Blog

In this Issue:

• Phase One Guidance for Clinically Appropriate Use of Virtual Care in Primary Care
• Wawa FHT in the News
• Canada-Wide Study on Health Equity and Virtual Primary Care
• Upcoming Events

Phase One Guidance for Clinically Appropriate Use of Virtual Care in Primary Care
Content below developed by Ontario Health and edited for length

Dr. David Kaplan, Vice President, Quality, at Ontario Health, and Co-Chair of the Primary Care Expert Panel for Guidance for Clinically Appropriate Use of Virtual Care, explains how the guidance was developed, informed and why it can be a helpful resource for primary care clinicians.

Q: Why is Ontario Health developing guidance for clinically appropriate use of virtual care?
A:  As we know, the COVID-19 pandemic spurred the necessity for the health care system to pivot and rapidly adopt new ways of using available technology to reach patients and deliver care. While this was an extraordinary feat and has paved the way for the innovation we are seeing within health care, there have been reports of variation in practice and clinicians and patients alike have questions about the ‘best’ uses of virtual care. To address some of the questions about virtual care and put the learnings gleaned over the pandemic into practice, we, at Ontario Health, thought it would be helpful to build on the work previously conducted by the Ontario Telehealth Network (OTN) and provide some new guidance to clinicians around virtual care.

The Ministry of Health provided funding to Ontario Health to undertake this work and develop guidance for clinically appropriate use of virtual care. While important for all specialties, we started with developing virtual care guidance for primary care because we felt it had the potential to reach more people across Ontario and have the most impact. Over time, Ontario Health will develop tailored guidance documents that apply to other specialties.

Q: What does the guidance include?
A: The Phase I Guidance is expected to be released this fall. These materials are intended to be used by primary care clinicians and lays the foundation for decision-making around use of virtual care, patient-centric approaches, and respecting clinicians’ comfort with virtual care. The guidance also outlines the supports available to both clinicians and patients related to virtual care. Patient-facing ‘tools’ have been developed to complement the guidance materials and can assist clinicians to explain virtual care, the various modalities of virtual care and support patients to decide if virtual care is appropriate for their needs. We want clinicians to feel confident in their decisions related to virtual care.

Q: How has the guidance been developed?
The development of the guidance was modeled after related work led by Ontario Health, such as Quality Standards and Person-Centred Virtual Cancer Care Clinical Guidance. A review of statements, policies and standards set out by professional regulatory agencies, an inventory of existing guidelines and evaluation of these guidelines against a method for determining strength of this guidance, and a scoping review was conducted. We also looked at available data to determine how virtual was being used in Ontario to help inform our work.

A primary care-specific expert panel was also established to help give direction to this work and included a mixed membership of primary care physicians, nurse practitioners and patient partners. It was important to our project team to include people from each of the six Ontario Health regions so we could be inclusive of and capture how primary care exists and is practiced across the province.

Q: How has the use of virtual care shifted?
A: Before March 2020, clinicians had regularly used the telephone for sharing lab results and refilling medication prescriptions. Video was being used, but primarily by specialists in Ontario and only if certain conditions were met. It was also used by primary care clinicians, though on a smaller scale. Virtual care in this context wouldn’t have been considered ‘mainstream’ until the pandemic.

Through work we conducted with INSPIRE-PHC, a research group based out of Queen’s University, we’ve been monitoring use of telephone and video primary care delivered by clinicians. Recent data demonstrates virtual care continues to see uptake and use in primary care settings. This is a formative time for the evolution of virtual care in primary care and Ontario Health’s guidance can support primary care clinicians to take a systematic, stepwise approach to planning and delivering virtual care.

The Guidance for Clinically Appropriate Use of Virtual Care in Primary Care is expected to be released later this Fall and we will share once they are available.  

Wawa FHT in the News
In a twist on the traditional rural-to-urban referrals, Wawa FHT received a request for help from a nearby urban centre. With no providers delivering medical abortions in the city or surrounding area, Wawa FHT expanded their medical abortion program to include a virtual component and provide care to this underserviced urban population. The team won a 2022 Spotlight Bright Lights Award and has been featured on CBC News.

Canada-Wide Case Study on Health Equity and Virtual Primary Care
Dr. Jay Shaw is leading a project with the Canadian Network for Digital Health Evaluation that aims to gain insights into how primary care organizations across Canada have successfully incorporated health equity into virtual primary care design, implementation, and delivery. The Primary Care Research Network is inviting primary care organizations across Canada to participate in a 30-to-40-minute phone interview about how equity considerations were incorporated when they implemented virtual primary care. For more information, email the research coordinator, Simone Shahid, at WCH.

Upcoming Events
Guidance for Clinically Appropriate Use of Virtual Care
Wednesday, November 9, 2022, 8-9 am
Please join Dr. David Kaplan and Dr. Risa Bordman from the Primary Care Expert Panel – Guidance for Clinically Appropriate Use of Virtual Care, as they present the third of a 3-part series on the Guidance for Clinically Appropriate Use of Virtual Care.  Please register in advance.  

Primary Care Report: Using Data for Improvement – a focus on using the opioid prescribing indicators to drive improvements in patient care
Thursday, November 10, 2022, 12-1 pm
Ontario Health is hosting a webinar for primary care providers on using the opioid prescribing indicators in the MyPractice: Primary Care report to drive improvements in patient care. Please REGISTER HERE to join the session. This is the fourth installment of an accredited series that will focus on using data from the MyPractice: Primary Care report for quality improvement. This 1-credit-per-hour Group Learning program has been certified by the CFPC and the Ontario Chapter for up to 1.0 Mainpro+Ⓡ credits.

Supporting Caregivers Supports Patients- The Critical Role of Primary Care in Preventing Caregiver Burnout
Thursday, November 24, 2022, 12-1 pm
Primary care providers can play a key role in preventing burnout and enhancing caregiver well-being by initiating early interventions and connecting caregivers to support. Co-hosted by The Ontario Caregiver Organization and the Primary Care Collaborative, this webinar will include insights from a caregiver with lived experience, as well as examples of primary care initiatives across Ontario that are connecting caregivers to support. Click here to register.

Highlights and Implications of the Ontario Science Table’s Brief on Primary Care
Wednesday, November 30, 2022, 7:45-8:45 am
On October 3, 2022, the Ontario COVID-19 Science Advisory Table (OST) released its final brief, a 3-part exploration of how primary care responded to and was affected by the pandemic, and implications for ongoing health system planning and policy. In this webinar, you will hear from a panel of primary healthcare experts who contributed to that brief, as they share some of the most significant findings and implications. To register, click here.

Climate Conscious Inhaler Prescribing
Thursday, December 8, 2022, 12-1 pm
This webinar will explore the carbon footprint of healthcare systems and how inhalers contribute to it, examine two problems related to inhaler prescribing and imagine practice change that results in an immediate reduction in emissions: “high value, low carbon care”. To register, click here.

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Questions? Comments? Contact us at improve@afhto.ca.