to increase capacity in the family health team to effectively serve trans primary care clients, including providing assessments and referrals for surgery. In this interactive presentation, family doctors, nurses and mental health counsellors will:

• Explain the legislative changes and their importance;
• Provide an overview of the standards of care;
• Share their process to doing surgical assessments and referrals in an interprofessional family health team context; and
• Share resources to support FHTs to assess their readiness, and increase their capacity to provide assessments and referrals

Presenters

• Dr. Laura Pripstein, Medical Director and Staff Physician, Sherbourne Health Centre
• Rahim Thawer, MSW, RSW, Mental Health Counsellor, Sherbourne Health Centre
• Laura Sparrow, RN, Registered Nurse, Sherbourne Health Centre
• Jeffrey Reinhart, RN, Registered Nurse, Sherbourne Health Centre

2. Transgender and Gender Diverse Care: St. Michael’s Hospital Family Health Team’s Drive to Create an Interprofessional Model for the Referral Process for Gender Affirming Surgery

Style: Workshop (session is structure for interaction and/or hands-on learning opportunities) Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers Learning Objectives

1. Participants will learn how surgical intervention can be integrated into the healthcare provided to  transgender and gender non-conforming patients
2. Participants will be familiarized with new MOHLTC referral guidelines for gender affirming surgery
3. Participants will learn about an inter-professional family health team’s step by step protocol development for assessing/preparing patients for gender affirming surgery
4. Participants will be familiarized with resources in Ontario for supporting health in transgender and gender nonconforming patients

Summary/Abstract This workshop outlines an interprofessional approach for Family Health Teams (FHT) to support surgical transition in transgender, non-binary, and gender nonconforming patients (referred to here as “trans people”). The St. Michael’s Academic Family Health Team (SMAFHT) is located downtown Toronto, and offers multidisciplinary services used by trans people. Many trans people seek surgical intervention to bring their primary sex characteristics in line with their gender identity, a group of surgeries called “gender affirming surgeries(GAS)”. In March 2016, MOHLTC updated the referral process for GAS, greatly expanding the health professionals that can refer patients for GAS, including Physicians, Nurse Practitioners, Nurses, Social Workers, and Psychologists. This is an exciting step forward that is significantly improving access to these essential surgeries. One major barrier that remains however is that many primary healthcare and Allied Health providers are not familiar with the process of referring for GAS. To address this barrier, a multidisciplinary working group within the SMAFHT have developed a protocol outlining a multistep, team-based approach to assessing and preparing patients for GAS. The protocol is based on MOHLTC guidelines and is designed to increase practitioners’ confidence and build competency. This workshop will review the new MOHLTC guidelines and the step-by-step processing for assessing readiness and preparing patients for surgery. The workshop will also discuss how this process will vary across different professions. Participants will leave with a greater understanding of their role in helping trans patients access GAS as well as resources for how to incorporate this into their FHT setting. Presenters

• Kathleen Tallon, MA, Psychology PhD Student, Ryerson University, St. Michael’s Hospital Academic Family Health Team
• Ammaar Kidwai, MA, Psychology PhD Student, Ryerson University, St. Michael’s Hospital Academic Family Health Team
• Kelly Horner, Ph.D., CPsych, Director, Psychology Training Clinic, Ryerson University, St. Michael’s Hospital Academic Family Health Team
• Celia Schwartz, MSW, RSW, Registered Social Worker, St. Michael’s Hospital Academic Family Health Team

Authors & Contributors

• Sue Hranilovic, Nurse Practitioner, St. Michael’s Hospital Academic Family Health Team
• Amy Babcock, MSW, RSW, Registered Social Worker, St. Michael’s Hospital Academic Family Health Team
• Linda Jackson, MSW, RSW, Executive Director St. Michael’s Hospital Academic Family Health Team, Program Director Inner City Health, St Michael’s Hospital
• Thea Weisdorf, MD, FCFP, ABAM, Staff Physician, St. Michael’s Hospital-Inner City Health Program, Assistant Professor, Department of Family and Community Medicine, University of Toronto

Theme 5. Optimizing use of resources

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session C & D
• Time: 8:30am-10:15am
• Room:
• Style: Presentation (information provided to audience, with opportunity for audience to ask question)

1. Mind, the Gap:  The Importance and  Effectiveness of Mindfulness Programming in Primary Health Care

Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment) Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff Learning Objectives

1. Participants will be able to state the benefits of a mindfulness program within primary care and the recommended structure and content of a mindfulness program that promotes both knowledge and skill acquisition.
2. This presentation will focus on the “lessons learned” in the implementation of a large scale program across both urban and rural patient populations and 5 FHO’s.

Summary/Abstract The Peterborough Family Health Team (PFHT) is a large family health team, serving both rural and urban patients and supports 5 FHO’s. PFHT began offering mindfulness programming 8 years ago. Since that time, the program has adapted and developed to meet the needs of the patient population. A patient centered approach of being able to increase access and accessibility to patients of all 5 FHO’s was a goal embarked on in 2016-2017 and the lessons learned from this will be provided. The program is now in great demand across Peterborough and county and approximately 24 mindfulness programs and over 360 patients are served yearly.  PFHT has supported the resourcing of this program due to program effectiveness and the ability to respond to patients who are challenged by many and differing health needs.  Reducing stress and improving coping is helpful in any health recovery and promotion.  As well the program has been implemented due to the substantial literature  research  supporting the effectiveness of mindfulness strategies to cope with a multitude of health issues.  Research also shows that group intervention can help participants acquire skills and knowledge, allows participants to experience the “universality” of the human experience, promotes socialization and reduces social isolation – also a key ingredient in  positive health outcomes. The presentation will provide an overview of the program and how it has been adapted from other well known mindfulness programs to address patient needs. The implementation of this program has also informed other centralized group programming for PFHT such as CBT-Insomnia and Mindfulness Based Cognitive Therapy. Presenters

• Julie Brown, Mental Health Lead, Mental Health Clinician, Peterborough Family Health Team
• Lori Richey, Executive Director, Peterborough Family Health Team

Authors & Contributors

• Julie Brown
• Lori Richey
• Lyne Edington
• Amanda Hiemstra

2. Development, Delivery and Evaluation of a Brief Mindfulness Based Stress Reduction Group in a FHT: Practical Advice and Lessons Learned

Focus: Balance between both (e.g. Presentation of a best-practice guideline that combines research evidence, policy issues and practical steps for implementation) Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers Learning Objectives Participants will learn about the development, delivery and evaluation of an abbreviated Mindfulness Based Stress Reduction (MBSR) group, led by social workers, in an interdisciplinary primary care setting.  Participants will come away with practical advice to assess the feasibility of offering a similar abbreviated MBSR in their own clinical setting. Summary/Abstract Mental health conditions are among the most common and disabling conditions managed in Primary Care. Mindfulness Based Stress Reduction (MBSR), typically given as an 8 week group, has been shown to help with stress and mood. There is emerging evidence that an abbreviated 4 week MBSR program is as effective as the 8 week group.  However there remains a paucity of practical information to guide primary care practitioners who wish to develop, execute and evaluate a MBSR programs.  The potential benefit of a shortened program is that it involves fewer resources from a human resources perspective, but it also may appeal to patients who may be more open to committing to a shorter group involving less time.  From a practical point of view a shorter clinic-based intervention is more likely to be feasible for primary health care teams to deploy regularly and may provide an entry into mental health services, especially as patients wait for more individual sessions due to high demand for services. To optimize care delivery with clinic resources, we evaluate the effectiveness of a 4 week MBSR Group delivered by two Masters level social workers with beginner MBSR training. The practice of mindfulness was measured with the validated Five Facet Mindfulness Questionnaire (FFMQ). There was pre and post group FFMQ evaluation as well as mailed questionnaires in follow-up at one, three and six month intervals. Participant satisfaction was also measured post group. Presenter

• Vela Tadic MSW RSW, Clinical Social Worker and Clinical Educator; Adjunct Professor, Family Medicine, Bruyère Academic Family Health Team; University of Ottawa

Authors & Contributors

• Elizabeth Muggah MPH MD FCFP, Family Physician, Bruyère Academic Family Health Team; Assistant Professor, Director of Quality Improvement, Family Medicine, University of Ottawa

Theme 1. Effective leadership and governance for system transformation

Presentation Details

• Date: Thursday, October 26, 2017
• Concurrent Session C & D
• Time: 8:30am-10:15am
• Room:
• Style:
• Focus:
• Target Audience:

Learning Objectives

1. Clinical leaders will explore, test and work on communication and team leadership skills that will increase their effectiveness in enabling a team to work well together
2. Participants will gain a better understanding of themselves as a leader and increase their confidence in dealing with challenging situations
3. Participants will come away with ideas that can be used in their own organizations including tools to enhance their own leadership growth

Amidst the numerous changes facing clinical leaders, including sub-region development, shifting relationships with LHINs and new FHT contracts, the biggest challenge may be in leading change and enabling a diverse team to work together.  This workshop will focus primarily on two related skill sets: coaching and leading teams. Clinical leaders will learn about the purpose and value of the coaching conversation but also when a non-coachable situation affects progress. Best practices for inspiring teams as well as troubleshooting when teams become dysfunctional will also be addressed. The overall goal of this workshop is to increase the confidence level of clinical leads and provide tools to take away and scenarios to practice.  This workshop may include pre-workshop reading and/or assessments. Summary/Abstract Presenter

• Colleen Grady, Assistant Professor, Family Medicine, Centre for Studies in Primary Care
  • Colleen Grady is a researcher with a special interest in physician leadership development and complexity science. She brings to her work several years of leadership experience in healthcare, social services and local government and has supported organizations both large and small in how they encourage and cultivate the talent within.  Her current research focuses on medical education, clinical leadership related to health system transformation and complexity leadership. She has had the privilege of working with physicians in both acute care and primary care, including as Executive Director of a Family Health Team.  Colleen currently holds the position of Research Manager with the Centre for Studies in Primary Care, Department of Family Medicine, at Queen’s University in Kingston, Ontario.