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  • Bits & Pieces: how to become a high-performing team, farewell to Catherine Macdonald & more

    Your Weekly News & Updates

    How to become a high-performing team

     

    What makes a good team great? To find out, join us on March 6 in Ottawa and March 8 in Toronto for Building Together: How to become a high-performing team. It’s free, interactive, and interprofessional! Register now for Ottawa and Toronto.

    Farewell to Catherine Macdonald

    It is with genuinely mixed feelings we announce that Catherine Macdonald will be leaving AFHTO to join the Alliance for Healthier Communities (formerly AOHC) in a new role of Knowledge Translation Specialist, working directly with their performance and communication teams.

    Catherine has been with AFHTO for three and a half years, starting first as our conference assistant before moving on to supporting our Governance & Leadership and Quality Improvement Decision Support Programs, so many have you had the pleasure of working with her over the last few years.

    We’re going to miss Catherine but know she will bring to the Alliance a wealth of experience and dedication that will continue to further the quality agenda in primary care. Please join us in wishing Catherine our sincerest best wishes and wish her well in the new role. Her last day with AFHTO will be Friday, February 1st – any questions related to the QIDS work can be directed to improve@afhto.ca.

    Considerations for implementing the NP role within your team

    Join Beth Cowper-Fung, AFHTO’s President and Board Chair and Clinical Director of Georgina NPLC & Claudia Mariano, Manager, Practice and Policy, NPAO, for an interactive session on the role of an NP in team-based primary care. Bring your questions and examples and hear directly from two experienced NPs.

    When:  Friday, Feb. 22nd, 2019
    Time:  12:00 to 1:00 p.m.

    Register here.

    LeaderShift Spring 2019 LEADS applications now open

    Earn your LEADS certificate this spring for free. Applications for four new LEADS cohorts are now open and travel subsidies are available. You can apply for:

    • Toronto #1: March 5- 20
    • Oshawa: May 1- 30
    • Hamilton: May 1- June 5
    • Toronto #2: May 7- June 6

    Application deadlines are on the LeaderShift website.  Spread the word to your colleagues, and if you applied for a cohort in 2018 and didn’t get an opportunity to attend, now’s your chance to re-apply. Learn more today.

    Primary Care and Health System Change video available

    In November The Change Foundation hosted Primary Care and Health System Change webinar, the recording of which is available here. Focused on how to lead change in Ontario, the conversation was facilitated by globally recognized change leader, Dr. Helen Bevan. Dr. Robert Varnam, who has led transformative primary care change in the National Health Service (NHS)- England, and an esteemed panel of primary care physicians, including Dr. Rob Annis, North Perth FHT and AFHTO’s board and Dr. Sarah Newbery, Marathon FHT, joined her.

    Building on this momentum, The Change Foundation has agreed to convene Ontario’s first virtual primary care network to discuss health system change. AFHTO and the Ontario College of Family Physicians look forward to continuing to support creating the space and opportunity for future discussions with primary care and propelling change within Ontario.

    Does joining a virtual community interest you? Click Here

    CHOGIP and online Human Resources toolkit

    CHOGIP: as AFHTO members, you’re eligible for the customized Community Health Ontario Group Insurance Program (CHOGIP). Contact Arthur J. Gallagher to request a complimentary consultation session to review your present Benefits Plan on a no-cost/no-obligation basis.

    Human Resources toolkit: AFHTO, in partnership with Humaniqa and Arthur J. Gallagher & Co. (Gallagher), is pleased to offer a comprehensive, online Human Resources toolkit. This web‐based solution offers tools and resources aimed at streamlining and easing the administrative burden for HR professionals. The program is free to CHOGIP members and available at a discounted price for others.

    HOOPP webinars for primary care

    Eighty percent of public sector employees said that pension benefits are a critical factor in accepting a job. Find out if becoming a participating Healthcare of Ontario Pension Plan (HOOPP) employer is right for you. The presentation will include detailed steps to becoming a participating HOOPP employer including information about becoming an OHA member.

    New resource to help obtain income support for patients with mental illness related disability

    Many people receive mental health care in primary care with limited access to specialists, yet ODSP uses specialist treatment and hospitalization to determine degree of disability. This report from the Collaborative Mental Health Care Working Group, University of Toronto can help you advocate for your patients.

    Global Leadership Conference proposals due Feb. 1

    On October 24-27, 2019 the International Leadership Association (ILA) is hosting their 21st Annual Global Conference “Leadership: Courage Required” in Ottawa.

    Submission deadline is Feb. 1, 2019 and can be submitted at their site.

    Health Quality Ontario news

    2019/20 Quality Improvement Plans (QIPs) priorities: priorities are now available and based on issues highlighted in Measuring Up 2018.

    The 2019/20 QIP priorities focus on issues related to reducing wait times, better transitions and hallway health care. There are also fewer indicators to make it easier for organizations to complete and implement their plans.

    New quality standard for low back pain: Health Quality Ontario has released a new quality standard: Low Back Pain. For more information about quality standards, visit their website.

    Falling Through the Cracks: Greg’s Story: Jan. 24, 2019

    Bookmark the webinar link for HQO’s virtual screening of Greg’s Story, a short film of a cancer patient’s journey through Alberta’s healthcare system. Learn more here.

    Leukemia 101- Training for oncology nurses and allied healthcare professionals: Feb. 6, 2019

    Join this free webcast on Leukemia, hosted by the LLSC. Learn more here.

    Government Webcast Series: Strategic Planning and Public Complaints: Feb. 20, 2019

    Attend this webcast on strategic planning and public complaints. Register now!

  • Asking patients about sexual orientation, gender identity: study

    Andrew D. Pinto, Tatiana Aratangy, Alex Abramovich, Kim Devotta, Rosane Nisenbaum, Ri Wang and Tara Kiran; St. Michael’s Hospital Academic Family Health Team

    Abstract

    BACKGROUND: Sexual orientation and gender identity are key social determinants of health, but data on these characteristics are rarely routinely collected. We examined patients’ reactions to being asked routinely about their sexual orientation and gender identity, and compared answers to the gender identity question against other data in the medical chart on gender identity.

    METHODS: We analyzed data on any patient who answered at least 1 question on a routinely administered sociodemographic survey between Dec. 1, 2013, and Mar. 31, 2016. We also conducted semistructured interviews with 27 patients after survey completion.

    RESULTS: The survey was offered to 15 221 patients and 14 247 (93.6%) responded to at least 1 of the sociodemographic survey questions. Most respondents answered the sexual orientation (90.6%) and gender identity (96.1%) questions. Many patients who had been classified as transgender or gender diverse in their medical chart did not self-identify as transgender, but rather selected female (22.9%) or male (15.4%). In the semistructured interviews, many patients expressed appreciation at the variety of options available, although some did not see their identities reflected in the options and some felt uncomfortable answering the questions.

    INTERPRETATION: We found a high response rate to questions about sexual orientation and gender identity. Fitting with other research, we suggest using a 2-part question to explore gender identity. Future research should evaluate the acceptability and feasibility of administering these questions in a variety of care settings. These data can help organizations identify health inequities related to sexual orientation and gender identity.

    Click here for access to full article

    Relevant Links:

  • Powassan and Area FHT officially opens new home

    The North Bay Nipissing article published on January 21, 2019

    By Laurel J. Campbell

    Powassan Town Square building gets thumbs up from residents, politicians, medical professionals

    POWASSAN — Over 100 people toured the new medical clinic during its grand opening on Jan. 18.

    “This is a wonderful centre,” said Nipissing MPP Vic Fedeli. “Its state-of-the-art technology and equipment provides the utmost in quality care and the layout and services offered here really put the patient first.”

    The new home of the Powassan and Area Family Health Team encompasses over 6,700 square feet in the Powassan Town Square building at 507 Main Street; five physicians, a nurse practitioner, two registered practical nurses, a mental health co-ordinator, and administrative and support staff work out of the space, which is also home to a foot care nurse, a certified diabetic health care educator, and a home and community care co-ordinator.

    “Integrating family health care services, such as are provided here, with the rest of our health care system is critically important,” said Fedeli. “The advantages offered by this medical centre will attract new health care professionals and allow for even more expansion of practices and acceptance of new patients in the future. This facility goes a long way in helping to cut hospital wait times and hallway care by providing for patients in their own community.”

    “For this building to happen partnerships had to be established with the province, the municipality, the developer, the health team and board, and be the doctors. A lot of negotiation went on and a lot of trust had to be established.” — Peter McIsaacSheila Latour, chair of the family health team board, smiled at the irony of Fedeli’s comment.

    “We helped define the term ‘hallway medicine’ at our previous location on King Street,” she said. “We had nurses in the halls delivering medications because we didn’t have enough office space. We played musical rooms. If someone wasn’t in on a given day, we’d put the foot care nurse in their space. Then she’d be in a different office next time. We had patients being weighed in the corridor, and when we wanted to hold patient education sessions we had to close the reception room, because it was the only place we could meet.”

    The new clinic has 10 examination rooms “so we don’t have to shuffle patients in and out of rooms during their visit,” said family health team executive director Anna Gibson-Olagos. “The doctors also have a large bullpen, a shared collaborative space for their office needs, and all the charting and notes that are involved outside of actually seeing the patient. It’s nice and big, so they can use it for meetings as well.”

    There are also rooms dedicated to dietary consultation, counselling, board meetings and public and patient education, IT storage, administration, a procedure room that fits a family, and a large staff kitchen.

    “If we wanted to have a staff lunch meeting before, we had to do it in the reception area when there were no patients waiting,” said Gibson-Olajos. “Our fridge, like our medications, was in the hallway. Now we have a room where we can have informal meetings, and a space where staff can just get away for a few minutes of solitude on a rough or emotional day.”

    The close quarters at the former medical centre also caused concerns over patient comfort and privacy, especially in the case of an emergency.

    “On occasion, we do have to call 911 for a patient,” Gibson-Olajos said. “At the previous clinic, the ambulance came to the front door and the stretcher came in through the waiting room, and had to stop in the hallway while the patient got dragged out of the examining room. There was no dignity or privacy for anyone.

    “We now have a separate entrance at the side of the building that leads directly to the examination hallways, and is designed for emergency use of stretchers and other equipment without anyone in reception or the counselling rooms being any the wiser. We’ve already had to use it once and it worked so much better for the patient, the EMS and the doctors involved.”

    Mayor Peter McIsaac said that the Powassan Town Square building “will be the corner stone of the community for the next 100 years or more,” and credited developer Sante Tomaselli for his foresight.

    “Mr. Tomaselli has made a huge investment in Powassan,” said McIsaac. “For this building to happen partnerships had to be established with the province, the municipality, the developer, the health team and board, and the doctors. A lot of negotiation went on and a lot of trust had to be established.”

    The vision of getting the Ministry of Health and Long Term Care to award a family health team to Powassan came from the former Municipality of Powassan Economic Development (MoPED) committee that did the work on the proposal and application in 2010.

    “After the health team was granted, one of the first things the ministry did was send someone to look at our medical clinic,” recalled Latour, who was a MoPED board member at the time. “He took one look around and said we would need a new building. It’s taken us eight years to get this far, and thanks to Mr. Tomaselli working with us in designing his building, we hope to make this a health care hub for Powassan and surrounding communities.”

    “Powassan is the heart of good living,” said McIsaac, “and the opening of this new medical facility today has proven it.”

    Click here to access the North Bay Nipissing article

  • Essex County NPLC expanding to Amherstburg

    The Windsor Star article published on January 15, 2019

    By Mary Caton, The Windsor Star

    Renovations will begin soon on the shuttered St. Bernard’s elementary school in Amherstburg in order to transform part of the building into a new nurse practitioner-led clinic.

    The town purchased the school from the Windsor-Essex Catholic District School Board last year with an eye towards making it a community hub.

    “Shovels will be flying once the construction companies are in place,” said Amherstburg Mayor Aldo DiCarlo.

    Town council approved the necessary renovations Monday on the heels of receiving approval from the Ministry of Health and Long-Term Care for $650,000 in funding for the clinic.

    The Essex County Nurse Practitioner-Led Clinic (ECNPLC) will expand its services into Amherstburg under a 10-year agreement.

    The group presently has clinics in Essex and Windsor.

    Pauline Gemmell, ECNPLC’s executive director, wrote a business case for an Amherstburg location last summer.

    “We had been told there was a need in the community,” Gemmell said. “Now that we’ve got the expansion funding, we’re very excited.”

    Gemmell said the Amherstburg clinic will have three full-time nurse practitioners, one full-time registered practical nurse, one half-time social worker, one half-time registered dietitian, one half-time health promoter and physiotherapy services.

    She said each nurse practitioner takes care of approximately 800 patients, meaning the clinic could serve 2,400 patients.

    “We have all kinds of (patient) applications already,” she said. “We are anticipating we’ll probably be full pretty quickly.”

    The ECNPLC’s website explains its clinic model “is designed to improve access to care for the thousands of individuals and families who do not currently have a primary health-care provider.”

    A nurse practitioner can assess, diagnose and treat a wide range of health issues in consultation with physicians and other health-care professionals.

    “We do a lot of education in our clinics,” Gemmell said.

    Gemmell said the Amherstburg clinic will require approximately 4,000 square feet of space within the defunct school’s 30,000-square-foot imprint.

    The goal is to have the clinic up and running by spring or early summer.

    DiCarlo said discussions continue with other possible tenants, including “at least one more big client” he hopes to announce in the near future.

    He’d like the hub to offer a mix of services “that generally spreads across the generations. I don’t like the old idea of putting seniors in the corner. I like the idea of mixing young and old. We’d like to see some shared use agreements.”

    Click here to access the Windsor Star article

  • Madawaska Valley opens family health team

    The Bancroft this Week article published on January 15, 2019

    By Chris Drost, Bancroft this Week

    The waiting area of the new Madawaska Valley Family Health Team was full of smiling faces on Friday, Jan. 11 as dignitaries, physicians and community representatives gathered with staff to celebrate the official ribbon cutting for the new family health team.

    Dr. Alex Otfield, who was introduced as a driving force behind the project, highlighted the fact that it has only been about a year since the application for the new family health team was submitted.

    Local physicians have collectively enrolled over 1,000 patients in the past six months and on Dec. 10, 2018, the FHT began seeing its first patients.
    The FHT currently includes two nurse practitioners Craig O’Brien and Tierney Lunney who work in cooperation with local physicians.

    Recruitment is actively underway for one full-time social worker, a part-time dietitian and part-time physiotherapist, according to executive director Susan Farrar.

    Champlain West clinical lead, Max Buxton, said “this is the model that physicians want to work in and it provides the best arrangement that patients can benefit from. It will provide access to services that patients won’t otherwise have locally, or what physicians working on their own could not provide. It is optimal for both young and older physicians.”

    Beginning Monday, Jan. 14, the FHT will begin taking a limited number of urgent care patients for those who do not currently have a family doctor.
    Farrar explained, “we will continue to expand our services as our team grows, to provide the community of Madawaska Valley with improved access to primary health care in the future. We eventually expect to be able to help provide care to all patients in need in our local area.”

    Service covers a wide area from Whitney to Eganville, Combermere and Madawaska Valley.

    Service covers a wide area from Whitney to Eganville, Combermere and Madawaska Valley.

    Funding for the FHT has come through the Ontario Ministry of Health and the Champlain LHIN.

    Dr. Otfield expressed his hope that this new FHT in Madawaska Valley will be the start of a new wave of family health teams across the province.

    The Ministry and the LHIN identified our community as in need based on hard data, according to Otfield.

    Funding came through a new budget line called “Interprovincial Primary Care Funding.”

    Following the official ribbon cutting and official photos, attendees enjoyed refreshments and cake in celebration of this important milestone for the community.

    Click here to access the Bancroft this Week article

  • Bits & Pieces: reminder to learn how to advocate for team-based care, free CAMH course & more

    Your Weekly News & Updates

    Reminder: This Friday, learn how to advocate for team-based care

    Join Hill+Knowlton Strategies, our government relations firm, this Friday, January 18, from 12 p.m. to 1:30 p.m. to hear about the new government’s priorities, to discuss how to work with your MPP, and to review the prepared key messages that will resonate.

    It’s important that MPPs are champions for team-based care as the government reviews primary care in the province and how it’s delivered. Learn how to effectively communicate with yours! Register for the webinar here.

    Leading transformation: building adaptive capacity

    This Advanced Learning Program offered by the Institute of Health Policy, Management and Evaluation (IHPME) has two modules, starting Feb. 28, 2019. Learners are presented with a leadership framework that focuses on building the capacity within themselves, their teams and their organizations to respond adaptively to the depth, pace and scope of change. You can learn more here and apply here. Early bird deadline is Jan. 17, 2019.

    Buprenorphine-Naloxone treatment for opioid use disorder: Free course from CAMH

    The Centre for Addiction and Mental Health (CAMH) is offering a free course on buprenorphine-naloxone treatment for frontline providers who provide treatment for opioid use disorder. The course fee ($350) is waived and covered by the Opioid De-Implementation Project if you use the link below to register.

    OISE Psychology Clinic welcomes child/youth and family therapy referrals

    Ontario Institute for Studies in Education (OISE) Psychology Clinic, a University of Toronto training site, has expanded services and is currently welcoming child/youth and family therapy referrals. Sliding scale fees are available. The clinic also offers opportunities for onsite visits to talk about the services being offered. To learn more, visit their site and see their poster.

    What are your clinical needs as a primary care provider?

    The Centre for Effective Practice (CEP) needs your help to select topics to inform their tool development process. What areas of patient care do you believe need clinical tools (e.g. decision aid, medication algorithm or evidence summary)? What topics interest you and would serve your needs as a primary care provider?

    Make your voice heard by participating in a short survey. It only takes five minutes and your answers will directly inform the clinical tools developed this year. All individual responses will remain anonymous.

    The CEP develops new clinical tools each year based on feedback from primary care providers such as yourself. All of the clinical tools and resources can be freely accessed on cep.health.

    Click here to take the survey.

    Prescription to get active

    Prescription To Get Active uses the power of a doctor or NP’s prescription to help encourage deconditioned, sedentary at risk patients to get more active. There are no costs associated with becoming a prescribing member and prescribers are asked only to commit to the program and reporting total Rx’s written on a quarterly basis.

    The only standardized provincial program to offer this level to all Ontarians, it’s now running in Markham, Stouffville, London, Toronto and Bancroft. You can find out more below:

    Volunteers needed for post-stroke rehabilitation research study

    Research has shown that music engages the brain bilaterally throughout extended networks.  Volunteers between the ages of 30 and 79 who have had a stroke more than 6 months ago and have difficulty with arm and/or hand movements are needed for a clinical research study using music and rhythm in post-stroke rehabilitation.

    For further information:

    ,or contact the investigator, Catherine Haire, at 647-521-5381; catherine.haire@mail.utoronto.ca.

    Predicting the Future: Charitable sector careers for the workforce of 2020: Jan. 22, 2019

    Learn what’s driving the Future of Work and the value of incorporating new tools and approaches into how you address staffing challenges. Register now!

    Changing CARE: Made-in-Ontario approaches to improving the caregiver experience: Jan. 28, 2019, Toronto

    Registration is required for this free event by the Change Foundation. Learn more here.

    Government Webcast Series: Strategic Planning and Public Complaints: Feb. 20, 2019

    Attend this webcast on strategic planning and public complaints. Register now!

  • Data to Decisions eBulletin #83: More tools for continuous improvement

    In this issue

    • Transitions in Tilbury
    • Help with patient surveys and QIPs
    • Developing a tool to help manage patients with dementia
    • More tools to help you keep getting better

    Transitions in Tilbury

    Last month, we shared the resources from Focus on Follow-Up, which included lots of innovative projects from our teams in the North East. But great things are happening all over! In case you missed Tilbury’s conference presentation, you can check out the slide deck here. In a hurry? Watch the trailer below. Want evidence that timely follow-up saves lives and makes our health system more sustainable?

    Help with patient surveys and QIPs

    Just in time for QIP season: A new tool that can automate your patient surveys and help you build your 2019-20 Quality Improvement Plan. We know that patient experience surveys are a great source of data, but we also know that distributing them and gathering the data can be time-consuming and difficult. HQI is a brand-new patient engagement & quality improvement tool from Cliniconex that uses your EMR to automate the process. It sends out patient experience surveys after they visit your team, then gathers and analyzes the data for you. Its dashboard function lets you track your performance over time and compare your aggregate results with your peers. HQI can also help you move from measurement to improvement. It allows you to spend less time gathering and formatting your survey data and more time developing QI initiatives. As you look at your data, it takes you step-by-step through the process of recording your insights, goals, and change ideas, and it turns these into a quality improvement plan (QIP) using Health Quality Ontario’s QIP template.

    • Want to know more? Check out this sneak peek of HQI that was shared with “the Q” – QIDSS, QIIMS, Data & Quality Coaches, and QIDSS-like folks – on a webinar back in December.
    • Want to see if your team fits the profile? Schedule a follow-up session for your team. Email sales@cliniconex.com or call 1-844-891-8492.

    Developing a tool to help manage patients with dementia

    Are you a family physician who assesses patients with dementia? Maybe you wish you had better tools to support you in this work, or you have ideas about what would make such a tool great. Here’s a chance for you to share these ideas and help create some tools that will make it easier for clinicians like you to make good assessments! Researchers at Queen’s and Ryerson Universities and Bridgepoint Active Healthcare are developing an eLearning platform for dementia assessment and management. To help them get it right, they’re conducting focus group sessions with clinicians from January through March. You’ll only need to attend one session, no longer than two hours, and you’ll receive an honorarium to offset the costs of travel and taking time away from work. There’s also an opportunity to participate remotely if travelling to Toronto or Kingston would present a barrier. Want to learn more? Ready to sign up? Email Lorraine Pirrie or Carolyn Steele-Gray. Or call Carolyn at 416-461-8252 x 2908.

    More tools to help you keep getting better

    Our partners at the Excellence through Quality Improvement Project (E-QIP) are presenting a series of webinars to support your team’s QI efforts. See below for times, dates, and links to register.

    In Case You Missed It: Check out eBulletin #82 or other back issues here!

    Questions? Comments? Connect with the QIDS team at improve@afhto.ca.

  • Supports Available for Management of Chronic Pain and Addictions

    Originally posted January 9, 2019. Last updated November 5, 2019. 

    HQO is convening a large set of partner organizations, including AFHTO, to compile a coordinated program of supports to help clinicians manage their patients’ pain, including appropriate use of opioids. An overview of the “partnered supports” process can be found here. On March 8th, 2018, HQO presented a webinar outlining these supports; the slide deck from that webinar is available here. More detail on some of these resources are presented below. This list is presented as a menu, from which primary care providers can choose based on what’s right for their patients and their team. To help you identify the patients who would benefit from this kind of care, consider using a QIDSS-developed EMR query to create a list of patients who use opioids.

     

    Buprenorphine-Naloxone Treatment for Opioid Use Disorder (Centre for Addiction and Mental Health)

    The Centre for Addiction and Mental Health (CAMH) is offering a course on Buprenorphine-Naloxone Treatment for Opioid Use Disorder for frontline providers who provide treatment for opioid use disorder. This course presents a framework for providing maintenance treatment for opioid use disorder with buprenorphine/naloxone, including its use in a primary care setting. The course walks the learner through the key elements of selecting, preparing, initiating and maintaining a patient with opioid use disorder on buprenorphine/naloxone treatment.

     

    FREE: Opioids Clinical Primer (MacHealth; Women’s College Hospital; University of Toronto Department of Family and Community Medicine)

    This primer is a series of six free, accredited online courses targeted at primary care providers (physicians and non-physicians). Key topics include: Diagnosing and Managing Opioid Use Disorder; Initiating Buprenorphine; Strategies for Prescribing Opioids and Managing Patients on Opioids; Addressing the Connections Between Substance Use Disorder and Mental Health; Managing Patients with Chronic Pain – Beyond Opioids. Courses are available through MacHealth; you will be required to sign up (for free) with your email address.  The first course was released in December 2018. Three courses are currently available, and three more are coming soon.

     

    Team-Based Approaches to Chronic pain management: Opioid Stewardship 

    This presentation, delivered by Dr. Jennifer Wyman, will introduce you to some of the principles of safe pain management and opioid stewardship, as well as the Opioids Clinical Primer. Click here to access the slides.

     

    Collaborative Mentoring Networks for Addictions and Pain (OCFP)

    The Ontario College of Family Physicians (OCFP) Collaborative Mentoring Networks now include Medical Mentoring for Addictions and Pain (MMAP). This program supports physicians with relevant expertise to mentor family physicians interested in chronic pain and addictions. The Collaborative Mentoring Networks are certified under Mainpro+.

     

    Management of Chronic Non-Cancer Pain (CNCP) Tool, Opioid Manager, and Opioid Tapering Template (Centre for Effective Practice)

    Through a multidisciplinary and multidimensional approach, the Centre for Effective Practice (CEP) has designed a Management of Chronic Non-Cancer Pain (CNCP) Tool. This tool will assist family physicians and primary care nurse practitioners develop and implement a management plan for adult patients living with pain.

    Developed under the clinical leadership of Dr. Arun Radhakrishnan, Dr. Jose Silveira, and Dr. Andrea Furlan, the updated Opioid Manager (2017) and Opioid Tapering Template (2018) are designed to support health care providers prescribe and manage opioids for patients with CNCP. As an update of the original Opioid Manager (2011), the new Opioid Manager includes feedback from end users and recommendations from the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.

    In addition to the Management of CNCP Tool and the Opioid Manager, the CEP will be offering an academic detailing service to primary care providers, beginning in Winter 2018. Watch this space for more information.

     

    Opioid Use Disorder Tool (Centre for Effective Practice)

    This tool, launched in December 2018, was developed by CEP to support primary care providers in screening, diagnosing, and implementing opioid agonist therapy (OAT) for patients who have problems with opioid use. It emphasizes a stigma-free and empathetic approach and provides talking tips to help navigate difficult conversations about opioid misuse. Clinical leadership was provided by Arun Radhakrishnan and Jennifer Wyman. You can access it here.

     

    EMR Support for Opioid Use Management (OntarioMD)

    Through their EMR Practice Enhancement Program (EPEP), OntarioMD provides customized, CME-accredited support, including access to Peer Leaders, for physicians who wish to optimize their EMR use –  including using the EMR for safer opioid prescribing. OntarioMD is working closely with AFHTO and EMR vendors to develop more EMR tools to help with management of opioid use, including development of an EMR dashboard. Watch this space and our weekly newsletter for updates.

     

    EMR Tool for CNCP (eHealth Centre of Excellence)

    The eHealth Centre of Excellence has developed an EMR tool in partnership with the Centre for Effective Practice (CEP), which incorporates the Management of Chronic Non-Cancer Pain (CNCP) Tool (see above). It is currently available for TELUS PS Suite and OSCAR EMR, and an Accuro version will be developed. The tool is divided into the following sections: Baseline Assessment, Ongoing Assessment, Non-Pharmacological Therapy, Non-Opioid Medications, Opioid Medications and Intervention Management and Referral. This approach allows clinicians to conduct a complete assessment and provide a tailored management plan that incorporates the patient’s goals, while adhering to current best practices in providing improved CNCP management overall.

     

    Opioid Use Toolbar (East Wellington FHT, Guelph FHT, and TELUS Health)

    East Wellington FHT, Guelph FHT, and TELUS Health developed this toolbar to support opioid tapering in the TELUS PS EMR. It was informed by content from the 2017 Canadian Guidelines for Opioids in Chronic Non-Cancer Pain and the EMR tool developed by the Centre for Effective Practice (described above). Kevin Samson, who leads the TELUS Community of Practice and supports AFHTO’s EMR Data Management Subcommittee, was involved in its development and has posted information about it here.

     

    Opioid prescribing profiles (Health Quality Ontario)

    The most recent iteration of the MyPractice report gives information to individual physicians about their opioid prescribing patterns.

     

    ECHO Ontario Chronic Pain & Opioids

    To learn more about ECHO (Extensions for Healthcare Outcomes) you can check out their webinar presented to AFHTO members on January 30th, 2018. Their webinar from November 19, 2018, on opioid tapering and tools for use in clinical practice with Dr. Andrea Furlan can also be seen here.

     

    Making the Choice, Making it Work: Treatment for Opioid Addiction

    This is a book from the Centre for Addiction and Mental Health (CAMH) and is available as a PDF on their website. It describes a variety of approaches and is particularly focused on opioid agonist therapy.

     

    Reducing Harm from opioids in primary care (St.Michael’s Hospital Academic FHT)

    The inter-professional team following interviews with staff physicians, patients and analysis of data has created a multifaceted strategy to reduce the harm from opioids within their neighbourhood. Further information about their initiative can be found in the poster presentation here. 

    Opioid Stewardship: Implementing Pharmacist Led Assessments for Patients Co-Prescribed Opioids and Benzodiazepines at an Academic Family Health Team

    To learn more about how a pharmacist can help your team reduce patients’ mean daily opioid and benzodiazepine doses, you can check out a poster presentation here. 

    Online opioid self-assessment programopioid 

    The Online Opioid Self-Assessment Program is a FREE course developed with funding from Health Canada to improve opioid prescribing. It’s highly interactive and uses assessment as a technique for knowledge exchange and guideline implementation. In order to facilitate active

    learning, a variety of techniques are employed, including videos, case presentations and an assortment of question types to keep you engaged and apply it in practice.

     

    Dr. Andrea D. Furlan MD PhD, ECHO Ontario Co-Chair, developed this interactive course with other colleagues in physiatry, family medicine and addictions medicine. This course is based on the updated 2017 Canadian Opioid Guideline.

     

    Other Resources

    Take advantage of the wisdom of the field: Several AFHTO members have successfully developed tools and programs to support opioid stewardship and pain management. See below for examples and links to resources you can adapt for your own patients.

    Chronic Pain and Addictions Management in a Family Health Team (Marathon FHT)

    The Marathon Family Health Team has had a Chronic Pain & Addictions program since 2014. Now called the High-yield approach to Risk Mitigation and Safety (HARMS) program, it has two streams tailored to different degrees of risk. As a part of these programs, patients being prescribed opioids sign a contract with their prescribing practitioner and agree to urine drug screens (UDS). You can see an overview of the program here [PDF].  Supporting documents, including the patient information handout, contracts, and UDS protocol are available to AFHTO members here.

    Pain Management With Less (or no) Medication (Belleville NPLC)

    AFHTO teams have demonstrated that there are ways to manage pain without the use of opioids or other medications. Belleville NPLC, an AFHTO-member team, collaborated with musculoskeletal experts to participate in a low back pain management project. Although it started as a pilot, they have expanded the project by collaborating with local partners. Patients report that they rely less on medications, including opioids, to help manage their back pain. Belleville NPLC won a 2017 Bright Lights award for their implementation and expansion of this program. You may wish to consider adopting a similar program in your team and reaching out to your peers at the Belleville NPLC to learn more about what they did and what they have learned from it.

    Get some context: The Ontario Drug Policy Research Network and the Institute for Clinical Evaluative Sciences (ICES) have developed an online, interactive tool called Indicators of Opioid Prescribing in Ontario. This tool allows you to access data about rates of opioid prescribing and opioid agonist therapy (OAT) use in Ontario by age, sex, region, and drug type. Want to see patient stories about how opioid use disorder affected them, and how they benefited from treatment? 

     

  • Bits & Pieces: Welland McMaster FHT reduces ED visits, LeaderShift update & more

    Your Weekly News & Updates
    Welland McMaster FHT reduces ED visits with Mental Health and Addictions Response Team Since its inception in July 2018, Welland McMaster FHT’s 2018 Bright Lights-nominated program – Mental Health and Addictions Response Team (MHART) – has responded to 101 emergency calls for low acuity mental health and addictions patients with only 9 of those callers needing transport to the ED. The program has already seen a 5% reduction in mental health transports by ambulance to the ED compared to the same time period prior to MHART launch and they aim to reduce ED visits by 10% by January 2019. Find out how here. In this Issue: Welland McMaster FHT reduces ED visits with Mental Health and Addictions Response Team Opioid Use Disorder Tool LeaderShift update St. John Ambulance first aid training discount RN prescribing: seeking feedback on proposed regulation changes Upcoming events regarding strategic planning and more          
    Opioid Use Disorder Tool The Centre for Effective Practice has launched the Opioid Use Disorder Tool. It was developed to support primary care providers in screening, diagnosing and implementing opioid agonist therapy (OAT) for patients who have problems with opioid use. It emphasizes a stigma-free and empathetic approach and provides talking tips to help navigate difficult conversations about opioid misuse. Access it here.
    LeaderShift update LeaderShift has engaged OPTIMUS | SBR to help increase the leadership capacity in the sector by identifying different leadership career pathways through different primary research and engagement activities. The team will identify opportunities and barriers to enhancing leadership capacity and develop recommendations to build upon strengths while addressing issues and gaps. At the end of the project they hope to achieve the following:

    • An increased understanding of the career pathways and compensation levels of community and primary healthcare leaders (in-sector, cross-sector, out of sector)
    • Actionable recommendations to enhance the retention of leaders in the sector
    • Actionable recommendations to operationalize key lessons, capabilities, and capacity built through the Leadershift program
    • Identification of opportunities to increase the leadership profile of the sector

    There will be opportunities for leaders to provide input through several engagement activities; they will be reaching out to organize these sessions over the coming weeks. They’d like to ask each organization to identify one HR Lead/Manager to provide input and support the collection of data and documents from member organizations. Please identify your HR Lead/Manager via the survey link. If you are a small organization with an ED that manages the HR please also indicate that in the survey. Please try to complete the survey by the end of this week to help facilitate the set-up of engagement events this month. Rachel Steger, the project manager at OPTIMUS | SBR, would be happy to answer any questions or provide any further detail on the project and can be reached at rachel.steger@optimussbr.com. Thank you for your continued support and your participation in this project.
    St. John Ambulance first aid training discount St. John Ambulance in Burlington would like to extend the offer of a 25% discount for those professionals seeking to renew any of their required qualification in cardio pulmonary resuscitation (CPR) from Jan 1st to Feb. 28, 2019 at their branch location. Please feel free to call the branch to book your course and quote CPR201902.         RN prescribing: seeking feedback on proposed regulation changes The College of Nurses of Ontario’s (CNO’s) Council is seeking feedback on draft regulations that will:

    • permit RNs to prescribe certain medication and communicate diagnoses for the purpose of prescribing; and
    • impact nursing practice related to dispensing and administering medications.

    Visit their consultation page for more information, including the draft regulation. You can submit your feedback to regulations@cnomail.org or complete the online survey by Feb. 18, 2019.
    Governance Webcast Series: Strategic Planning, Jan. 15, 2019 Learn how strategic planning can bring your organization growth and success. Register now! Asthma Action Plans: From Research to Real World Usage, Jan. 10, 2019 Attend this webcast on Asthma Action Plans, hosted by The Lung Association. Learn more here.
    Asthma Action Plans: From Research to Real World Usage, Jan. 10, 2019 Attend this webcast on Asthma Action Plans, hosted by The Lung Association. Learn more here. Changing CARE: Made-in-Ontario approaches to improving the caregiver experience: Jan. 28, 2019, Toronto Registration is required for this free event by the Change Foundation. Learn more here.

     

  • Welland McMaster FHT reduces ED visits with Mental Health and Addictions Response Team

    The Niagara Region has been experiencing an increased demand for emergen­cy health services, which places non-sustainable demand on available resources. Niagara Emergency Medical Services (NEMS) engaged in strategic program development to address low acuity mental health and addictions calls in the community. This resulted in Welland McMaster FHT’s 2018 Bright Lights-nominated program – Mental Health and Addictions Response Team (MHART). Made up by an Advanced Care Paramedic, a Mental Health Nurse and a Mental Health Community Worker, since its inception in July 2018, MHART has responded to 101 emergency calls for low acuity mental health and addictions patients with only 9 of those callers needing transport to the ED. They have also made 70 referrals to community agencies and mental health supports. The program has already seen a 5% reduction in mental health transports by ambulance to the ED compared to the same time period prior to MHART launch and they aim to reduce ED visits by 10% by January 2019. To learn more, click on the poster image below.

    Niagara Mental Health and Addiction Response Team (MHART): A Collaborative, Inter-sectoral Initiative[/caption] Relevant Links: