c3 creating and sustaining a primary care - public health partnership_frank martino
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Creating & Sustaining a Primary Care – Public Health Partnership
The Peel Region Experience
Frank Martino, MD, CCFP (EM), FCFP
“Relationships are Core to Family Medicine”
June 2014
CFPC Conflict of Interest Disclosure of Commercial Support
Presenter Disclosure
Presenter: Frank Martino Relationships with commercial interests: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: None
Our Focus Today
Communication Co-planning
System Integration
Communication
The Evolution of Primary Care
A Historic Departure
The late 80s and 90s saw a move to community practice for primary care
The evolution had begun in tertiary centres
Larger community hospitals followed suit
This concept led to the urbanization of family medicine
Primary Care Transformation
Patient’s Medical Home
A VISION FOR CANADA
THE COLLEGE OF FAMILY PHYSICIANS OF CANADA
LE COLLÈGE DES MÉDECINS DE FAMILLE DU CANADA
Partnerships
The Bright Idea!
SARS
Central West, Mississauga Halton LHIN, Primary Care, Public Health Network
Sponsor: Ontario College of Family Physicians Membership: Peel Public Health, Chiefs of Family Medicine, Regional Family Medicine Leadership, LHIN Administration Terms of Reference Monthly Meetings
Opportunities REACH Portal
Communication Sharing EMR Adoption
Peel Public Health– “more than vaccinations”
Realizing the value of the team…
Collaborations
Services and Programs Continuing professional development Health Promotion Prevention Health Systems Design
Defining Our Different Roles Unified Goals
Relationship Building
6 Steps to Meaningful Primary Care Engagement 1. Develop Primary Care engagement champion(s) 2. Go to primary care 3. Act on what you hear 4. Build a network of primary care leaders 5. Nurture relationships with the Early Adopters 6. Foster ownership (not buy-in)
Outcomes Family Medicine Rounds CMEs
Smoking Cessations The Returning Traveller Healthy Sexuality Antibiotic Stewardship Childhood Obesity Breastfeeding Seniors Health
Effective Use of Resources and Services
“EFFICIENCY”
Relationships
Pandemic Planning
Creating and Sustaining a Primary Care — Public Health Partnership:
Lessons from Peel Region
Megan Ward, MD, MHSC, CCFP, FRCPC
PREVENT MORE TO TREAT LESS. Public Health and Primary Health Care TOGETHER
June 2014
CFPC Conflict of Interest Disclosure of Commercial Support
Presenter Disclosure
Presenter: Megan Ward Relationship with commercial interest: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: None
Co-planning: pandemic influenza
Public Health
• Directed by Regional Council to
create a Regional plan • Became a link between municipal
and health sectors
Planning Process
Health sector • Public health • Primary care • 3 hospitals • 2 LHINs • Paramedics • CCAC • Long term care • MOHLTC • 350 Pharmacies
Municipal sector • Public health • Region of Peel • Brampton, Caledon, Mississauga • Emergency planners • Police • 4 school boards • NGOs
Primary Care
• 860 primary care physicians • 10% of 1.3 million Peel residents covered by FHT • History of good primary care-public health connections
Pandemic Planning
• 2 year process 2007-08 • Chiefs of Family Medicine at the planning table • Ongoing updates to all physicians through well established
communication mechanisms • Special sessions with MOHLTC for physicians
Successes
• Agreement on a primary care model • Agreement on immunization plan • Broad agreement across health and municipal sectors • Open communication
Challenges
• Lack of infrastructure • Lack of local media • Negotiating with so many partners
Results
• Execution of plan almost immediately • Effective public health and primary care dialogue throughout
H1N1 • Successful response: morbidity, mortality, system pressures
Comments
• Dr Frank Martino • Dr Paul Philbrook
Creating and Sustaining a Primary Care-Public Health Relationship: System Integration
Prevent More to Treat Less, June 5, 2014 Paul Philbrook MD, CCFP
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CFPC Conflict of Interest Disclosure of Commercial Support Presenter Disclosure Presenter: Paul Philbrook Relationship with commercial interest: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
System Integration
Do we really have a system?
• Hospitals • Public Health • CCAC • LHIN • Primary Care Providers • Specialists • Labs, DI • Oh, and PATIENTS!
Are these groups connected?
• Chiropractor • Complementary Medicine • Pharmacy • Dietician • Physiotherapy • Hospice • Long Term Care
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What should an integrated system look like?
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Doctor in the middle!
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
HOSPITAL is the focus!
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Credit Valley Hospital 2200 Eglington Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Build a system Around the patient
What about the patient?
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Patient in the Middle? Everybody thinks the patient is in the middle Does everybody really think together?
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Patient in the middle: what does that look like?
• Rapid Response Nursing • Virtual Ward • Health Links • Primary Care Network • Quality Improvement: Research and Innovation
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Rapid Response Nursing
• CCAC program • Focused on patients being discharged from hospital • Patients are identified by LACE score • Follow up by nurse within 24 hours, by FD in 7 days • For 30 days • Prevention of Readmission • ++ Collaboration with hospital
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Virtual Ward
• Focused on patients being discharged from hospital • Patients identified by high LACE score • Follow up by family doctor within 1 week • For 6 weeks • Own FD is engaged through this time • Prevention of Readmission • ++Collaboration with hospital
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Health Links
• Linking hospital inpatient care givers with community
caregivers. • Wrapping care around the patient • Team members: hospital FHT, CCAC • Focuses on high risk patients
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Primary Care Network
• Sponsored and supported by MH LHIN • Led by Grass Roots primary care providers • Focuses on care issues and concerns from the community
caregiver’s perspective
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Quality and Innovation
• A University of Toronto initiative based in Mississauga • Focus on embedding Quality in all initiatives • Developing “microsystems” of care • Uses “teaming” strategies • Deliver scaleable new care models
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Credit Valley Hospital 2200 Eglington Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Collaboration with Public Health • Public health has the Big Picture •Data, perspective
•Help design new programs and initiatives: e.g. cancer prevention, obesity, smoking cessation.
•Advocacy: design of cities, tax incentives for wellness screening etc
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Credit Valley Hospital 2200 Eglinton Avenue West, Mississauga
Mississauga Hospital 100 Queensway West, Mississauga
Queensway Health Centre 150 Sherway Drive, Toronto
Where do we want to go? Let’s create a well designed, integrated system.
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