Ultimate Blogging Championship

Tag: Library

  • Realizing Patient Goals

    2011 AFHTO conference presentation PRESENTER (S): Andrea Petroff, BA Honours. Psych, M.I.R. (Masters of Industrial Relations), Executive Director; Claudia Mariano, NP-PHC, MSc Primary Health FHT/ORG: West Durham FHT ABSTRACT: Our commitment to our patients, our community, and to ourselves, to provide the best possible care for chronically ill patients, meant that we needed to take a cold, hard look at how we currently manage versus how we need to be managing this vulnerable patient population. Focusing first on patients with diabetes; we took a strategic approach to establishing FHT procedures and policies that can be easily applied in managing other chronic illness. These are the tactics we employed:

    • Developed outcome and monitoring goals for all Type Two diabetic patients >18yrs
    • EMR review of baseline patient statistics measured against goals set
    • In-depth analysis of current resources, practice design, interprofessional collaboration and office efficiencies to identify gaps that jeopardized our goals
    • Prioritized actions to address areas of concern and assigned personnel to lead change for improvement

    Click here to view presentation.

  • Using Spirometry in Clinical Practice

    2011 AFHTO conference presentation PRESENTER (S): Angie Shaw, RRT,CRE Respiratory Educator; Amy Massie, RRT, CRE Respiratory Educator FHT/ORG: New Vision FHT ABSTRACT: This workshop will assist Family Health Team members in utilizing spirometry as a valuable tool in various clinical settings. Case studies will be presented, worked and reviewed. There will be a brief review of spirometry interpretation principles. Participants will then have the opportunity to practice interpretations, and consider recommendations based on the case presentations. Upon completion of the workshop participants will be better able to use spirometry results as a valuable tool in diagnosis and treatment of obstructive/restrictive lung conditions, and have an improved understanding of what recommendations to make based on results from spirometry testing. Click here to view presentation.

  • Self Management for Chronic Pain Patients

    2011 AFHTO conference presentation PRESENTER (S): Shellie Buckley, RN FHT/ORG: Stratford FHT ABSTRACT: Self management is a fairly new, vogue term used in healthcare but does it really work for patients with chronic pain? The data collected at the Stratford Family Health Team over the past two  years shows chronic pain patients will attend six week group sessions and will benefit not only at the time but continue to demonstrate positive effects weeks and months later. Following the standardized model of the Stanford Chronic Pain Self Management Program patients are supported and guided through a six week structured program. Each week patients learn and develop skills or tools to help them be competent and successful self managers. A collection of real patient case studies will be reviewed to demonstrate the benefit of self management for the patient with chronic pain. Click here to view presentation.

  • FHTs in the Intelligent Community

    2011 AFHTO conference presentation PRESENTER (S): Tim Iredale, Stratford Family Health Team; Paul West, Rhyzome Networks FHT/ORG: Stratford FHT ABSTRACT: The Stratford FHT is located in a city that is one of the Top 7 Intelligent Communities of 2011.  The Stratford FHT has partnered with Rhyzome Networks to improve its IT infrastructure which has resulted in better access to our EMR and improved FHT collaboration.  Rhyzome Networks offers 60 kms of fiber optics which supports a city wide mesh WiFi.  This improved IT infrastructure has provided consistent and redundant connectivity and capacity for IP based voice and data communications between offices.  The Stratford FHT receives results electronically into our EMR within minutes of them being posted at our local Hospital as a result of this intrastructure.  Physicians can access our EMR securely from a WiFi enabled device anywhere within the City of Stratford.  The next step is a patient portal made available through the city wide WiFi to any Stratford FHT patient regardless of economics. Click here to view presentation.

  • 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.

  • Chronic Respiratory Disease Management in the Community

    2011 AFHTO conference presentation PRESENTER (S): Maria Savelle, RN, Certified Respiratory Educator, Nurse Educator FHT/ORG: Stratford FHT ABSTRACT: The Stratford Family Health Team Respiratory Clinic began as a pilot project in June 2009 after it was identified there was a need to assess and provide education regarding patient self-management of chronic respiratory conditions (COPD and Asthma). After a successful trial period, the SFHT Respiratory Clinic opened to all patients rostered with the 13 physicians of the Stratford Family Health Team. A specially trained registered nurse (COPDTrec, AsthmaTREC, SpiroTREC, TEACH trained) accepts referrals from physicians and Allied staff. Office spirometry is performed, and three champion physicians interpret the results to diagnose COPD and/or asthma. Pharmological management is decided between the Nurse Educator and the responsible physician. Follow up education regarding self-management of their respiratory condition is then provided either one-on-one, or in a group education session by the Nurse Educator. Follow up visits are arranged to ensure compliance with respiratory medications, assessing control/management of symptoms, and further patient teaching is provided to aid the patient in optimum self-management (Action Plans, Diary of symptoms, identifying need for reassessment in times of increased symptoms, etc.) If the patient is smoking, smoking cessation counseling is offered by the Nurse Educator as part of the follow up visit regime. The SFHT was a part of the QIIP COPD Learning Community, and was able to identify a number of patients appropriate for spirometry testing by way of screening with the Canadian Lung Health Test – a number of patients were newly diagnosed with lung conditions earlier, due to this screening process, and a number accepted smoking cessation counselling as a result of their screening and spirometry testing procedures. The Stratford Family Health Team Respiratory Clinic continues with the Nurse Educator assessing patients Monday to Friday, 8-4, where a constant flow of referrals for new patients continues in the busy clinic. The goal of the clinic is to identify respiratory conditions, ensure proper treatment according to current guidelines, teach patient self-management of respiratory conditions, in the hopes of reducing physician office and ER visits related to respiratory symptoms. 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.

  • Preparing for Electronic Labs

    2011 AFHTO conference presentation PRESENTER (S): Katharine De Caire, RN (EC), MN; Katalin Ivanyi, MD, CCFP, FCFP FHT/ORG: McMaster FHT, Stonechurch Site ABSTRACT: Laboratory information systems are an important component of an electronic health record. The ability to electronically access laboratory test information assists health care providers to make faster, better patient care decisions, enables timely access to information, provides better coordination of care and improves workflow Shared care is the basis of a Family Health Team. In a shared care environment a team’s Physicians and Nurses are both accountable for managing patient lab results and these accountabilities need to be clearly defined, communicated, and documented. In 2011 Stonechurch Family Health Centre began to prepare for the implementation of electronic labs. Our team recognized that managing test results effectively is vital to quality patient care and a failure to follow up on test results can lead to patient harm. In this presentation we will highlight our team’s paper-based process for results management, discuss our journey to prepare for electronic labs and present our final plan. Click here to view presentation.