Report: 2018 Champlain Primary Care Congress

Report: 2018 Champlain Primary Care Congress July 2018

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Table of Contents Introduction 4 Purpose 4 Program Development & Overview 4 Event Highlights 5 Participants 5 Exhibitors 5 Opening Remarks 6 Morning Session: Sub-Region Leadership Teams & Discussion 6 Morning Interactive Session & Panel: The Access Challenge Exploring Solutions in Champlain Sub-Regions 9 Afternoon Panel: How Health Links Makes a Difference 11 Afternoon Session: Working Together, Working Differently - Leading Change in Sub-Regions 12 Afternoon Closing Session: Equity Indigenous Health 13 Overall Impression of the Event 14 Suggestions for Future Event Planning 14 Appendix A - Program 16 Appendix B Exhibitors 18 Appendix C - Champlain LHIN Sub-Region Leadership Teams 19 Appendix D - Case Scenarios 20 3

Introduction On March 7, 2018, the sixth annual Champlain Primary Care Congress (Congress) was held in Ottawa. This annual continuing professional development (CPD) event for primary care providers across the Champlain region is unique: it emphasizes system integration, and connectedness with community resources as a means to providing better clinical care for patients and improving population health. This year s theme focused on integrated primary and community care in Champlain LHIN subregions. As in previous years, this event is a collaboration of the Champlain LHIN and University of Ottawa (uottawa), Faculty of Medicine CPD Office. Purpose The purpose of this year s Congress was to provide clinicians, allied health professionals, representatives from community organizations, administrators, planners, policy makers, researchers and, patients and caregivers an opportunity to: Meet and network with the five Champlain LHIN sub-region leadership teams Learn about available resources in digital health, care coordination and quality improvement, and Contribute to shaping integrated care within sub-regions. Program Development The event was organized by a planning subcommittee, which was comprised of the following individuals: Dr. Aly Abdulla, family physician and Champlain LHIN Clinical Lead, Ottawa West Catherine Dumoulin, uottawa CPD Office Conference Planner Dr. Paul Hendry, uottawa CPD Office Vice Dean Renee Lebovitz Pelletier, Champlain LHIN Integration Specialist Dr. Jacques Lemelin, Champlain LHIN Clinical Lead, Primary Care Dr. Heather Lochnan, uottawa CPD Office Director Ann Miller, nurse practitioner and Champlain LHIN Clinical Lead, Diabetes & Vascular Health Bob Parson, uottawa, CPD Office Curriculum Design and Learning Specialist Karen Patzer, Champlain LHIN Senior Integration Specialist. Program topics were identified through: Proceedings from the 2017 Champlain Congress Feedback from primary care providers Champlain LHIN strategic priorities. Additionally, a learning session was held on health equity, specifically focused on Indigenous populations. 4

The uottawa CPD Office reviewed and approved the program. The event was an Accredited Group Learning Activity (Section 1) for 6.0 hours, as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada. The group learning program met the certification criteria of the College of Family Physicians of Canada, and the uottawa s Office of CPD certified it for up to 6.0 Mainpro+ credits. Event Highlights This report provides highlights from the day s program 1. Specifically, for each session, there is a summary, participant feedback 2, and pearls of learning, where applicable. Throughout the event, a variety of learning formats were used, including keynote speakers, panel presentations, discussions supported by interactive software (Mentimeter 3 ), meet-andgreet opportunity for sub-region leadership teams and participants, and exhibits. Participants Participant, by type Number Participants, by sub-region Number Eastern Champlain 15 Eastern Ottawa 16 Central Ottawa 35 Western Ottawa 13 Western Champlain 11 Sub-region not identified 23 Exhibitors Total 113 The planning committee selected exhibitors 4 to support the program theme. Exhibits enabled Congress participants to: Meet and network with LHIN sub-region leadership teams, and find out information about each sub-region s population and service characteristics Learn more about specific programs and tools available to primary care providers that support patient care management in mental health, chronic disease selfmanagement, coordination of care for people with the most complex needs, and population health; and Nurses and other health professionals 49 Physicians and nurse practitioners (NPs) 30 Connect with and learn more about initiatives in digital-health and health human resources. Exhibitors 11 Facilitators 12 All exhibitors offered printed materials in both official languages. Client / families / caregivers 11 Total 113 1 Appendix A 2 Feedback was collected afterwards, through an online survey. The number of respondents varied by survey question, as answering each one was optional. 3 Mentimeter is a software-based tool that enables presenters to engage and interact with audiences in real-time. 4 Appendix B 5

Opening Remarks Chantale LeClerc, Champlain LHIN CEO shared the LHIN s vision of an integrated health system, and set the tone for the day with an inspiring message of moving forward together for better patient care, population health and health system performance. Participant Feedback Of the 17 who responded to this question, 88% indicated that they agreed or strongly agreed that the learning objectives were met. I am a non-clinician, but a caregiver of two and volunteer for the LHIN and this makes me feel great that they are listening and we are moving forward. Morning Session: Sub-Region Leadership Teams & Discussion The first session of the day was to introduce Champlain LHIN sub-regions. Each sub-region has a leadership team 5 consisting of two LHIN directors (sub-region, and home and community care), and primary care clinical lead(s). The teams were introduced, and the audience learned more about each member s role. Five of the clinical leads also shared their vision for an integrated system within their respective sub-regions. To give more context, highlights from the LHIN s Jan / Feb 2018 sub-region public consultations were presented. This set the stage for a more in-depth interactive discussion and presentations on key topics of interest to primary care providers: E-Solutions Quality Improvement Coordinated Access. The purpose of the small group discussions was to stimulate thinking on how participants can get involved with and contribute to improving health and health care issues within their subregion. Tables were arranged by sub-region and participants were asked to discuss two questions: 1) How can you be involved in addressing the issues raised in the sub-region consultations? 2) Access to primary care is a priority in all sub-regions. Identify three ways in which you can contribute to improving access. 5 Appendix C 6

Discussion Summary By sub-region, the following summarizes responses collected from the small group discussions. 1) How can YOU be involved in addressing sub-region issues raised in sub-region consultations? 2) Ways to contribute to improving access? Eastern Champlain Support Inter-professional team proposals Link with other organizations and resources that are not specifically health care Participate at collaboration tables Ensure all providers are aware of ConnectingOntario Northern and Eastern Region (CONER) access After-hours access family health teams (FHTs) and community health centres Electronic connections System navigation Expand use of allied health professionals within the system Expand awareness of mental health services such as BounceBack, cognitive behaviour therapy and You Matter Eastern Ottawa Involvement in planning tables Maximize use of EMRs and other e-tools including Connecting Ontario Support meaningful capacity building in Primary Care (with consideration for supports for adoption and sustainability) Consider approach to improved access to existing community primary resources supporting team based care Enhance access to multidisciplinary teams Support for e-tools After-hours access Discontinue disincentives to shared care amongst primary care providers Central Ottawa Connect disconnected providers e.g. solo practitioner access to inter-professional teams and resources and better communication through common electronic medical records (EMRs) Simplify processes for patients including more education or central point of access/one number to call Improve upstream work e.g. prevention and health promotion Spread information and knowledge about Health Links Add more allied health professionals and team-based care as well as programs including NPs, alternative care, midwifery Extend hours of access primary care Be more strategic and inclusive of health equity in planning and program triage e.g. immigrant population needs Do more for seniors Health Links, reduce wait lists After-hours or extended care access (to include incentives, on-call system and linkages to other organizations, partners) Improve communication mechanisms to primary care physicians need an accurate distribution list, technology with adjusted billing model Increase patient/public awareness of services available e.g. 211 Include care team and specialist/ subspecialty supports for primary care Increase NPs, and use of NPs Recognize social determinants of health, use a healthy equity lens Provide support for CME events on population health, connecting chronic disease associations/foundations to primary care providers Bring care closer to home e.g. Indigenous population, downtown clinics, primary care outreach, Health Links approach to care Work with families around mental health issues 7

Western Ottawa 1) How can YOU be involved in addressing sub-region issues raised in sub-region consultations? Work to have coordination at a systems level (currently piece meal ) Empower patients and support peer support programs, groups, etc. Consider urgent care settings accessible to communities Maximize hours of operation and scope of practice Adjust remuneration models to support change Support e-sharing between hospitals and primary care Engage public in improving health literacy Enable caregivers/family members to know about services that are available Advocate for inclusion of social determinants of health as Health Links has done Support societies and networks such as Dementia Society as a great resource for information and access to services Focus on issues that pertain to me and learn more about it Give opportunities for volunteers Continue to emphasize access, continuity and coordination of services within the Health Links model Train sub-specialities in community or within family medicine and support community paramedic programs especially helpful for patients who aren t connected to specialty care Use community pharmacists to do medication reconciliation reviews for patients in Health Links Use system navigator resources already in place for better coordination e.g., in community health centres Extend primary care office hours. Support inter-professional teams but needs to be rewarded through compensation structure 2) Ways to contribute to improving access? After-hours access for rostered and unrostered patients Integrate digital health into primary care Include sub-specialties within primary care for rostered and un-rostered patients Reward Inter-professional care quality through appropriate compensation structures Advocate for more family physicians and NPs Support early identification and interventions of health problems e.g. screening, children assessments 8

Western Champlain 1) How can YOU be involved in addressing sub-region issues raised in sub-region consultations? As primary care practices we will: Share more information about BounceBack with our peers & consider referrals to BounceBack for patients Review whether our patients should be referred to Health Links We need: To get primary care providers where we need them Incentives for FFS practitioners to convert to FHTs More access to specialist consultations 2) Ways to contribute to improving access? Continue to promote joint education sessions with our neighbouring fee-forservice peers Recruit more primary care practitioners Share more information about BounceBack with peers and consider referrals to the program Review whether our patients should be referred to Health Links Participant Feedback Of the 14 who responded, 93% agreed or strongly agreed that the learning objectives were met. Key messages learned from this session included: Knowing who the LHIN s clinical leads were so participants could talk and connect with them Identifying ways to improve access to primary care Seeing progress on the Ministry s Patients First agenda, and engagement with family physicians. Morning Interactive Session & Panel: The Access Challenge Exploring Solutions in Champlain Sub-Regions Gain knowledge of available resources in e- solutions, quality improvement (QI), and coordinated access. Each topic was explored using the same engagement process: Small group discussions, based on a case scenario and question 6 Use of the Mentimeter tool to collect participant feedback and give an immediate snap-shot of the discussion Expert presenter(s) on the topic Questions & Answer. Results collected through the Mentimeter tool are presented below in the graph and word clouds. A fast-paced, highly interactive learning session engaged participants to: Reflect on their knowledge of existing solutions for challenges to accessing care, and 6 Appendix D 9

e-solutions Quality Improvement 10

Coordinated Access Participant Feedback Of the 13 who responded, 92% agreed or strongly agreed that the learning objectives were met. The pearls learned from the session were: Adapting to change Useful exercise to look at access issues and share frustrations E-solutions and coordinated access an important tool for quality improvement. Afternoon Panel: How Health Links Makes a Difference The afternoon began with a panel of impassioned presenters: a caregiver of an individual with complex needs, a care coordinator and a family physician all of whom described how coordinated care, known as the Health Links approach, made a positive difference in their lives and professional practice. Improved coordination of care for people with the most complex needs is a strategic priority of the Champlain LHIN. The target population of the Health Links approach is people who live with four or more chronic conditions, have complex needs, and often as a result, frequently need to seek care that is high cost to the health system (emergency departments, hospitals and primary care). The vision is for each of these individuals to have one coordinated care plan, a care team supporting the individual s goals, and a single point of contact to coordinate their care. Among providers working with this population, Health Links care coordination will be the new normal standard practice. 11

Caregiver Julia Huckle spoke about the challenges of being a single mother and health professional supporting her son. He has complex behavioural, social and medical needs. She emphasized that the key ingredient to success with this new approach was a single care plan that each member of his care team used as their guide to support her and her son. Everyone on the care team worked and communicated together - saving work, energy and stress. An initial care conference with Ms. Huckle created an opportunity for the care team to listen to her and her son s needs and begin mapping out coordinated support efforts with clear roles and responsibilities. Ms. Huckle said, Things that I had been trying to solve for over a year were solved in that hour. Nathalie Mehrer, a Health Links care coordinator, explained the steps involved in care coordination and emphasized the importance of the care conference stating that care conferences are worth the effort. Patients and their caregivers feel listened to and more supported, and providers have clear roles in support of the patient s goals. Duplication of services can be reduced or eliminated, service gaps identified, and communication channels established. Dr. Marilyn Crabtree spoke about the family physician role in this approach, and the challenges and benefits when working as part of a virtual care team. An important benefit is that any family physician can have a care team supporting their most complex patients. Participant Feedback Among the 13 respondents, 85% agreed or strongly agreed that the learning objectives from this session were met. The pearls learned from the session included Hearing the voice of the caregiver Health Links are important tools for integrating a solid health care system Health Links needs technology to scale up. I am looking to learn more, I hope the LHIN will take up the Health Links approach to EVERYONE'S CARE...Everyone should have a great coordinator / advocate for great care for their loved ones. Afternoon Session: Working Together, Working Differently Leading Change in Sub-Regions After the Health Links panel, family physician and Cancer Care Ontario s Champlain Regional Primary Care Lead, Dr. Declan Rowan, provided a compelling argument of how integrated care requires providers and patients to work together and to work differently. Citing examples from leading change experts, Dr. Rowan emphasized that change is necessary to improve our health system. He invited all participants to make a pledge for change. Participants were asked to spend a few minutes personally reflecting on how they would respond to the following statement, and then to submit their responses using the Mentimeter tool: My pledge to make the change I want to see in my practice/sub-region is The diagram below is a sampling of the pledges made by the participants. 12

Participant Feedback All 13 who responded to whether the learning objectives were met agreed, or strongly agreed. The pearls learned in the session included: Good presentation on change. Inspiring Encouraging to hear acknowledgement that change is hard Leadership and alliance among health care providers is the best tool to keep moving forward. Afternoon Closing Session: Equity Indigenous Health The closing session was a learning journey about Indigenous health. Guy Freedman, fifth-generation Métis, Champlain LHIN board member, and president and senior partner of the First Peoples Group, gave an insightful, thought-provoking presentation on Indigenous health inequities. Mr. Freedman used engaging story-telling, including about his own health journey, humour, historical facts, current data and hope for improvements in Indigenous care and health outcomes. 13

Participant Feedback Nearly all (92%) respondents agreed or strongly agreed that the session s learning objectives were met. The insights and information participants gained from the session confirmed or motivated them to change their practice in the following ways: Equality and delivery of care is universal for everybody Will try to connect to ensure learning opportunities for our residents Deepened understanding of the crosscultural aspect of working with this population. The event closed with remarks from Dr. Nick Busing, Champlain LHIN board member, and family physician with more than 40 years of clinical and leadership experience. He inspired participants to continue forging new relationships and building better ways of addressing health issues within sub-regions. Overall Impression of the Event Of the 13 who responded to the question on their overall impression of the event, 89% were satisfied or extremely satisfied. There was a high degree of satisfaction with the Congress, format, registration process, venue, and communications. Areas of improvement included: Quality of food and beverage choice More exhibitors Concentrate more on those with complex needs Implementing changes and moving forward Shorten evaluation feedback survey. Suggestions for Future Event Planning Participant feedback is very important in the planning of future engagement events. All respondents (13) indicated that they would attend a future Congress The most common ways in which participants learned about the event was: o Attendance at a previous conference (42%) o Email notification (42%) o Word of mouth (17%) o CPD Office website (8%) Excellent event. Very good use of time. Loved the mentimeter. Excellent speakers and very relevant topics given the health care context we are working in. Big thanks to all the lecturers for taking the time to bring everybody together, moving and shaping the future of health care. This event has been improving since I have been attending for the last three years and this was the best ever. I had thought of attending in the morning only, but I ended up staying all day. It was great. Participants quotes 14

Topics of interest for future congress programs included: o Specifics on improvements from subregion development and planning o Health Links and chronic, multi-issue genetic diseases, and how to work with these patients o The Internet of Things what will the health care system look like in 3, 5, 10 years? o Adding specialists and sub-specialities to the program o Learnings from other LHINs. 15

A - Program 16

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Appendix B Exhibitors All exhibitors have public websites. Click the links below, or use an internet search engine to find them. Champlain LHIN o Sub-Regions (Eastern Champlain, Eastern Ottawa, Central Ottawa, Western Ottawa, Western Champlain) o Digital Health o Health Links Health Quality Ontario Leeds, Grenville and Lanark District Health Unit Living Healthy Champlain Ontario MD Ottawa Public Health 18

Appendix C - Champlain LHIN Sub-Region Leadership Teams Sub-Region Director Home and Community Care Director Primary Care Clinical Lead(s) Kevin Barclay Glenda Owens Dr. Max Buxton Western Champlain kevin.barclay@lhins.on.ca 613.747.3228 glenda.owens@lhins.on.ca 613.745.8124 x 5999 Toll-free 1.866.902.5446 x 3228 Toll-free 1.800.538.0520 x 5999 Kevin Barclay Glenda Owens Dr. Aly Abdulla Western Ottawa kevin.barclay@lhins.on.ca 613.747.3228 glenda.owens@lhins.on.ca 613.745.8124 x 5999 Toll-free 1.866.902.5446 x 3228 Toll-free 1.800.538.0520 x 5999 Eric Partington Clare McCabe Dr. Ben Robert Central Ottawa Eric.Partington@lhins.on.ca 613.747.3216 clare.mccabe@lhins.on.ca 613.745.8124 x 5941 Dr. Kamil Premji Toll-free 1.866.902.5446 x 3216 Toll-free 1.800.538.0520 x 5941 Christine Gagne-Rodger Kevin Babulic Dr. Lee Donohue Eastern Ottawa christine.gagnerodger@lhins.on.ca 613.747.3262 kevin.babulic@lhins.on.ca 613.745.8124 x 5922 Dr. Thérèse Hodgson Toll-free 1.866.902.5446 x 3262 Toll-free 1.800.538.0520 x 5922 Nathalie Gilbert Kevin Babulic Dr. Marilyn Crabtree Eastern Champlain nathalie.gilbert@lhins.on.ca 613.747.3278 kevin.babulic@lhins.on.ca 613.745.8124 x 5922 Toll-free 1.866.902.5446 x 3278 Toll-free 1.800.538.0520 x 5922 19

Appendix D Case Scenarios 1) E-Solutions 2) Quality Improvement 3) Coordinated Access You receive a notification from the hospital that one of your patients has recently been discharged. The admission diagnosis was exacerbation of COPD and renal failure, the latter being a new diagnosis. Your receptionist sets up a follow-up appointment with the patient within seven days of the discharge. This 60 year-old patient misses the appointment so you ask your reception to follow up. The patient missed the appointment because she didn t have transportation to get there, her dog was sick, and she couldn t let your office know because her phone was cut off for three days due to a late billing charges. She tells your receptionist that she is not feeling well and another appointment is arranged. She makes it to the appointment but barely. She has difficulty breathing, she s limping and holding her lower back and her general appearance is disheveled. She seems a little disoriented and complains that her back pain is getting worse and the pain goes down her left leg. You look at her medications and see that they have been changed while in hospital and you determine that she hasn t filled the prescription. She says she can t afford to do so. You re a little unsure of why the medications were changed and would like to speak to the admitting physician but she can t remember her name. In addition you are unsure about the management and follow up for her renal failure and would like to as ask Nephrologist about this. You know her back pain is exacerbating other health issues, you suspect that she is using more alcohol and pain killers to numb her pain and that she could use some help with her social situation. What e-solutions might you use to help this patient? You are part of a small practice that has a few physicians and an administrative assistant. You are hearing the increasing calls for improved quality in the healthcare system. In the new sub-regional planning environment, you know the LHIN plans to work with the clinical leads to further develop the involvement of primary care in improving quality in the region. You are starting to get data about how your practice is doing on certain measures such as cancer screening and you seem to be doing okay on these measures compared with others in the province. In your practice your biggest challenges are ensuring good access for urgent appointments and looking after your mental health patients who lack access to counselling and psychiatric supports. You aren t sure what other practices in the Champlain region are struggling with. You have heard about Quality Improvement (QI) as a method to make and sustain improvements in healthcare. You and your staff are so busy you can t imagine doing more than what you are already doing. We are keen to learn from you. As a group, identify three QI priority areas across primary care practices in your sub-region. You re nicely tucked into bed but can t sleep because you re worried about Sal, a retired attorney who is 83 years old and complexly ill. He came in to see you today for the third time in two weeks. He has uncontrolled type-2 diabetes, COPD, worsening heart failure, and retinopathy that requires monthly intraocular injections. His driver s license was revoked two months ago due to visual loss. He lives alone and is trying his best to cope with his multiple health problems but is getting steadily worse. His sister and her daughter are supportive but live in Toronto. You have already arranged Meals on Wheels, ParaTranspo, and his pharmacy is blister packing and delivering his medications to him. He is adamant that he will stay in own home and looks to you for the answers. You ve tried everything you can think of to help and yet it doesn t seem to be helping. What resources or services would help you coordinate this patient s care? 20

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