Ultimate Blogging Championship

Tag: Health Promotion & CDPM

  • Coaching Health Self-Management

    2011 AFHTO conference presentation PRESENTER (S): Durhane Wong-Rieger, PhD FHT/ORG: Institute for Optimizing Health Outcomes ABSTRACT: This workshop provides an introduction to Health Coaching for Patient Self-Management.  Case studies and brief demonstrations/role plays will be used. After participating in this program, participants will be able to:

    1. Define the role of self-management in promoting treatment adherence and health behaviour change
    2. Identify the knowledge and skills patients learn as self-managers
    3. Know five-stage model of health coaching and concepts that support self-management
    4. Know principles of motivational interviewing and stages of change
    5. Identify the roles of healthcare professionals in facilitating patient self- management

    Click here to view presentation.

  • Summerville Arthritis Program

    2011 AFHTO conference presentation PRESENTER (S): Lucy Bonanno, Executive Director;  Nadya Zukowski, Health Promotion Specialist FHT/ORG: Summerville FHT ABSTRACT: The Summerville Arthritis Program is a novel, collaborative approach to community Osteoarthritis care. Our interdisciplinary team partnered with The Arthritis Society and Pfizer to map out the delivery of a comprehensive yet flexible program. The program guides the patient through in-house services including a group education session, one-on-one counseling, a joint injection clinic and the ‘Maximize Your Health’ Stanford Chronic Disease Self-Management Program. It also identifies a pathway for Rheumatoid Arthritis care. The program was piloted winter 2011 and is now being offered Summerville-wide starting fall 2011, thus optimizing patient-centered care. Click here to view presentation.

  • Advancing the RN role in Chronic Disease Management

    2011 AFHTO conference presentation TITLE: Advancing the RN role in Chronic Disease Management and Prevention in Primary Care PRESENTER (S): Sylvia Scott, Clinical Manager FHT/ORG: Guelph FHT ABSTRACT: Health care systems continue to be challenged to respond effectively to the increasing impact of chronic diseases on population health and health care resources. Using the Ontario Chronic Disease Management and Prevention Model, Guelph Family Health Team (GFHT) responded by integrating advanced registered nurse roles in primary care practice team settings with a goal to improve care for individuals with and or at high risk for chronic conditions. This presentation will discuss a unique interdisciplinary and collaborative model led by RN as the case manager within programs or embedded in the practice team. Their role is provide a holistic approach to the patient/caregiver in order to prevent or manage chronic health conditions by engaging the patient to identify and prioritize their own physical and emotional well-being. The RN also works with the patient/caregiver by monitoring progress and barriers to achieving wellness goals and clinical outcomes. The overall goal is to build patient/caregiver and interdisciplinary team capacity. This is achieved through the RN’s role by triaging in order to facilitate patient focused care, timely provider and community collaboration, patient education, and systems navigation across the entire health care spectrum. Outcomes measures include improved access to primary care, reduced number of emergency room visits and or hospital admissions, improved self-management and improved overall quality of life. Click here to view presentation.

  • The use of Genetics and Personalized Medicine in Health Promotion and Chronic Disease Management

    2011 AFHTO conference presentation PRESENTER (S): Sean Blaine, BSc MD CCFP, Lead Physician; Jill Davies, MSc., CCGC, Genetic Counsellor, Program Director, Medcan Clinic FHT/ORG: STAR FHT ABSTRACT: Genomic information is growing at an exponential rate and can be used as a tool in clinical decision making. It is now technically and economically feasible to consider the application and utilization of genomic sequence data in clinical care.  Identifying individuals at increased risk for rare hereditary diseases as well as common diseases can lead to improved clinical outcomes through health promotion and early detection.  This requires a proactive multidisciplinary approach combining new technologies with family history information, clinical data and patient education around risk reduction and disease prevention.   New technologies can also identify specific genetic variants in enzymes of drug metabolism which have an impact on the selection and dosing of medication.  In this way, pharmacogenomic (PGx) testing allows physicians to optimize drug selection and dosing based on a patient’s unique genetic makeup. The application of PGx in clinical practice is expected to improve health outcomes by decreasing medical costs and increasing patient compliance with medication regimens. Click here to view presentation.

  • New Innovations and Best Practices in a FHT

    2011 AFHTO conference presentation PRESENTER (S):

    Karen Y. Brooks, RN, BScN, CRE, CDM Nurse Educator; Dr. Margaret Tromp, MD, CCFP, FCFP

    FHT/ORG: Prince Edward FHT

    ABSTRACT: “Left undiagnosed or untreated, chronic disease may also exact serious health and economic consequences from patients, families, and communities” (Every, 2007, p. 70). A FHT Family Physician and CDM Nurse Educator, have implemented aspects of The Edmonton Southside Primary Care Network Chronic Disease Model. This has brought the care of chronic disease back into the family physician’s office, where FHT team members contribute, but work to improve care and coordination of service is achieved within. We have customized this approach within our family practice. Highlighted is the MOHLTC’s seven themes of priorities for FHT’s, correlated with practice management of several chronic diseases. Utilization of upstream approaches to patient preventatives and screening is addressed. A patient may see the CDM Nurse Educator, the Family Physician, or both, and spend time discussing disease management. “This team approach frees the physicians to see more patients, to concentrate on those who need them and to take satisfaction from knowing they are doing a good job” (Spooner, 2007, as cited in Every, 2007). You won’t want to miss ‘The Pork’n Beans’ of CDM. Click here to view presentation.

  • iPrep: Illness Prevention and Rehabilitation Program

    2011 AFHTO conference presentation PRESENTER (S): Dr. Lori Teeple FHT/ORG: Bluewater Area FHT ABSTRACT: To assist participants to transform their lifestyle into one of healthy eating and exercise so as to achieve and maintain a healthier body weight and waist circumference to prevent or remit disease such as diabetes, hypertension, cardiovascular and cerebrovascular events.  Target Group: Patients with BMI > 25 and Waist Circumference WC>102 cm (men) and WC> 88 cm (women). Program Objectives: 1. To help six women achieve a weight loss of 10% of their body mass in 12 months through a combination of education, mentoring and coaching utilizing advanced internet technology and weekly/bi-weekly visits.   2. The program will be evaluated on an annual basis by determining the number of females who have completed the 12 month program and reduced their weight and waist circumference, creating a healthier body and rehabilitating disease such as diabetes, hypertension and lipid disorders.  The program will give the females encouragement to continue with their ongoing lifestyle changes.  Each participant will be asked to complete and evaluation upon the completion of program. Evaluation: The iPrep program was started January 2011 and after six (6) months all participants have seen positive results and are encouraged about their lifestyle changes.  The program is looking to expand the number of participants and include men. Click here to view presentation.

  • Central Intake Triage

    2011 AFHTO conference presentation PRESENTER (S): Dr. Kathleen Brooks, M.D., FRCP (C); Mary Jane McDowell, MSW FHT/ORG: Prince Edward FHT ABSTRACT: Within the services offered by the Prince Edward Family Team nowhere is critical decision making more important than at the point of entry to our mental health system. At a time when demand for mental health services exceeds available resources, the importance of effective triage at the front door takes on increased importance. Mental health agencies can sometimes be reluctant to divert scarce clinical staff, especially the more experienced, in order to perform the role of coordination, intake and triage. The PEFHT views mental health intake as a critical decision point in serving our patients with mental health issues and as such our first hire to the program was a social worker who assumed the title of mental health program coordinator. Experienced and effective coordination and triage provides for a cohesive, accessible and equitable use of a limited resource. Click here to view presentation.

  • Respiratory Health Resources from the Ontario Lung Association

    BreathWorks™ Helpline – 1-888-344-LUNG (5864)

    BreathWorks™ is The Lung Association’s national COPD program that offers practical information and support for people with COPD and for their families and caregivers. The BreathWorks™ Helpline is available 8:30 am – 4:30 pm Monday to Friday and is staffed with Certified Respiratory Educators, health care professionals with special training in COPD. They provide counselling on COPD symptoms, diagnosis, management and smoking cessation. To access COPD resources, click here: https://lung.healthdiary.ca/Guest/SearchResults.aspx?C=24&M=0&K=&N=&S=1&P=

    Asthma Action™ Helpline – 1-888-344-LUNG (5864)

    Available for Ontario residents, this free helpline is available 8:30 am – 4:30 pm Monday to Friday and is staffed with Certified Respiratory and Asthma Educators. They provide counselling on asthma control, treatment options and the importance of trigger avoidance. To access asthma resources, click here: https://lung.healthdiary.ca//Guest/SearchResults.aspx?C=27&M=0&K=&N=&S=1&P Free fact sheets and other resources Call the Helpline 1-888-344-LUNG (5864) or go to www.on.lung.ca to order The Lung Association’s free educational materials. Resources include asthma handbooks, asthma fact sheets for adults and children, a variety of fact sheets on managing COPD, breathlessness, energy management, pulmonary rehabilitation and exercise.  Also available are resources on air quality, smoking cessation and the effects of second hand smoke exposure, tuberculosis, pulmonary fibrosis, and sleep apnea.

    Other Resources

    The Lung Association websites offers information on asthma, COPD and other respiratory diseases  www.on.lung.ca or www.lung.ca Ontario Thoracic Society’s Provider Education Program (PEP) develops, implements and evaluates continuing medical education (CME) programs and materials that promote the implementation of the Canadian Asthma Consensus Guidelines (CACG) and CTS COPD Guidelines for physicians and allied healthcare professionals in Ontario. Visit http://olapep.ca/ for continuing education on COPD, Asthma and Spirometry. Funded by the MoHLTC, the Primary Care Asthma Program (PCAP) facilitates and enhances effective implementation and coordination of best practices and outcomes to participating sites. It uses specific tools designed to guide practitioners and clients through effective management of asthma, as well as developing and evaluating resources needed to effectively provide asthma care in the primary care setting. http://www.on.lung.ca/Page.aspx?pid=513 Sign up for Asthma Action and BreathWorks Newsletters to learn the latest news about lung health and Lung Association initiatives.  To sign up for The Lung Association’s asthma and COPD newsletters, go to www.on.lung.ca. The Lung Association’s National Database provides a list of asthma education centers, respiratory rehabilitation programs and COPD support groups across the country.  To access it, go to www.lung.ca. The Canadian Lung Association (CLA) has also released videos on exercise and COPD to help the public and patients understand the importance of exercise in managing COPD.  Please visit: http://www.youtube.com/watch?v=DFemC5giG1Y Copies of all the current respiratory guidelines, including asthma and COPD,  are found on Canadian Thoracic Society’s (CTS) website: http://www.respiratoryguidelines.ca/ Living Well with COPDTM is a self-management education program developed to help patients with COPD and their family in managing their disease.  It contains references guides for health care professionals as well as many patient education tools  www.livingwellwithcopd.com password “copd” Smokers’ Helpline – 1 877 513-5333 is run by The Canadian Cancer Society and is a free, confidential telephone service that people can call for easy access to a trained quit coach.

     Additional links

  • The Virtual Ward

    This slide presentation from the AFHTO 2010 conference describes the Virtual Ward – a method of providing the support of a hospital ward but in the patient’s home environment. It provides care to the most medically and socially complex patients in their home setting along with multidisciplinary case management. The SETFHT Virtual Ward is for patients who have been admitted to Toronto East General Hospital for a chronic condition such as heart failure, bronchitis, emphysema or diabetes who are without a family doctor. Patients are offered to be rostered within the FHT and be part of the Virtual Ward.  Once patients are at home, they receive follow-up care from various health care providers by phone and home visit as necessary. This may include phone calls to monitor their daily symptoms, answering their questions about medications and ensuring they have the supports to manage. They may also receive equipment that will help them monitor their health condition at home such as a blood pressure cuff, weight scale or a blood sugar monitor. This innovative approach to attaching patients to a family doctor and then providing comprehensive care to them once at home, will hopefully prevent further admissions to hospital and reduce wait times in emergency. It also allows patient to learn how to self manage their condition in order to take care of their own health at home. PRESENTER: Carol Toenjes FHT: South East Toronto Family Health Team Click here to view.

  • Successfully Integrating Spirometry Into Primary Care

    This slide presentation from the AFHTO 2010 conference is for FHT health care providers and administrators interested in integrating spirometry into their clinical practice. The session will review New Vision’s successes in integrating spirometry and discuss strategies for other FHTs to implement spirometry including resources available in Ontario. This workshop includes powerpoint presentation and group discussion. PRESENTERS: Angie Shaw, Amy Massie FHT: New Vision Family Health Team Click here to view.