part ii(b) other submissions · on june 28, 2007, the minister of health and long-term care...
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Stakeholder Feedback on the Chirpody/Podiatry Referral: The Current Model of Footcare in Ontario
Part II(b):Other Submissions
Note:
The responses within have not been edited by the Health Professions Regulatory
Advisory Council (HPRAC). HPRAC is not responsible for any errors and
omissions found on the submissions. The stakeholder comments are posted
according to access to information guidelines (for guidelines visit, http://www.hprac.org/en/privacy.asp)
Table of Contents Introduction .................................................................................................................................................. 1
Table 2: Responses from organizations (Continued) ........................................................................3 Ontario Orthopaedic Association ............................................................................................................................... 3 Ontario Podiatric Medical Association ...................................................................................................................... 52 Ontario Society of Chiropodists ............................................................................................................................... 67 North Bay Regional Health Centre ........................................................................................................................... 77 Pedorthic Association of Canada ............................................................................................................................. 81 Registered Nurses’ Association of Ontario .............................................................................................................. 161 South West Local Health Integration Network ......................................................................................................... 170
Introduction On June 28, 2007, the Minister of Health and Long-Term Care directed the Health Professions Regulatory Advisory Council (HPRAC) to "review issues relating to the regulation of chiropody and podiatry and provide advice as to whether and how there should be changes to existing legislation regarding these related professions". The Minister asked that the Council include "an analysis of the current model of foot care in Ontario, issues regarding restricted titles, and whether the existing limitations on the podiatrist class of members should continue." To provide context for an upcoming analysis of the regulation of chiropody and podiatry, and to address a broad component of the Minister’s referral, an initial consultation session was held on the current model of foot care in Ontario1. Consultation opened on April 4, 2014 and closed on July 4, 2014. The objective of the consultation session was to gather information on how foot care is delivered in the province; and learn more about the issues facing foot care providers, patients and other involved Ontarians. Participants were asked the following question:
Tell us your (or your organization’s) views on the current model of foot care in Ontario. What do you (or your organization) see as the major issues facing patients, practitioners, and others?
A link to an online survey was posted on HPRAC’s website and stakeholders submitted comments through this route; or by completing the survey and manually sending it into the HPRAC office; or by providing their views in the form of a letter. HPRAC’s consultation process is expected to crystallize broad themes and unanticipated issues; it is not viewed as a quantitative source of stakeholder interests or concerns. By the close of consultation, 198 stakeholders made submissions to HPRAC:
• 178 submissions were submitted online in the form of the survey. Part I of the stakeholder feedback focuses on these submissions.
• 21 submissions were mailed, faxed or emailed to the HPRAC office, in the form of the survey or in the form of a letter. Part II(a) & Part II(b) of the stakeholder feedback focuses on these submissions.
In total HPRAC received 199 submissions.2
1 A second consultation session will be held later in 2014 to address the remaining aspects of the Minister’s referral. 2 One organization made two submissions.
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The following organizations provided a submission to HPRAC on the current model of foot care in Ontario:
• ALYL Inc./Footloose • Canadian Association for Prosthetics and Orthotics • Canadian Federation of Podiatric Medicine – Submission A • Canadian Federation of Podiatric Medicine – Submission B • Canadian Life and Health Insurance Association Inc. • Canadian Podiatric Medical Association • College of Chiropodists of Ontario • College of Nurses of Ontario • College of Pedorthics of Canada • Feet for Life Medical Foot Care Ltd. & Feet for Life School of Podiatric Nursing Inc. • First Choice Foot Care • Giselle's Foot Care • Independent Business Specialty Interest Group of the RPNAO • The Michener Institute of Applied Health Sciences • North Bay Regional Health Centre • North East Local Health Integration Network • North Shore Family Health Team • Ontario Association of Medical Laboratories • Ontario Association of Prosthetists and Orthotists • Ontario Chiropractic Association • Ontario Community Health Centre (unspecified) • Ontario Medical Association, Sport & Exercise Medicine Section • Ontario Orthopaedic Association • Ontario Physiotherapy Association • Ontario Podiatric Medical Association • Ontario Society of Chiropodists • Prosthetics Orthotics Barrie • Pedorthic Association of Canada • Registered Nurses’ Association of Ontario • Rexdale Community Health Centre • South West Local Health Integration Network
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Table 2: Responses from organizations (Continued) Question 1: Tell us your (or your organization’s) view on the current model of foot care in Ontario. What do you (or your organization) see as the major issues facing patients, practitioners, and others? Ontario Orthopaedic Association
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Ontario Podiatric Medical Association
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Ontario Society of Chiropodists
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North Bay Regional Health Centre
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Pedorthic Association of Canada Dear Mr. Corcoran,
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On behalf of the Pedorthic Association of Canada please accept the attached submission to HPRAC which outlines in detail the barriers and challenges faced by foot care practitioners in Ontario and offers recommendations for an improved foot care model. You may find of particular interest the Policies and Procedures Manual for Custom Made Footwear in Alberta. We have attached it here as Appendix ‘C’ and it provides an excellent example of the important role custom footwear and orthoses play in an effective foot care model, and how these important assistive devices can be better utilized to serve Ontario patients. I look forward to an opportunity to meet with you, as previously discussed in order to address any questions you may have with this submission and to further share the position of Pedorthists and the important role they play in the creation of a world class foot care model in Ontario. Sincerely, Jonathan Strauss, Executive Director
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Registered Nurses’ Association of Ontario Dear members of the Health professions Regulatory Advisory Council,
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Attached please find RNAO’s submission on the current model of foot care in Ontario. Thank you for the opportunity to provide information on this issue, so as to inform HPRAC’s development of recommendations to the Minister of Health and Long-Term Care. If you have any questions or issues with the file, please contact Josephine Mo, my executive assistant, at [email protected], or by phone at 416-408-5603. We also welcome you to connect with Josephine and/or myself, if you would like to arrange further discussion. Warm regards, Doris
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South West Local Health Integration Network The current state of foot care is fragmented .There are a number of providers and health service
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organizations providing diabetes foot care for the prevention, treatment, and management of ulcers in the London area, however, they tend to work independently of one another. This fragmented and uncoordinated approach to diabetes foot care leads to both gaps and duplication of services. These, in turn, can result in higher cost for services and inconsistent outcomes which translate to decreased quality of care for the patient. It was noted through the service inventory that although there are services offered for the prevention, treatment, and management of diabetes foot ulcers such as orthotics for offloading and foot care services[1], when they are not services covered by OHIP or insurance they may not be accessed by clients. Future state • Is an integrated, system-level service delivery model • Is based on a person-centred, preventive, and interdisciplinary team approach • Is in conjunction with optimal diabetes control • Supports the elements and principles of diabetes foot management and ulcer treatment as
identified by the IWGDF • Includes the evidence-based best practices of foot assessments, risk stratification, and
offloading in addressing diabetes foot management and ulcer treatment • Utilizes a harmonized risk stratification and referral algorithm • Has as a key consideration the social determinants of health • Leverages existing services and organizations with a constraint of “no-net-new” dollars • Utilizes the full scope of practice of practitioners • Is cost efficient through service delivery by the most appropriate provider [1] Foot care services include: • Treatment for corns, calluses, ingrown toenails, and thickened toenails • Cutting and filing of toe nails • Foot hygiene
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