c3 creating and sustaining a primary care - public health partnership_frank martino

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!

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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Doctor in the middle!

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HOSPITAL is the focus!

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Credit Valley Hospital 2200 Eglington Avenue West, Mississauga



Build a system Around the patient

What about the patient?

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Patient in the Middle? Everybody thinks the patient is in the middle Does everybody really think together?

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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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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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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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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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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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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



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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Where do we want to go? Let’s create a well designed, integrated system.

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c3 creating and sustaining a primary care - public health partnership_frank martino

Documents

primary health care

primary care physicians

evolution of primary

health sectors

public health network

chiefs of family medicine

peel residents

peel region megan ward