Tag: Concurrent Sessions

Theme 4. The “How to” stream

• Date: Wednesday, October 24, 2018
• Concurrent Session E
• Time: 2:30-3:15pm
• Room: Harbour B
• 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 “How To”:

• Implement a patient-centered approach to manage transitions from hospital to home in a primary care setting
• Capture/identify discharged patients using your EMR
• Follow-up with ALL in-patient discharges within 7 days (no triaging, no eligibilities) Efficiently perform a medication reconciliation on discharged patients
• Integrate timely screening tools and internal/external referrals (Health Links, LHIN Home/Community Care, Malnutrition, Diabetes)
• Utilize the interdisciplinary team to increase capacity in the hospital discharge follow-up process
• Incorporate different modules of the process depending on available resources

Summary/Abstract Literature and research state and prove that post hospital discharge follow-ups within 7 days reduce 30-day readmissions and improve patient-centered care.  This presentation focuses on “how to” implement an effective hospital discharge follow-up process with existing resources in primary care. Following-up with ALL discharged patients was the team’s goal, therefore, scalability was cemented as a core foundation during the design phase.  This led to the development of a modular process that can be implemented by teams of all sizes and varying resources. The core module is the Hospital Discharge Follow-up process which can be combined with additional independent modules: Medication Reconciliation, Screening, and Program Navigation. Tilbury District Family Health Team implemented this 7-day hospital discharge follow-up   process that uses a holistic and team-based approach to accomplish the following: contact patient, assess patient condition, perform a medication reconciliation, screen for malnutrition/readmission risk and provide individualized post hospital discharge support. The team leverages queries/searches and forms within the EMR to seamlessly identify and assemble pertinent information on every in-patient discharge from all surrounding hospitals. These tools streamline communication and collaboration within the team and allow PCPs/IHPs to have timely and more meaningful hospital discharge follow-ups with patients. Patients are very appreciative of this process and have expressed feelings of security, relief and trust that their Family Health Team will provide them with support during times of transition. This modular process was designed to be actionable, scalable, and shareable in a primary care setting, and the AFHTO conference is the best forum to share. Presenters 

• Diana Nichol, RN, BScN, Tilbury District Family Health Team
• Andrew Atkins, QIDSS, Windsor Family Health Team

Theme 1. Mental health and addictions

• Date: Wednesday, October 24, 2018
• Concurrent Session A
• Time: 2:30-3:15pm
• 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

Learning Objectives Learning Objectives: The Addictions Counsellor works with patients and their family members suffering from substance abuse and other addictions. The feasibility and impact of such a role was analyzed. This will include:

1. An inquiry into the Addictions Counsellor role and how it parallels the mental health service in collaboration with the broader interprofessional health team.
2. Outcome measurements such as the Treatment Efficacy Assessment as well as patients’ perceptions and satisfaction with the care they received.
3. Observations, enablers and challenges of implementing this role in a primary care setting.

Summary/Abstract Primary health care providers are uniquely situated within the broader system to provide accessible, individualized, and continuous care for individuals with mental health and addictions needs. Specifically, primary health care providers provide assessment, counselling, and referral and are often patients’ first line of contact for their healthcare needs. In Ontario, opioid misuse is one of the leading causes of accidental death. This public safety issue has sparked the government’s commitment to preventing opioid abuse and modernizing pain management practises.  Addictions is increasingly being acknowledged as a complex issue requiring a holistic and comprehensive approach. Within our broader quality improvement strategy and organizational commitment to addressing addictions, North York Family Health Team (NYFHT) introduced the role of Addictions Counselor as part of a pilot program within our Mental Health Services team. The NYFHT Addictions Counselor works with patients suffering from substance abuse and other addictions such as gambling. This individual also provides addictions support for family members in a patient centered, holistic approach. In addition to individual counselling, the Addictions Counselor will also support the development of coping and recovery programs. The results of this pilot will provide insight into the feasibility and impact of such a role in a family health team setting. Preliminary quantitative and qualitative outcomes and observations will be shared. In particular, patient outcomes including the Treatment Efficacy Assessment (TEA) score will be examined, as well as an exploration into patient satisfaction and perceptions of this program. Presenters:

• Katrina Demetriou, BA (Hons), ADMH (Hons), CCAC, MACP (Cand.) / Certified Canadian Addictions Counselor, North York Family Health Team 

Authors/Contributors:

• Katrina Demetriou, BA (Hons), ADMH (Hons), CCAC, MACP (Cand.) Certified Canadian Addictions Counselor, North York Family Health Team
• Joyce Lo, RN, MN Project Coordinator, North York Family Health Team
• Susan Griffis, RN, MA, DBA, CHE Executive Director, North York Family Health Team

Theme 5. Why hasn’t this expanded: scalable pilot programs

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room: Pier 2 & 3
• Style: Presentation (information provided to audience, with opportunity for audience to ask question)
• 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, Representatives of stakeholder/partner organizations

Learning Objectives

1. Discuss how poverty affects health and mental health
2. Explore specific interventions to reduce poverty and improve health in clinical practice
3. Provide practical tips and strategies to help advocate for income supports for our patients While this presentation can be covered in 45 minutes, a 1.5 hr presentation would allow for greater audience participation and a more thorough understanding of social support programs

Summary/Abstract In this engaging and interactive workshop participates will follow a case study of an individual from 25 years to retirement and explore the various income supports necessary to support this person’s health, increase medical care engagement, and increase medication adherence.  From mental health crisis through to retirement, participants will learn when to apply for various social programs, how to apply to them, as well as why money matters to support both mental and physical health.    This presentation will also discuss the Income Security Health Promotion program at St. Michael’s Academic Family Health Team.  An innovative program with big impacts on the social determinants of health.  This program is well researched and shows big impacts in three key  outcome areas: increasing income, reducing expenses, and improving financial literacy.   This interactive session will allow for question and answer periods and an engaging style as we investigate which social benefit program to apply to next.  Presented at various medical venues this workshop has received high praise for its interaction, engaging style, and the expertise of the presenters.  Engage with two income experts as we answer the question “why does money matter anyways”. Presenters

• Alyssa Swartz, MSW RSW Income Security Health Promoter, St. Michael’s Academic Family Health Team
• Chloe Walls, MSW, RSW Income Security Health Promoter, St. Michael’s Academic Family Health Team

Theme 6. The future of the regional approach to healthcare

• Date: Session Cancelled
• Concurrent Session E
• Time: 
• Room:
• Style: Workshop (session is structure for interaction and/or hands-on learning opportunities)
• 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.), Representatives of stakeholder/partner organizations

Learning Objectives Sharing lessons learned in the overview of the formation of the Francophone Community of Practice in the Mississaugua Halton LHIN. How to foster thriving collaborative relationships with the local francophone planning entity (Reflet Salveo). How to conduct a consultation process with the local francophone community based on the experience in the Mississauga Halton and Central West LHIN, including the use of actors to create visual and visceral learning about the minority official language experience in Ontario. Opportunity to participate in a re-creation of the interactive planning and reflection process to apply back in your community with various diverse communities. Summary/Abstract In the GTA the needs of the francophone community are difficult to quantify due to the small and extremely diverse proportion of the population who identify as francophone. This session will describe the regional planning approach at the LHIN and francophone planning entity level and the FHTs role. Walking through the process of establishing a community of practice to function in English but engage the minority language population services providers will be described and some of the resulting successful projects and services that have been achieved will be described as well as lessons learned through the process.  Through the use of dramatic vignettes performed by a pair of actors, the audience will participate in the same process the francophone community experienced to develop a rich response to common minority population experiences. The community engagement model is simple but very effective and easily translatable to other types of minority communities’ consultation. It also provides a fun tool for participants to take back to their home community. Presenters

• Rosslyn Bentley, Executive Director, Credit Valley FHT
• Elizabeth Molinaro, Lead, French Language Services, Mississauga Halton LHIN
• Christiane Fontaine, Health Promoter – francophone, East Mississauga CHC
• Florian Francois, Actor, self employed

Authors/Contributors:

• Gilles Machildon, Executive Director, Reflet Salveo
• Housseyn Belaiouer, Planning and Community Engagement Officer Reflet Salvéo
• Tanzina Islam, Manager, Health Promotion & Community Relations, East Mississauga Community Health Centre
• Charis Romilly Turner, Director, East Mississauga Community Health Centre

Theme 6. The future of the regional approach to healthcare

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room: Harbour A
• 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.), Representatives of stakeholder/partner organizations

Learning Objectives In this session, participants will learn how interdisciplinary professionals from different organizations with similar missions can collaborate to produce synergistic programs and outcomes. We will focus on how group decision making and collaborative planning, implementation, and evaluation is critical when developing a program. Participants will hear about, the internal supports required for successful team building as well as the lessons learned so far in this process. Summary/Abstract For the past four years, the Windsor-Essex County Heath Unit has worked collaboratively with two Family Health Teams, two Nurse Practitioner Led Clinics and two Community Health Centres in a partnership called the Community Primary Care and Public Health Leadership Committee.  Within this larger collaborative, a subgroup of Registered Dietitians (RDs) have come together to research, design, and evaluate an evidence-based classroom-delivered healthy eating series, entitled Eat4Life.  This three module series is taught by RDs from all participating organizations and is offered throughout Windsor and Essex County. This shared delivery model allows for a broad program reach while lessening the burden on any individual organization. The evaluation strategy was agreed on and adopted by all participating organizations. Module 1- Healthy Eating, has been developed, delivered and evaluated by all of the partners. Results of the evaluation have been used to update this module. Module 2- Weight Loss, has taken more time than planned to develop due to lack of unanimity about the most appropriate evidence-based approach for weight loss. Module 3- Mindful Behaviours, has involved mental health clinicians from several of the partner organizations in the development stage of the module. This is a key example of the multidisciplinary involvement in the delivery and development of the program. Eat4Life is a real world example of a regional collaboration between primary care and public health.  The success of this partnership highlights how working collaboratively across organizations can improve patient access and experience, while minimizing the workload for each individual organization. Presenters

• Karen Bellemore, MScFN, RD. Public Health Nutritionist, Windsor-Essex County Health Unit
• Lauren Fleming, R.D., Windsor-Essex CHC

Authors/Contributors:

• Heather Nadon, R.D., Windsor Essex County Health Unit
• Lauren Fleming, R.D., Windsor-Essex CHC
• Christine M. Wellington, R.D., VON Lakeshore NPLC
• Claudia Takahashi, R.D., City Center CHC

Theme 5. Why hasn’t this expanded: scalable pilot programs

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room: Harbour C
• Style: Panel Discussion (in addition to providing information, panelists interact with one another to explore/debate a topic)
• 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

• As a result of this session, participants will:
• Learn strategies for successfully and comprehensively co-managing patients with low back pain, opioid use, and other co-morbidities across two interprofessional team models to maximize sub-region resources,
• Learn about the impact of coordinated care from the patients perspective,
• Learn about successful care pathways used in this pilot, and
• Learn the value of having MSK experts incorporated into interprofessional teams and scaling and spreading this pilot

Summary/Abstract Low back pain is a leading cause of disability worldwide and is reported in over half of opioid users. Currently, there lacks funded interprofessional primary care that includes musculoskeletal (MSK) experts to manage patients’ low back pain. Helping to address this, the Ministry of Health and Long-Term Care launched seven Primary Care Low Back Pain Pilot sites that include MSK experts, such as chiropractors, physiotherapists, and occupational therapists working in interprofessional primary care teams to manage patients’ low back pain. The pilots have been highly successful in reducing patients’ low back pain, pain medication use, and disability and improving patients’ quality of life. Many of the patients’ in this pilot are of low socioeconomic status without extended health benefits who prior to the pilot, were unable to access any funded, primary care treatment for their low back pain.  This session, presented by chiropractors, a physiotherapist and executive director  occupational therapist from two different interprofessional pilot site models will highlight the experiences of providers and patients, the evaluation findings and how the care pathways used in this pilot can be scaled and spread to other health teams. Presenters

• Bruce Flynn, DC, Lead Chiropractor, Belleville NPLC
• Murray Townsend, DC, Chiropractor, Mount Forest Chiropractic
• Suzanne Trivers, Executive Director, Mount Forest FHT
• Ronda Schnurr-Smith PT, MScPT, Physiotherapist, Impact Physiotherapy

Theme 4. The “How to” stream

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room:  Pier 9
• 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: Clinical providers

Learning Objectives

1. Understanding of how legal issues impact health
2. Recognize importance of key partnerships and collaborations
3. Be able to implement a legal health clinic in your clinic
4. Impact of access to legal consultation in familiar primary care setting

Summary/Abstract The McMaster Family Practice(MFP) Legal Clinic is a partnership with MFP, Legal Aid Ontario(LAO) and Hamilton Community Legal Clinic(HCLC) where patients are screened for everyday issues that could become legal issues.  Through this process patients are offered a free, in clinic consultation with one of our partner lawyers through LAO and HCLC depending on the area of law.  In review and discussion of the screening tool Legal Health Check Up – we will identify everyday issues that could become legal issues and how the legal issues impact health.    We will review the collaborations and partnerships that made the MFP Legal Clinic possible and the benefits to all partners.  We will share how our patients are screened and how we have fit the process from screening to consultation within our clinic work.  And, we will also share the impact that this access to legal consultation has had on our clinic and patients. Presenters

• Dan Edwards, System Navigator, RSSW, McMaster Family Practice
• Gina Agarwal, MBBD PHD MRCGP CCFP FCFP and Staff Family Physician McMaster Family Practice, Associate Prof, McMaster University
• Sharon Crowe, B.A. (Hons), LL.B Staff Lawyer, Hamilton Community Legal Clinic

Theme 4. The “How to” stream

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room: Pier 4
• Style: Panel Discussion (in addition to providing information, panelists interact with one another to explore/debate a topic)
• 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 The three key learning objectives of this session are:

• To understand why caregivers are important in care
• To learn how we engaged family health team providers in the development of an awareness toolkit in primary care
• To demonstrate how family health teams can collaborate with caregivers to improve quality of care

Summary/Abstract Connecting the Dots for Caregivers aims to improve awareness and recognition, information exchange and communication between caregivers and providers.  It is a collaborative partnership between The Huron Perth Healthcare Alliance, Alzheimer’s Society of Perth County, North Perth Family Health Team, One Care Home and Community Support Services, South West Local Health Integration Network and STAR Family Health Team.  The project is funded by The Change Foundation and supports improving the caregiver experience. During the first phase of the initiative, ‘The Time to Talk’ toolkit was launched at STAR Family Health Team to raise awareness of the role of family caregiver, and to build support for both family caregivers and healthcare providers. A collection of tools are currently being piloted at STAR Family Health Team before being rolled out to partner organizations.  This innovative initiative was co-designed by caregivers and healthcare providers with support from the project team members.   Various techniques used to engage providers throughout the process will be shared.  This initiative will be evaluated, improved if necessary, and then expanded to the other organizations. Presenters

• Erin Heisz, Family Physician, STAR Family Health Team
• Heidi Didiomete, Family Caregiver
• Catherine Walsh, RN, BScN, MSc-Co-Design Lead/Educator, Huron Perth Healthcare Alliance
• Mary Atkinson-RN, BSc, MBA, CHE Executive Director-North Perth Family Health Team
• Michelle Carter, MRT (ACR), BHSc Quality Improvement Specialist, Huron Perth Healthcare Alliance

Authors/Contributors:

• Mary Atkinson-RN, BSc, MBA, CHE Executive Director-North Perth Family Health Team
• Monique Hancock- Executive Director- STAR Family Health Team
• Harpreet Bassi and/or Michelle Carter- Moderators, Senior Program Associate-Change Foundation/ Quality Improvement Specialist- Huron Perth Healthcare Alliance
• Michelle Carter, MRT (ACR), BHSc Quality Improvement Specialist, Huron Perth Healthcare Alliance
• Jennifer Hubbard, Project Manager, Huron Perth Healthcare Alliance
• Samantha McRae, Co-Design Lead Educator, Huron Perth Healthcare Alliance
• Danielle Van Duzer, Communications Specialist
• Catherine Walsh, RN, BScN, MSc-Co-Design Lead/Educator, Huron Perth Healthcare Alliance

Theme 3. Expanding your reach

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room: Pier 5
• 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 At the end of this workshop, participants will have the tools to build their own Adolescent Outreach program. Specific learning goals for this workshop include:

1. To learn to develop strategies on engaging and building relationship with local high schools
2. Creating a program that is aligned with the school’s curriculum
3. Creating a dynamic inter-professional team to deliver the program
4. Incorporating learners and teaching in this model
5. Evaluation of the program

Summary/Abstract The Adolescent  Outreach Program was created in 1988 to allow adolescents  in our community an opportunity to ask questions and have their health concerns addressed by physicians in a confidential and non-judgmental setting.  The program also aimed to increase Family Medicine residents’ exposure to the health issues and concerns facing adolescents, a group that traditionally does not visit their Family Physician regularly. In 2011, with the establishment of Sunnybrook Academic  Family Health Team, inter-professional teams consisting of a physician, residents, dietitian and social worker as appropriate started visiting local high schools to provide education on topics such as mental health, sexual health, body image etc. Each session is approximately one hour in duration, with approximately 20 – 25 students in attendance.  Students have the opportunity to submit written questions anonymously and ask questions directly on pre-identified topics. Teams led by residents use various interactive methods such as games/quizzes/small group activities to engage adolescents.  With information technology available at the finger tips of adolescents, it’s necessary to have a secure platform to provide correct health education early.  Therefore, primary care involvement in Adolescent health needs to be increased across the province. Our program is one such example of a platform to educate and promote health for adolescents. This session will outline the process of creating a formal inter-professional Adolescent Outreach program in a Family Health Team, whether it be in an Academic setting or not. We will share our best practices as well as lessons learned since the establishment of the program. Presenters

• Purti Papneja, Family Physician and Assitant Professor at University of Toronto, Sunnybrook Health Sciences Center, Department of Family and Community Medicine
• Anne Wideman, Family Physician and Assitant Professor at University of Toronto, Sunnybrook Health Sciences Center, Department of Family and Community Medicine

Theme 2. Healthy relationships, healthy teams

• Date: Thursday October 25, 2018
• Concurrent Session E
• Time: 11:00-11:45am
• Room: Harbour B
• 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 As a leader do you wish that people around you would speak up more? Does resistance to change in your organization frustrate you? Do you feel that there is too much complaining and not enough positive action? Do you aspire to tap into the collective intelligence of not only your management team but of your entire organization? Liberating Structures greatly cuts down time spent to managing top-down decisions, create space for all contributions to emerge and be taken into consideration. Participants will gain some insights to how to liberate themselves as formal leaders from the burden of being consistently “in command” Summary/Abstract Since its inception, the Guelph FHT has evolved as an organisation in many areas. Staff engagement is a core component of the Guelph FHT Strategic Plan and has evolved significantly to include collaborative decision-making and greater expectations around patient engagement, change management, community partnership and evaluation and QI. By liberating structure, we want to create space for all ideas to emerge and be considered, enabling and inviting staff to participate and contribute on a daily basis. This new philosophy “lives” in our organization in many ways, including tiny shifts in the way we meet, plan, decide and relate to one another. Inclusive leadership” leads to increased innovation, fosters teamwork and has dramatic impact on motivation. From practice-based team huddles to discipline meetings , working groups and committees (examples include: COPD/ CHF Quality, Education/ Wellness , Outcomes, Health Link, Best Employer, Health and Safety) staff are involved in micro-structures aimed at sharing information generating ideas and building new approaches to our work. For staff, these processes build morale, enhance skills and strengthen our team. One might ask how an organisation could remain efficient and productive with this level of engagement.  We believe the influx of employee ideas and initiatives has had a direct impact on process improvement, leading to increased efficiency, higher retention and better work/life balance for all. Presenters

• Sam Marzouk, MB BCh MBA, Director Business Services, Guelph Family Health Team