3. Comprehensive team-based care
- Date: Friday, September 20, 2019
- Concurrent Session C
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Time: 8:45am – 9:30am
- Room: TBA
- Style: Presentation (information provided to audience, with opportunity for audience to ask question)
- Focus: Balance between both (e.g. Presentation of a best-practice guideline that combines research evidence, policy issues and practical steps for implementation)
Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers
Learning Objectives
Chronic insomnia often coexists with other mental health and addictions issues. Overuse of sedative hypnotic medications often do not help, but instead contribute to significant long-term side effects especially in the elderly.
At the end of the presentation, the attendees will learn practical tips on how to:
- Improve engagement of physicians around sedative-hypnotic deprescribing
- Tailor deprescribing regimens to better suit individual patients
- Integrate Cognitive Behavioral Therapy for Insomnia (CBT-i) in deprescribing
- Utilize allied health resources more effectively, resulting in potential cost saving
Summary/Abstract
In recent years, many FHTs have started sedative-hypnotic deprescribing initiatives in response to Choosing Wisely Canada’s call for action. In addition, some FHTs have invested in providing Cognitive Behavioral Therapy for Insomnia (CBT-i), an evidence-based intervention that helps patients sleep better without medications. We will discuss implementation strategies, effectiveness and cost-effectiveness, including:
- How to improve uptake by FHT physicians and patients;
- What factors affect the pace and success (and relapse) of deprescribing; - How to integrate CBT-i to provide seamless care;
- Whether there are potential cost savings to this process.
Since the inception of the sedative-hypnotic deprescribing program at the North York FHT three years ago, a number of strategies have been utilized to improve uptake from team physicians and patients, such as having physician champions, leveraging the FHT QI plan, utilizing EMR to identify patients and track outcomes, recruiting medical residents to support QI projects, collaborating with internal and external stakeholders, and sharing results. Patients can be complex: of the approximately 120 patients referred to the pharmacists so far, many have comorbid conditions including anxiety, depression or restless legs syndrome. Tailoring is needed for deprescribing and there is variability in deprescribing pace and success. Social workers and pharmacists have received CBT-i training. This allows the provision of CBT-i in a group setting and on an individual basis. Our data suggests there may be ways to coordinate CBT-i and deprescribing for selected patients. This may allow an enhanced deprescribing pathway and potential cost savings.
Presenter
- Eric Lui, Pharmacist, North York Family Health Team
- Christine Truong, Pharmacist, North York Family Health Team
- Rita Ha, Pharmacist, North York Family Health Team
- Laura Michell, NYFHT Social Worker, Mental Health Team Lead
- Dr. Maria Muraca, Medical Director, North York Family Health Team
- Dr. Joanne Laine-Gossin, NYFHT Physician, QI Team Lead, North York Family Health Team
Authors/Contributors
- Dr. Kimberly Wintemute, Choosing Wisely Canada Primary Care Co-Lead
- Dr. Michelle Greiver, Gordon F. Cheesbrough Chair in Family and Community Medicine at North York General Hospital
- Dr. Harvey Blankenstein, NYFHT Physician, QI Team Lead
- Laura Michell, NYFHT Social Worker, Mental Health Team Lead