Tag: Using Data to Improve Care

QI in Action eBulletin #126: The Health Equity Questionnaire
In this Issue:
- The Health Equity Questionnaire: Standardized Entry of Social Determinants of Health into EMRs
- Resources for social determinants of health
- Food for thought
- Updated Primary Care Data Reports for Ontario Health Teams
- Help shape the future of virtual health care in Ontario
- Phase I Guidance for Clinically Appropriate Use of Virtual Care for Primary Care evaluation survey
- Virtual Care Guidance Statements Checklist for Clinicians and other resources
- Upcoming Events
The Health Equity Questionnaire: Standardized Entry of Social Determinants of Health into EMRs

To provide the most equitable care for our patients we need to know their social determinants of health. Current EMR specifications don’t require that this information is included in the dataset for each patient and EMRs don’t provide a standardized way to enter it.

The Health Equity Questionnaire (HEQ) has been developed to allow social determinants of health information to be entered into EMRs efficiently and in a standardized way, allowing it to be easily accessed, updated, and searched.

Questions and data elements from an extensive set of existing tools were collected, prioritized, and distilled into a practical new format designed around provider workflows. Many stakeholders, including several EDI specialists, were consulted.

At the time of a visit, clicking on the ‘HEQ’ button in the chart will bring up the Questionnaire form. The provider can then enter any information that may be relevant to the patient’s care and save it to the chart. Clicking the button again will bring up a new copy of the form which is pre-populated with any previously entered data and can be updated as needed. The form is designed to display all the information in an “at a glance” view which means that all the information is shown in one window without any clicking or scrolling.

The questions can also be sent directly to the patient via secure messaging. They can then answer any of the questions that they’re comfortable with and their responses will be automatically entered directly into their charts. If an HEQ form is not already in the chart, then a new one will be created. If there is an existing form in the chart, then it will simply be updated with their responses.

Care must be taken to ensure that the patient understands why the questions are being asked, that the information will be treated with the same confidentiality as the rest of their medical information, that it will only be used to provide them with the best care possible, and that they only need to provide whatever responses they’re comfortable with.

A video demonstration of the tool is available here.

The toolkit can be downloaded from the TELUS Health Practice Solutions Community Portal by navigating in Chatter to Groups, Active Groups and then the East Wellington Family Health Team group. Plans are in progress to migrate the toolkit to the other main EMRs as well.

Questions and feedback are welcome and can be directed to Dr. Kevin Samson kevin.samson@ewfht.ca.

Resources for social determinants of health
Webinars and conference sessions
Select Resources
- QI in Action eBulletin #120: Striving for Health Equity and Better Health Outcomes
- IPHCC Wise Practices Guide
- Social Prescribing in Practice , one of the resources listed in QI in Action eBulletin #100- Rx: Social Prescribing
- The war in Ukraine and refugee health care: considerations for health care providers in Canada
- 2SLGBTQI identity and dementia: an introduction for healthcare and social service professionals
- Rainbow Health Ontario
- Evaluating program planning using an equity framework – Queen Square FHT. Article published in Healthcare Management Forum. Please note that you need to pay for the full article.
- Ne-iikaanigaana Toolkit ‘All Our Relations’: Guidance for Creating Safer Environments for Indigenous Peoples
Food for Thought
Updated Primary Care Data Reports for Ontario Health Teams
INSPIRE PHC has posted the updated Primary Care Data Report for all of Ontario. These reports track key primary care health system indicators and guide attachment strategies in Ontario Health Teams (OHTs). The Primary Care Data Working Group produced reports specific to each OHT and are intended to provide a deeper understanding of the attributed population of each OHT. Find out more.

Help shape the future of virtual health care in Ontario
Help shape the future of virtual health care in Ontario! We are looking for patients and caregivers in Ontario to take a 15 to 20-minutes survey on the experiences and expectations with virtual care appointments as a patient or caregiver with a doctor, nurse, or another healthcare professional in a family practice. This study from the University of Toronto and the Bruyére Research Institute is led by Dr. Rachelle Ashcroft and Dr. Simone Dahrouge.

To take the survey, please click one of the links below:
- Patient: https://bit.ly/PatientVirtualCare
- Caregiver: https://bit.ly/CaregiverVirtualCare
As part of the recruitment efforts, primary care clinics will have the opportunity to receive a customized report based on the template regarding the experiences of their patients with virtual care. In addition, you can view the report last year on virtual care that was shared broadly to key decision makers. Should you be interested in participating or learning more, please contact Simon Lam, research coordinator, at sck.lam@utoronto.ca.

Phase I Guidance for Clinically Appropriate Use of Virtual Care for Primary Care evaluation survey
Ontario Health is conducting an evaluation of the ‘Phase I Guidance for Clinically Appropriate Use of Virtual Care for Primary Care’ developed in collaboration with an Expert Panel. You’re invited to complete this survey to capture your awareness of, access to and adoption of the Phase I Guidance for Clinically Appropriate Use of Virtual Care for Primary Care.

You may access the survey here.

The survey should take approximately 5-10 minutes to complete, and your responses will remain anonymous. If you have any questions or concerns regarding the survey, please do not hesitate to contact Mimosa Zhao by email at zhao@theevidencenetwork.com.

Upcoming Events

Sickle Cell Disease: A New Quality Standard for High-Quality Care in Ontario
February 22, 2023, 12:00pm
This session will introduce Ontario Health’s recently released Sickle Cell Disease quality standard and describe how it can drive quality improvement and improve care for Ontarians across the health system. Register here.

Media Messaging on Equity: How do we do better?
March 6, 2023, 4:30 pm
The third-annual Vohra Miller Lectures in Critical Public Health Issues in collaboration with the Institute for Pandemics puts a spotlight on the media’s handling of equity issues, including health equity, during the COVID-19 pandemic and beyond. What are the forces that shape media coverage of equity matters? What does the future of the media landscape hold and, what are the possibilities? Register here.

In Case You Missed It: Check out eBulletin #125 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
February 10, 2023

Bits & Pieces: improving IHP networking and more

Your Weekly News & Updates

In This Issue
AFHTO’s IHP Directory: Improving IHP networking and communication Farewell to Raveen Bahniwal Climate Conscious Inhaler Prescribing webinar materials available Consultations with physicians on PHIPA changes Community Services Recovery Fund IMPaCT survey	Updated recommendations on the use of Paxlovid and Evusheld Reminder- join AFHTO’s Executive Director Mentorship Program! CareCanvas: Better Care, Made Easier OH updates- early psychosis intervention and Provincial Primary Care Lead, Cancer Screening Upcoming events including Virtual Care and Pandemic Reflections and more

AFHTO’s IHP Directory: Improving IHP networking and communication

IHPs in AFHTO member teams are encouraged to sign up to AFHTO’s IHP Directory! This directory will help improve AFHTO’s communication to IHPs, and it will support IHP networking, information sharing, and collaboration.

After you sign up, you will be emailed a link to a spreadsheet with the names, professions, team names, and work emails of all IHPs who have signed up for open communication. You may sort by profession to see the names of those in the same discipline as you.

AFHTO will be checking the directory and emailing links to new registrants every 1-2 weeks. We look forward to improved communication from AFHTO to IHPs, and across IHPs in AFHTO-member teams!

Farewell to Raveen Bahniwal

We must announce that Raveen Bahniwal will be leaving AFHTO for a literal dream come true- we hate to see her go, but we’re happy say it’s for a great opportunity as she has been accepted to medical school.

Raveen has only been with AFHTO for a short time as our Quality and Knowledge Translation Specialist, but so many of you had the pleasure of working with her, attended the webinars she has organized or the QIDSS session at the conference. She has also helped AFHTO with our growing research portfolio.

We’re going to miss Raveen but know she will bring so much to her future endeavours, and we look forward to her return to Ontario as Dr. Bahniwal. Please join us in giving her our sincerest best wishes. Her last day with AFHTO will be Friday, December 30 – any questions related to her work can be directed to info@afhto.ca.

Climate Conscious Inhaler Prescribing webinar materials available

On Dec. 8. CASCADES and the Primary Care Collaborative hosted a webinar exploring the carbon footprint of healthcare systems and how inhalers contribute to it, and imagining practice change that results in “high value, low carbon care”. Slides and video are now available.

Consultations with physicians on PHIPA changes

The Ministry of Health is seeking physicians interested in participating in a focus group to talk about their experiences with the Personal Health Information Protection Act, 2004 (PHIPA). This work is part of the Ministry’s Dialogue on Data engagement strategy. Your knowledge and experience will inform the development of a data strategy report to the Ontario Health Data Council that will be seen by the Minister of Health, the Information and Privacy Commissioner of Ontario, and many other important stakeholders. Learn more here.

Focus groups will take place January 17 to 19, from 12-1 pm and we are looking for 20 physician volunteers spread over the three days. If you are interested in participating, please email info@afhto.ca. Please share this opportunity with physicians on your team.

NOTE: at the moment they are only interested in talking to physicians affiliated with Family Health Teams

Community Services Recovery Fund
Members and/or their partners may be eligible for this fund, which is a $400 million investment from the Government of Canada to support nonprofits and charities as they focus on how to adapt their organizations for pandemic recovery. Find resources here or sign up for January webinar here.

IMPaCT survey

IMproving performance in Primary Care Teams (IMPaCT) Survey is a survey of primary care physicians working in Ontario to understand what influences how physicians interact with data about their patients and their practice. You can find the survey and additional details about the study here. If you have any questions, please contact, Braeden Terpeu (braeden.terpou@thp.ca).

Updated recommendations on the use of Paxlovid and Evusheld

Recent updates include:

Updated recommendation on the use of Evusheld-EN and FR– OH, Dec. 12, 2022
Updated recommendation on the use of Paxlovid- EN and FR – OH, Dec. 8, 2022

We continue to update multiple pages on our site with resources and news:

Novel Coronavirus (COVID-19) Updates– the original page, with news and updates. You can find links to related pages here as well.

Reminder- join AFHTO’s Executive Director Mentorship Program!

Are you a leader with 3+ years of experience in team-based primary care? Are you interested in supporting new EDs as they develop in their role? If YES, AFHTO is looking for executive directors to join our ED Mentorship Program, and we want to hear from you!

Please fill out this brief survey, and we will be in touch.

More information about the program is here.

CareCanvas: Better Care, Made Easier

The University of Toronto Department of Family and Community Medicine and the POPLAR network have launched a new tool to support practice improvement.

CareCanvas is an interactive online dashboard that that summarizes clinical information from a physician’s practice EMR to make it easier to care for patients. Three types of dashboards are available: one for physicians, one for clinics, and one for Ontario Health Teams.

CareCanvas summarizes more than 15 quality of care measures including information on diabetes, hypertension, prescribing, and immunizations. You can see trends in your practice over time and can compare your practice to that of your peers. For some measures, you can see differences in care by age, gender, and neighbourhood income.

CareCanvas is available to existing UTOPIAN contributors, with plans to expand the program to all of POPLAR in early 2023. Register here to access the dashboard. Sign up before December 31, 2022 to receive a dashboard with the next release.

OH updates- early psychosis intervention and Provincial Primary Care Lead, Cancer Screening

Provincial program for Early Psychosis Intervention (EPI) – Ontario Health’s Mental Health and Addictions Centre of Excellence
Provincial Primary Care Lead Cancer Screening– Ontario Health (Cancer Care Ontario) is seeking Expressions of Interest. Deadline Dec. 21, 2022.

Virtual Care and Pandemic Reflections, Dec. 16, 2022
54th in OCFP and UofT’s series “Changing the way we work” on Friday, December 16, 2022, at 7:55-9:15 am. Register here.

ADVANCE Special Topics series – Balancing Task and Process in Leading Integrated Care Systems, Jan. 9, 2023

Hosted by RISE. Professor Robin Miller, University of Birmingham in the UK, will discuss the promise and pitfalls of collaborative leadership within integrated care systems and how attending to process can support inter-sectoral teams to achieve the aim of collaborative governance. Register here.

Healthcare Decision-Making in Ontario, Jan. 10-31, 2023
Four-part webinar series hosted by Hospice Palliative Care Ontario. Facilitated by Jane Meadus, the Advocacy Centre for the Elderly (ACE), you can join to learn what you need to know about consent, capacity and healthcare decision making in Ontario. Register here.

Primary Care and COVID-19 Support CoP Monthly Call, Jan. to Jul. 2023
The Community of Practice hosted by Ontario Health to support Primary Care and Covid-19, holds monthly calls, and the new registration link for the first 7 months in 2023 is available. Register here.

December 13, 2022

Bits & Pieces: market salary review underway and more

Your Weekly News & Updates

In This Issue

Market salary review underway
Reminder- Climate Conscious Inhaler Prescribing, Dec. 8
Member stories
Supporting Caregivers webinar materials available
Highlights and implications of the Ontario Science Table’s brief on primary care materials available

The latest on COVID, Influenza and Respiratory Viruses materials and more
New guidance for OHTs
Upcoming events including Ontario Health’s Mental Health and Addictions Provincial Data and Digital Initiative Webinar and more

Market salary review underway

The Community Health Compensation Working Group – representing ten provincial associations – has retained Eckler Ltd. consulting services to conduct a community health market salary review for Ontario. The review will include interprofessional primary care, community support services, community mental health, and long-term care.

The final report will give us greater insight into wage disparities for 78 positions across primary and community care sectors. It is estimated that this work will be completed in spring 2023, and final recommendations will be presented to the government to support discussions on reasonable and fair compensation.

For additional information, please visit AFHTO’s website. We will keep you updated as the work progresses.

If you have questions, please reach out to Abisola at: abisola.otepola@afhto.ca.

Reminder- Climate Conscious Inhaler Prescribing, Dec. 8

Metered dose inhalers produce significant carbon emissions. Ironically, these contribute to changes to the climate that can exacerbate respiratory conditions. Simple practice changes can help disrupt this cycle and lessen the health sector’s contributions to climate change. Register here.

Member stories

Belleville NPLC – Belleville NPLC provides care for unattached newborns

Minto- Mapleton FHT – OPINION: nurse practitioners uniquely positioned to fill gaps in ailing health care system

Supporting Caregivers webinar materials available
On Nov. 24 The Ontario Caregiver Organization and Primary Care Collaborative hosted a webinar ‘Supporting Caregivers Supports Patients- The Critical Role of Primary Care in Preventing Caregiver Burnout’. This included insights from a caregiver with lived experience, as well as examples of primary care initiatives across Ontario that are connecting caregivers to support. Slides and video are now available.

Highlights and implications of the Ontario Science Table’s brief on primary care materials available
On November 30 we held a webinar on the Ontario COVID-19 Science Advisory Table’s final brief, a 3-part exploration of how primary care responded to and was affected by the pandemic, and implications for ongoing health system planning and policy. In this webinar, a panel of primary healthcare experts who contributed to that brief shared some of the most significant findings and implications. Slides and video are now available.

The latest on COVID, Influenza and Respiratory Viruses materials and more

Recent updates include:

The latest on COVID, Influenza and Respiratory Viruses materials– OCFP and UofT, Dec. 2, 2022
Family doctor tips on caring for children with respiratory symptoms in 11 languages– OCFP, Nov. 30, 2022

We continue to update multiple pages on our site with resources and news:

Novel Coronavirus (COVID-19) Updates– the original page, with news and updates. You can find links to related pages here as well.

New guidance for OHTs

Ontario Health Teams – The Path Forward– new guidance document, MOH, November 2022
Webinar on new guidance with the Deputy Premier and Minister of Health, along with other MOH and OH officials

Ontario Health’s Mental Health and Addictions Provincial Data and Digital Initiative Webinar, Dec. 12, 2022
Part of a quarterly series designed to share regular updates and gather feedback on the initiative. Register here.

IFIC Canada and Health System Performance Network Virtual Community, Dec. 20, 2022
A key component of integration is the role of partnering with the volunteer sector to improve outcomes for our patients, caregivers, and our population. Take a deep dive to learn firsthand about the role of engaging the volunteer sector. Register here.

ADVANCE Special Topics series – Balancing Task and Process in Leading Integrated Care Systems, Jan. 9, 2023

December 6, 2022

Bits & Pieces: CMOH & Ministry memos re Omicron and more

Your Weekly News & Updates

In This Issue
Focused vaccination efforts in response to Omicron variant #AFHTO2021 videos + 2022 planning committee sign up 2021 University of Toronto Family Medicine Report Post COVID-19 guidance and more	Primary care data reports for OHTs video Year-end communications and thank you Upcoming events including new ECHO sessions and more

Focused vaccination efforts in response to Omicron variant

With the Omicron variant becoming the dominant strain of COVID-19 and cases sharply increasing, the health system has been asked to implement an ‘all hands-on deck’ and immunize as many individuals over 50+ as possible before December 24th.

To highlight the urgency and the request from the Ministry, several memos have been released to the field:

The CMOH memo – Responding to Ontario’s current pandemic situation, including the Omicron variant of concern – sent on Dec.10
Ministry’s Primary Health Care Branch memo – Important Ministry Request – COVID-19 Vaccines – sent to teams on Dec.13
CMOH/MOH/OH memo – Focused Vaccination Efforts in response to Omicron Variant – sent Dec.14

As a follow up, we sent this email to the triad yesterday morning. We’ll provide more updates as soon as we can, so please check your email and let us know if you have any questions.

From OntarioMD regarding finding those who would be eligible for third shots:

OH eReport has included 3rd shots since Nov. 15. Now instead of 1 of 2 or 2 of 2, the record is showing 1, 2, or 3. All toolkits at OntarioMD website have also been updated to work with this new report.
Also, there is a New additional report which includes the full vaccination history of all rostered patients whose vaccination status is on record.

#AFHTO2021 videos + 2022 planning committee sign up

All our 2021 conference videos and slides are now available to members, including the closing plenary MOVING FORWARD TOGETHER: The Power of Resilience with Dr. Mamta Gautam.

Become an influencer (sort of)!

Maybe you’re not getting free swag as an Instagram influencer, but you can get free registration and that’s just as good! Become a part of our 2022 conference planning committee and shape our first hybrid conference. As members, you’re our main audience so you should have a major say in how 2022 looks.

Review our ToR and sign up by Jan. 4, 2022.

2021 University of Toronto Family Medicine Report

The 2021 University of Toronto Family Medicine Report is authored by nearly 100 family doctors and health care providers from across Ontario, Canada and beyond. On the theme ‘caring through crisis’, it features personal stories, reflections and anecdotes that represent just a small fraction of the incredible work happening in family medicine and primary care, as well as data from the University of Toronto Practice Based Research Network (UTOPIAN). It includes stories from a number of our teams including St. Michael’s Hospital Academic and Toronto Western FHTs.

Post COVID-19 guidance and more

Recent updates include:

COVID-19 Third Dose Recommendations – MOH, updated Dec. 13, 2021
Post COVID-19 Condition: Guidance for Primary Care- EN and FR– Ontario Health, Dec. 9, 2021

We continue to update several pages on our site with resources and news:

Novel Coronavirus (COVID-19) Updates– the original page, with news and Ministry situation reports (please note that the Ministry Situation Reports on COVID-19 are posted daily so review them to better understand the provincial response)
COVID-19 Vaccination Information
COVID-19 assessment centres in Ontario
COVID-19 information for Patients, Caregivers and the Public
Infection control resources and tools for primary care
Management and operations, human resources and COVID-19
Mental health and wellness during COVID-19
Providing Comprehensive Care During COVID-19
Resources for Re-opening
Virtual Care, Digital Health and COVID-19

Primary care data reports for OHTs video

Primary Care Data Reports for OHTs were presented at a webinar on December 8, 2021. Hosted by INSPIRE-PHC, this session was intended to orient attendees to the reports and was followed with a Q and A session. The recording is available here.

Year-end communications and thank you

Although we will have further emails, this is the last newsletter for 2021, and we’d like to say thank you to all our members who allow us to provide support. May you squeeze every bit of joy you can out of these busy times. Thank you for all your hard work this year, and our very best wishes for this season.

2022 Legal Issues for Primary Care Team Webinars, Jan. 6- Dec. 1, 2022

Led by Kate Dewhirst. Learn more here.

ECHO Care of the Elderly (COE): Dementia series, Jan. 12- Mar. 23, 2022
You can find information here and register here.

Opening ourselves: An introduction to anti-oppression practices and frameworks (part 1), Jan. 13, 2021
Hosted by Healthcare Excellence Canada. Register here.

ECHO Programs at UHN, starting Jan. 13, 2021

Liver -starting Jan. 17
Concussion- starting Jan. 19
Chronic Pain/Opioids- starting Jan.13
Rheumatology- starting Jan. 14
Register here.

Winter/Spring 2022 Continuing Professional Development, Jan. 18- June 2022
Queen’s Faculty of Health Sciences’ Continuing Professional Development program. View options here.

Quality Rounds: The Reality of Virtual Care: Lessons from the Pandemic, Jan. 28, 2022
Hosted by Ontario Health. Find out more here.

December 14, 2021

QI in Action eBulletin #113: Diabetes Care in Primary Care
In this Issue:
- AFHTO 2021 Conference Poster Highlights
- Your Role In Improving The Population Health Of People At Risk Or Living With Diabetic Foot Complications
- Query Supports: Identify your Target Population
- Ontario Health Updates
- Quality Standards
- Upcoming Webinars
AFHTO 2021 Conference Poster Highlights

At the AFHTO 2021 Conference, we hosted an exhibit of numerous posters highlighting evidence-based, impactful innovations by your colleagues. We encourage you to take a moment to check out these posters and reach out to teams to see how you can implement these innovations too!

Given November is Diabetes Awareness Month we would like to highlight a few innovations you can implement in your teams to improve diabetes care, all poster innovations presented at the AFHTO 2021 conference.

1) Proactive Diabetes Care

COVID-19 disrupted the continuity of care for patients and propagated deterioration of chronic conditions such as diabetes. Credit Valley Family Health Team (CVFHT) proactively assessed the impact of the pandemic on their diabetes patient care using a triangulated approach comprised of a clinic survey, EMR query, and a patient survey. CVFHT prioritized the needs, creating a Just in Time intervention which was a proactive virtual educational strategy designed to reduce deterioration of diabetes outcomes, foster patient engagement and improve patient self-management. The 2-part education intervention utilized a team-based approach and was grounded in principles of learning and behavioural psychology with the goal of promoting behaviour change. For more information, please contact: Dr. Zarifa, gihane.zarifa@thp.ca

2) Implement Self Management Tools for Patients

St. Joseph’s Urban Family Health Team’s initiative aims to improve the glycemic control of those with type 2 diabetes, reducing the risk of long-term complications. Their aim is to ensure all patients eligible, are offered flash glucose monitoring to monitor their glucose and provide them with more insight over lifestyle factors impacting their glycemic control. Their aim is that if this monitoring system does improve indices, that all patients requiring insulin therapy are offered this as an option, to improve their quality of life and reduce the risk of long-term complications. For more information, please contact: improve@afhto.ca

3) Dynamic Digital Engagement

Mount Forest Family Health Team, in partnership with IMA Medical Group, demonstrated how Engagement and Success can be tracked differently within a virtual care model. They also included how engagement over time can be leveraged to build more personalized success experiences that enhance their ability to guide themselves from pre-contemplation to action. For more information, please contact: Sarah Pink, s.pink@dafht.ca and Diane Horrigan, dhorrigan@mountforestfht.com

4) Updating EMR tools for Accessible and Trackable Data

Wound documentation using a validated tracking tool in combination with proper wound care product selection is a best practice. When Elliot Lake Family Health Team heard from their patients, “Patients really want to know how long it will take to heal their wound” they implemented a tool within their electronic medical record (EMR) to give patients accessible and trackable data. Elliot Lake Family Health Team was able to track wounds and able to predict which wounds will heal and which wounds will be hard to heal. For more information, please contact: Mary Ellen Mitchell, M.Mitchell@elfht.ca

Your Role In Improving The Population Health Of People At Risk Or Living With Diabetic Foot Complications

Earlier this year, AFHTO, in collaboration with Wounds Canada hosted a webinar to provide an overview of your role to improve the population health of people at risk or living with diabetic foot complications across the full continuum of care settings to improve patient experience, outcomes and costs.
Click here for the recording and slides.

Query Supports: Identify your Target Population
MyPractice: Primary Care Report provides an update on the HbA1c Indicator: % of patients with diabetes who had 2 or more HbA1c tests within the past 12 months, approximately every 6 months. In order to assist you with retrieving data in real time from your EMR, the QI in PC Council has created a number of queries which can be found here. Please note, these queries will have to be adjusted per team, but they provide a reference point. In addition, eCE has created a Diabetes Manager.

On November 18th the QIPC council shared a process that worked well for London FHT that collaborated with ‘Partnering for Quality’ to develop and create comprehensive searches for guiding data supporting quality improvement initiatives on Diabetes, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease. Using the foundational approach of identifying suspects for coding patients, to then selecting targets to improve the patient level of care, and displaying the data in PowerBI analytical software, made quarterly reporting easier and initiated further discussion around what targets to select next.

If there is interest in learning more details about how this may work for you contact the Partnering for Quality team about the PFQ-ID Dashboard toolkit. A simple no cost solution for obtaining your EMR data and presenting it back in an efficient usable way for the team.

Ontario Health Updates: Upcoming events and programs in support of Diabetes Awareness month
Content below developed by Ontario Health (Health Quality Ontario)

November is Diabetes Awareness Month around the world. Did you know that this year also marks the 100th anniversary of the discovery of insulin? In Ontario, about one in ten people have some form of diabetes. See below for some upcoming events and resources that can support you in your practice related to care for diabetes:

Webinar | MyPractice: Primary Care Report: Using Data for Improvement | Monday November 22, 2021 • 12–1 p.m. Ontario Health is hosting a webinar for primary care providers on using the diabetes management indicators in the MyPractice: Primary Care report to drive improvements in patient care. Please register here to join the session. This is the first of an ongoing series that will focus on using data from the MyPractice: Primary Care report for quality improvement.
This program is part of a series that has been certified for up to 4 Mainpro+ credits.

Quality Standards
To address gaps in the health care that people with diabetes receive across Ontario, and improve their health outcomes, Ontario Health developed three quality standards:
- The Type 1 Diabetes quality standard addresses care for people of any age with a diagnosis of type 1 diabetes.
- The Prediabetes and Type 2 Diabetes quality standard addresses care for children and adults who are at risk of developing prediabetes or type 2 diabetes or who already have a diagnosis of either. It includes the assessment, diagnosis, and management of prediabetes and type 2 diabetes.
- The Diabetes in Pregnancy quality standard addresses care for people with type 1 and type 2 diabetes who become pregnant and people diagnosed with gestational diabetes. It includes preconception care as well as management of diabetes during pregnancy.
Included with each quality standard is a patient guide you can use to support your conversations when discussing diabetes care with your patients. Stay tuned for information on upcoming webinars related to diabetes.

Family physicians can now earn up to 5.5 Mainpro+® credits for reading the diabetes quality standards through the Understanding Quality Standards in Primary Care program. To enroll or to learn more, please contact UnderstandQS@ontariohealth.ca.

Upcoming Webinars:

Practical Approaches to Polypharmacy: The Gentle Art of Deprescribing
Dec 1, 2021 (12-1 pm EST) | Register here.

In this webinar we will explore approaches to the issues and problems around polypharmacy and deprescribing in primary care patients. We will discuss approaches to the integration of patients’ goals and priorities with evidence. In the second part of the webinar, we will demonstrate the TAPER tool (Team Approach to Polypharmacy Evaluation and Reduction), an integrated pathway designed for use in a primary care team-based approach as routine “prevention” in primary care patients with polypharmacy.

Using Electronic Medical Records to Choose Wisely: Push, Pull, Nudge
Dec 1, 2021 (12-1 pm EST) | Register here
Reducing inappropriate antibiotic prescriptions has been a long-standing challenge in primary care. With the increasing adoption of digital tools in primary care practices, how might we take advantage of features within EMRs to help improve antibiotic prescribing?

Choosing Wisely Talks on December 1 at 12 p.m. ET will explore efforts to work with EMR vendors to embed antibiotic stewardship tools into their digital workflows. Dr. Darren Larsen, family physician and expert in digital health, will share how leveraging EMRs can not only help improve patient care, but also help change clinician behaviour.

In Case You Missed It: Check out eBulletin #112 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
November 19, 2021
QI in Action eBulletin #112: Ontario Structured Psychotherapy for Alcohol Use Disorder Survey, COVID-19 Guidance Updated, & more
In this Issue:
- Ontario Structured Psychotherapy for Alcohol Use Disorder Survey
- COVID-19 Guidance: Primary Care Providers in a Community Setting – UPDATED
- Ontario Health Updates: Upcoming events and programs related to quality standards (QS)
- Participate in Research
- Upcoming Webinars
Ontario Structured Psychotherapy for Alcohol Use Disorder Survey

The Ontario Structured Psychotherapy program (OSP) has been designed and implemented for people with mild to moderate anxiety and depression. Screening for substance use including Alcohol Use Disorder (AUD) does occur, however people are not disclosing concerns around their alcohol consumption in initial screenings. Clients often disclose concerns related to alcohol consumption after a few sessions which leaves some clinicians unable to adequately meet their clients needs.

Addictions and Mental Health Ontario (AMHO), along with the Ministry of Health (MOH) and the Mental Health and Addictions Centre of Excellence (MHA CoE), has convened an advisory committee to recommend next steps for an OSP program for clients with mild to moderate AUD. This survey is intended to gather information that would support the committee in making recommendations to support the development of the program.

The survey will take approximately 10-15 minutes to complete and will be open until November 12, 2021. Please note, this survey was initially designed for people working in the mental health and addiction sector. Not all question will be relevant to all providers, so feel free to only complete sections that are relevant to your care setting.

If you have any questions or further comments, please contact karen.cook@amho.ca.

COVID-19 Guidance: Primary Care Providers in a Community Setting

Ministry of Health has released a version 9.0 for the COVID-19 guidance for primary care providers in a community setting on October 19, 2021. Sections that are updated are on In-Person, Screening, Testing, and Occupational Health and Safety. Please keep an eye on the Ministry of Health (MOH) COVID-19 website for regularly updated versions.

Ontario Health Updates: Upcoming events and programs related to quality standards (QS)
Content below developed by Ontario Health (Health Quality Ontario)

RGP Toronto Implementation Coaching Series for Delirium Care

Join us this fall for a practical coaching series on how you can use the implementation guide for the Delirium quality standard to change care in your workplace! Come on your own or bring a team.

This will be a dynamic, interactive coaching series where all levels of implementers are welcome—no preparation required. Whether you are just getting started, are started but stalled, or on a roll, this series is for you!

Part 1: Assemble a Team | October 28, 2021 • 12:00–1:00 p.m. ET
In this session you will learn how to create an elevator pitch, provide a case for change, and decide how you will engage various stakeholders. REGISTER HERE

Part 2: Prioritize a Change Idea | November 25, 2021 • 12:00-1:00 p.m. ET
In this session you will learn practical methods to set priorities in diverse groups and how to set up two-way communication mechanisms. REGISTER

Part 3: Create a Plan | December 16, 2021 • 12:00-1:00 p.m. ET
In this session you will learn how to create a practical action plan, address barriers, and leverage facilitators so that your change sticks. REGISTER

Mainpro+® Self-Study Program | Understanding Quality Standards in Primary Care | Coming October 2021
Ontario Health is excited to announce a new opportunity for family physicians to earn Mainpro+® credits by reading the quality standards relevant to primary care. This one-credit-per-hour Self-Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 48.75 credits. To learn more, or to enroll in the program, contact: UnderstandQS@ontariohealth.ca.

Participate in Research!

Your opinion matters: Help us develop educational materials for lipid management.

Researchers at The Knowledge Translation (KT) Program at St. Michael’s Hospital and Women’s College Hospital are collaborating on a study called the “CANHEART Improving Cholesterol Management Study” to improve lipid management and cardiovascular health in Ontario.

The Community Heart Outcomes Improvement and Cholesterol Education Study (CHOICES) is an Ontario research study being conducted in certain health regions in Ontario with higher than average rates of cardiovascular disease. The study is being funded as part of Canada’s Strategy for Patient-Oriented Research (SPOR) and by the Canadian Institutes of Health Research (CIHR). CHOICES will involve implementing a ‘toolbox’ for cholesterol management to inform and empower people when it comes to the appropriate management of their cholesterol and cardiovascular health. The tools within this ‘toolbox’, such as cholesterol tip sheets, educational videos, and online decision aids, will be widely distributed in the high-risk health regions, to allow people to work with their primary care physician and share in the decision-making process together.

Currently, we are looking to recruit primary care physicians Ontario wide to review and provide feedback on an online decision aid tool aimed to improve cholesterol management among patients. Participants will be compensated with a $100.00 honorarium for their time. If you are interested in reviewing the tool and participating in a 30 – 45-minute confidential telephone interview, please contact Research Assistant, Suvabna Theivendrampillai at Suvabna.Theivendrampillai@unityhealth.to

Are you a Family Physician delivering virtual care?

A study on digital health and compassionate care led by Dr. Laura Desveaux from Women’s College Hospital is exploring how technology influences interactions in primary care. Family physicians who have experience delivering virtual care (e.g., video visits, asynchronous messaging, and remote monitoring) with their patients are being invited to participate in a 30–45-minute interview over Zoom. The interview will explore your experiences with technology, how you have adapted your practice, and what is needed moving forward. A $75 e-gift card will be provided in recognition of your time. To participate or discuss further, please contact the project lead, Kelly Wu (kelly.wu@wchospital.ca).

Upcoming Webinars:
- Delirium Awareness: Untapped Potential for Patient Care and System Transformation, Oct. 27, 2021
  - Provincial Geriatrics Leadership Ontario hosts a webinar with clinical experts to share perspectives in the identification and response to delirium. The session will discuss how care can be transformed by utilizing the delirium quality standard to implement institutional delirium awareness, screening, and monitoring. Register here.
- Practical Approaches To Polypharmacy: The Gentle Art Of Deprescribing, Nov 3, 2021
  - In this webinar we will explore approaches to the issues and problems around polypharmacy and deprescribing in primary care patients. We will discuss approaches to the integration of patients’ goals and priorities with evidence. In the second part of the webinar, we will demonstrate the TAPER tool (Team Approach to Polypharmacy Evaluation and Reduction), an integrated pathway designed for use in a primary care team-based approach as routine “prevention” in primary care patients with polypharmacy. Register here.
- Parenting Resilient Children, Nov. 4, 2021
- CFI@PRI’s first “Rooted in Change: The Centre for Family Initiatives at Pine River Institute Masterclass.” Dr. Brad Reedy of Evoke Therapy Programs will present a formula for increasing resiliency in our children. Topics will include parental anxiety, definitions of Self for parents and children, and how common myths in parenting need to be reconsidered. Register here.
In Case You Missed It: Check out eBulletin #111 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
October 22, 2021
QI in Action eBulletin #111: Webinars Repository, COVID-19 third dose, Provider Experience Research & Quality Standard Placemat
In this Issue:
- AFHTO Knowledge Translation & Exchange Webinars Repository Now Available
- New COVID-19 third dose vaccine eligibility search
- Seeking pharmacists’ input on experiences and contributions to mental health care during COVID-19
- Quality Standard Placemat
- Upcoming Webinars
AFHTO Knowledge Translation & Exchange Webinars Repository Now Available

Throughout the year, AFHTO and our partners have continuously provided knowledge translation & exchange webinars on various topics. We continue to support this work on timely and requested topics. To help streamline the process of signing up for upcoming webinars and accessing previous webinars, please refer to this page for a complete list.

Here is a list of webinars hosted throughout the year – please click the topic area to be taken directly to the webinar recording and if available, supplementary materials:
Now Available: New COVID-19 third dose vaccine eligibility search

Although two doses of the COVID-19 vaccine provide strong protection against the virus, a third dose may be required for those patients with an increased risk of infection. On August 17, the province released a list of vulnerable populations who are eligible for a third dose, which include transplant recipients, patients with hematological cancers, recipients of an anti-CD20 agent and more. Please note, as eligibility broadens such as the new guidance on September 14th, 2021 eCE is working on assessing changes and aligning efforts. Thus, this query is only up to date to the August 17th eligibility criteria.

The eHealth Centre of Excellence’s newest EMR vaccine eligibility search will help primary care providers to quickly identify patients from their ambulatory roster who may be eligible.

You can access the search (for TELUS PS Suite) by downloading it directly from the eHealth Centre of Excellence community portal. More information about COVID-19 Vaccination Support tools offered by the eHealth Centre of Excellence can be found here.

Note: This search will also be available for OSCAR and Accuro EMRs soon.

Seeking pharmacists’ input on experiences and contributions to mental health care during COVID-19
If you are a primary care pharmacist, University of Toronto researchers want to hear from you! Their study seeks to examine primary care team pharmacist contributions to patient mental health care and understand pharmacists’ experiences with collaboration during the COVID-19 pandemic. The 15 to 20 min survey includes a mix of multiple choice and open response questions.

This study from the University of Toronto is co-led by Dr. Rachelle Ashcroft, Assistant Professor at the Factor-Inwentash Faculty of Social Work, and Dr. Lisa Dolovich, Professor & Dean at the Leslie Dan Faculty of Pharmacy.

To take the survey, please click on this link: https://bit.ly/SplPharm.

Quality Standard Placemat
Content below developed by Ontario Health (Health Quality Ontario)

Reminder: We want your input on the quality standard placemats!

Ontario Health has recently developed a tool called the Quality Standard (QS) Placemat that is a resource for primary care providers. The placemat highlights key elements of care for a condition and is an evidence-based, quick-reference tool that concisely summarizes key information from the quality standard and includes links to resources and tools.

OH is looking for clinicians willing to review and use any of the QS Placemats for approximately 2 weeks. After that they would then like you to complete a short survey (link below) that will give you the opportunity to provide feedback on the usefulness of the tool.

If you or one of your colleagues be willing to help us test and provide feedback on the Quality Standard placemats, please complete the following survey by clicking on the link below. OH would appreciate it if you can complete the survey by September 30th, 2021.

Currently, there are seven quality standard placemats available:
Survey Link: https://survey.alchemer.com/s3/6387602/Quality-Standards-Placemat-Evaluation

If you are interested in participating or have any questions, please email Jorge Ginieniewicz at: jorge.ginieniewicz@ontariohealth.ca

Upcoming Webinars:
- COVID-19 Malnutrition – How To Identify And Treat In Team-Based Primary Care
  - September 20, 2021, 12:00-1:00 PM EDT
- Expanding Your Differential Diagnosis
  - October 14, 2021, 12:00-1:00 PM EDT
- Tapering And Stopping Opioids
  - October 19, 2021, 12:00-1:00 PM EDT
In Case You Missed It: Check out eBulletin #110 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
September 16, 2021
QI in Action eBulletin #110: COVID-19 Vaccination Reports, Cancer Screening Summary and Quality Standard Placemat
In this Issue:
- COVID-19 Vaccination Reports
- Resuming Cancer Screening During COVID-19
- Quality Standard Placemat
- Share your Thoughts on Addressing Patients’ Mental Health Needs as a Pharmacist
- Upcoming Webinars
COVID-19 Vaccination Reports
Currently COVID-19 Vaccination Reports are available to Primary Care Providers in a few ways that are summarized below:
- Health Report Manager (HRM®):
  - As of May 18, 2021, and onwards, physicians/NPs with access to HRM will receive HRM notifications with vaccination reports for patients for whom the Primary Care Provider (PCP) field was entered in at the time of vaccination. At the moment reports prior to May 18, 2021, will not be sent to the EMRs via HRM but work is being done to capture earlier vaccinations through HRM.
  - As of July 22, 2021, COVID-19 vaccination reports from the provincial COVaxON system are being enhanced with data from the Ministry of Health’s CAPE (Client Agency Program Enrolment) database to match patients to family physicians who practice in a Patient Enrollment Model (PEM). Patients are not always asked to identify their family physician for entry into COVaxON so the addition of CAPE data enables more reports to reach family physicians. If you practice in a PEM, you will now receive many more vaccination reports via HRM. The next improvement OntarioMD (OMD) is working on is a solution to send historical COVID-19 vaccination reports to family physicians.
  - To automate the process of entering these HRM reports into the immunization list of patients, eCE has created a Robotic Process Automation (RPA) (aka bot), which is currently compatible with the Telus PSS EMR. The bot is currently being offered at no cost and with supports from eCE. eCE will run the bot for you so no additional administrative supports will be required on your end. To see a demo of the bot in action, click here. To request more information or express interest in adding this bot to your workflow, please click here.
- COVaxON Aggregate Primary Care Vaccination Reports
  - As of July 15, 2021, PEM physicians/clinicians with access to ONEID have access to aggregate eReports from the same portal as the Cancer SAR reports to download a complete list of patients vaccinated up to July 15, 2021. After this date, the report will be updated on a monthly basis.
  - EMR-eReport Patient Vaccination Reconciliation Toolkit were designed to be used with the Ontario Health’s COVaxON Aggregate Primary Care Vaccination Report and are designed for Microsoft Excel, Open Office, and Mac Numbers. These toolkits are designed for TELUS PSS, QHR Accuro and OSCAR EMRs. An FAQ on the aggregate reports can be found here. In addition, an information session slide deck and FAQ document can be found here.
  - Please note, a ONE-ID is required to access these reports. For instructions on completing a ONE® ID self-registration, refer to the ONE® ID CPSO Registration Guide. To assign a delegate further information can be found in the FAQ document here.
- Clinical Viewers (ConnectingOntario ClinicalViewer and Clinical Connect):
  - These reports are available for physicians/clinicians for any time period, however on a per patient basis. For step by step instructions on how to access ClinicalViewers please refer to this reference document.
- COVaxON:
  - For physicians/clinicians with access to COVaxON, patients can be queried on a per patient basis to inquire on vaccination status.
For more information and updates on COVID-19 Vaccination Reports, please refer to the OMD page here.

Resuming Cancer Screening During COVID-19

Missed the last ebulletin? Ontario Health (Cancer Care Ontario) has created a summary page for your reference on the resumption of cancer screening during the pandemic.

Content below developed by Ontario Health (Health Quality Ontario)

Quality Standard Placemat

Ontario Health wants your input on the quality standard placemats!

Ontario Health has recently developed a tool called the Quality Standard (QS) Placemat that is a resource for primary care practitioners. The placemat highlights key elements of care for a condition and is an evidence-based, quick-reference tool that concisely summarizes key information from the quality standard and includes links to resources and tools. To facilitate use at point of care, the placemat can be uploaded and used within EMRs for easy access. We have developed step-by-step user guides to help you add the QS placemats into Accuro, PS Suite and OSCAR EMR systems.

They are looking for clinicians willing to review and use any of the QS Placemats for approximately 2 weeks. After that they would like you to complete a short survey (link below) that will give you the opportunity to provide feedback on the usefulness of the tool.

Currently, there are seven quality standard placemats available:
Would you or one of your colleagues be willing to help them test and provide feedback on the placemats?

If so, please complete the following survey by clicking on the link below. They would appreciate it if you can complete the survey by August 25th, 2021.

Survey Link: https://survey.alchemer.com/s3/6387602/Quality-Standards-Placemat-Evaluation

If you are interested in participating or have any questions, please email Jorge Ginieniewicz at: jorge.ginieniewicz@ontariohealth.ca

A new Quality standard placemat has been developed:

Early Pregnancy Complications and Loss QS Placemat—summarizes content from the Early Pregnancy

Complications and Loss Quality Standard, focusing on care for people experiencing complications, such as pain and vaginal bleeding, and/or the loss of their pregnancy in the first 13 weeks.

Share your Thoughts on Addressing Patients’ Mental Health Needs as a Pharmacist
If you are a primary care pharmacist, the research team wants to hear from you! This study seeks to examine primary care team pharmacist contributions to patient mental health care and understand pharmacists’ experiences with collaboration during the COVID-19 pandemic. The 15 to 20 min survey includes a mix of multiple choice and open response questions.

This study from the University of Toronto is co-led by Dr. Rachelle Ashcroft, Assistant Professor at the Factor-Inwentash Faculty of Social Work, and Dr. Lisa Dolovich, Professor & Dean at the Leslie Dan Faculty of Pharmacy.

To take the survey, please click on this link: https://bit.ly/SplPharm.

Upcoming Webinars:
- Tapering And Stopping Opioids
  - October 19, 2021, 12:00-1:00 PM EST
In Case You Missed It: Check out eBulletin #109 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
August 6, 2021
Aggregate Primary Care Vaccination Reports for Family Physicians
Dear Triad Members,

Yesterday Ontario Health (OH) released a memo about accessing the COVaxON Aggregate Primary Care Vaccination Reports for family physicians working in a Patient Enrolment Model (PEM) of your rostered patients who have been vaccinated.

A reminder that you do need a ONE® ID account to access the report – instructions on how to register for an account can be found in the memo. OH will also be hosting a number of information sessions and physicians, administration and QIDSS are encouraged to attend to learn how you can access the reports and other useful information.

We know that the report leaves fee-for-service, CHC family physicians and Nurse Practitioner-Led Clinics without this important information and solutions are being sought for you to receive similar information. We have also heard that many BSM (blended salary model) physicians in cFHTs are able to access the reports, but please let us know if that is not the case.

With about 20% of eligible Ontarians currently unvaccinated, and a higher percentage in the youth population (ages 12-17), the Ministry of Health and Ontario Health are asking for our help with outreach to unvaccinated patients – and specifically to youth and families to encourage their vaccination before the school year. Primary care has trusted relationships with patients, and we know they can play a key role in supporting their vaccination decisions.

An FAQ has been created in partnership with the Ontario Medical Association, OMA Section on General and Family Practice, OntarioMD, Ontario Health and the Ontario College of Family Physicians, and provides information on:
- what data you will receive;
- how to use the report and identify which of your enrolled patients have not yet been vaccinated;
- billing information; and
- supports available – including upcoming webinars and template scripts for outreach.
We know that you are all working very hard in looking after your patients and your community, and we recognize the many demands on primary care, from assessment centres to vaccination to increased demands in caring for even sicker patients.

We know how hard primary care worked to get as many #NeedlesInArms over the last few months and the tremendous amount of work that goes into counselling and educating your patients before vaccinating. Thank you for all your incredible work and please let us know if you have any questions.

Yours in good health,
The AFHTO Team
July 16, 2021
QI in Action eBulletin #109: Cancer Screening during the Pandemic and Onwards
In this Issue:
- Cancer Screening during the Pandemic and Onwards
- Tip Sheets for Primary Care Providers
- Breast Screening
- Cervical Screening
- Colorectal Cancer Screening
- Ontario Health’s Screening Activity Report
- EMR Tips to Help you Resume Cancer Screening
- Upcoming Webinars
Cancer Screening during the Pandemic and Onwards

Check out our recent Cancer Screening during the Pandemic and Onwards webinar co-hosted by AFHTO, The Alliance for Healthier Communities, the Ontario College of Family Physicians, the Nurse Practitioner Led Clinics Association and Ontario Health, hosted on June 21, 2021.

Learn some practical tips and examples on resuming cancer screening from our speakers:
- Dr. Ed Kucharski, Family Physician, Regional Primary Care Lead (Toronto Central)
- Dr. Jennifer Rayner, Director of Research and Evaluation, Alliance for Healthier Communities
- Diana Noel, Executive Director, Village Family Health Team
- Teresa Wetselaar, NP, West Parry Sound Health Centre
- Dr. Neil Naik, Family Physician, Interim Regional Primary Care Lead (Waterloo Wellington)
Content below developed by Ontario Health (Cancer Care Ontario)

Tip Sheets for Primary Care Providers

Ontario’s health care system has been significantly impacted by COVID-19 and these impacts will be felt for a while. Cancer screening was paused in March 2020 because of the pandemic, and gradually started to resume after the Chief Medical Officer of Health’s Directive 2 for healthcare providers was amended in late May 2020.

Ontario Health (Cancer Care Ontario) runs the province’s organized cancer screening programs, the Ontario Breast Screening Program (OBSP), the Ontario Cervical Screening Program (OCSP) and ColonCancerCheck (CCC). Ontario Health released Tip Sheets on gradually starting up breast, colorectal and cervical screening in June 2020, and most recently, has updated and streamlined the Tip Sheet for primary care providers. Tip Sheets have also been developed for OBSP sites, colposcopy, and endoscopy. Guidance in the Tip Sheets is based on the best available evidence as well as expert opinion.

As we begin the process of system recovery from the COVID-19 pandemic, here are some tips based on Ontario Health’s guidance to help you make decisions about how to resume screening for your patients. Please contact Ontario Health if you have any questions: cancerinfo@ontariohealth.ca.

Breast Screening
For most people at average risk of breast cancer, routine breast screening is a mammogram every two years for people ages 50 to 74. If capacity is limited in your area, OBSP sites have been asked to focus on the following groups and you can support by encouraging these patients to be screened:
- High Risk OBSP participants
- People at average risk who have never been screened before
- Average risk participants who have been told to rescreen in one year
The Ontario Health (Cancer Care Ontario) website has more information on the current routine breast cancer screening guidelines.

Cervical Screening
If someone comes to your office and they are due for cervical screening, the OCSP suggests screening them. Routine cervical screening every three years with cervical cytology (Pap test) is recommended for people with a cervix. While formal OCSP guidelines currently recommend starting screening at age 21, Ontario Health encourages primary care providers to start cervical screening for patients at age 25 in alignment with best new evidence.

OCSP guidelines will be formally updated with the implementation of human papillomavirus (HPV) testing in the OCSP. Routine cervical screening can stop at age 70 for people with three or more normal cytology tests in the previous 10 years.

If you are unable to provide routine cervical screening, people at elevated risk for cervical cancer should be prioritized because they need annual screening. Examples of people at elevated risk include anyone who is:
- Discharged from colposcopy with persistent low-grade cytology
- Discharged from colposcopy with an HPV-positive test and a normal or low-grade cytology
- Immunocompromised (e.g., HIV positive)
Colposcopy services have also resumed. To make sure people at the highest risk for cervical cancer are able to get timely colposcopy appointments, it is recommended that primary care providers refer patients with:
- a single high grade cytologic abnormality (e.g., HSIL+, AIS) or
- two consecutive low grade cytologic abnormalities (e.g., LSIL, ASCUS).
Patients with a single low grade cytologic abnormality should be re-screened in primary care in approximately 12 months with cytology. As a reminder, any patient that is positive for HPV strains 16 or 18 should be referred to colposcopy, regardless of cytology result.

Colorectal Cancer Screening

Routine screening with the fecal immunochemical test (FIT) should be done every two years for people ages 50 to 74 with no first-degree relatives diagnosed with colorectal cancer.
If you have limited capacity for screening, CCC recommends focusing your screening efforts on people over the age of 60.

Here are some tips for sending in FIT requisitions to prevent delays:
- Please do not batch fax requisitions as this can lead to errors and subsequent delays
- Ensure that your patient’s mailing address information is correct including apartment numbers
- Do not send repeat orders until at least 4 to 6 weeks have passed to allow for processing and mailing time
- To request a replacement kit for your patient, ensure that the replacement kit checkbox near the top of the requisition is marked and submit the new requisition to LifeLabs
Referrals to colonoscopy can also be resumed, especially for patients with an abnormal FIT result, patients who are at increased risk for colorectal cancer, or patients who are eligible for post-polypectomy surveillance with colonoscopy.

As a reminder, patients with a previous low risk adenomas (1 to 2 tubular adenoma(s) <10mm in diameter with no high-grade dysplasia) should return to average risk screening with FIT five years after their colonoscopy instead of continued surveillance with colonoscopy. You can find out more about the current colorectal cancer screening recommendations on our website.

Ontario Health’s Screening Activity Report
The Screening Activity Report (SAR) is an online tool available to primary care physicians who practice as part of a patient enrolment model (PEM), or to non-patient enrolment model physicians and nurses who practice in the Sioux Lookout Municipality and Sioux Lookout Zone (27 First Nation communities).

The SAR provides screening data for breast, cervical and colorectal cancers and can help to improve screening participation by identifying patients who are eligible for screening or require follow-up tests. Physicians can also view a comparison of their screening rates to other registered PEM physicians in their region.

As we recover from COVID-19 in the coming months, and catch up on preventive care like cancer screening, a tool like the SAR can support your practice. The SAR uses ONE® ID to authenticate users; for more information on how to register visit our website.

EMR Tips to Help you Resume Cancer Screening
In fall 2020, Ontario Health partnered with OntarioMD on a blog on EMR tips to help primary care start to screen patients again for cancer. The blog includes tips to identify higher-priority patients for cancer screening in your EMR systems and can be found here.

Upcoming Webinars:
- PTSD, Relationships & Accessible Support
  - July 14, 2021 (12-1 pm ET)
- Delivery of Cognitive Behaviour Therapy for Insomnia via Virtual Platform
  - July 21, 2021 (8-9 am ET)
In Case You Missed It: Check out eBulletin #108 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.
July 8, 2021

Tag: Using Data to Improve Care

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