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 The
Cessations
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 35
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 None Other: 36
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
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
37
What should an integrated system look like?
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Doctor in the middle!
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
39
HOSPITAL is the focus!
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
40
Build a system Around the patient
What about the patient?
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglington Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
41
Patient in the Middle? Everybody thinks the patient is in the middle
Does everybody really think together?
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
42
Patient in the middle: what does that look like? • • • • •
Rapid Response Nursing Virtual Ward Health Links Primary Care Network Quality Improvement: Research and Innovation
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
43
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 Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
44
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 Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
45
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
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
46
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
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
47
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
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
48
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
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglington Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
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Where do we want to go? Let’s create a well designed, integrated system.
Credit Valley Hospital
Mississauga Hospital
Queensway Health Centre
2200 Eglinton Avenue West, Mississauga
100 Queensway West, Mississauga
150 Sherway Drive, Toronto
50