Poster Displays

Posters at the AFHTO 2021 Conference:

2021 Key Dates:

  • October 27 & 28 - AFHTO 2021 Virtual Conference

Online Poster Gallery

An online gallery of posters will be made available to attendees on the virtual platform during the conference. All poster presenters listed should be registered for the conference- to chat with poster presenters, search up the poster presenter's name(s) in the conference platform's attendee list to start a conversation. 

Posters available at the conference:

 

    Poster # Theme Title Summary
    1 1. Beyond our walls: expanding access to interprofessional team-based care

    The Pandemic within the Pandemic: Drilling Down on Domestic Violence

    As COVID-19 cases surged across the province beginning in March 2020 and the government issuing multiple stay-at-home orders, a large percentage of the population was laid off, furloughed or forced to work from home to limit the spread. This household confinement led to another widespread issue related to domestic and intimate partner violence.  To address this issue, North York Family Health Team, one of the largest academic and multisite FHTs, came together to collaborate with providers at Women’s College Hospital Sexual Assault and Domestic Violence Care Centre. With this partnership, a working group was formed consisting of case workers, child and youth workers, RNs, social workers, psychiatrists as well as physicians and nurses trained in trauma, sexual violence and IPV.  This working group came together to create and modify a DV screening tool which aims to screen the 50,000+ women 18-70 years of age on domestic and child abuse, assess their perceived level of safety in their own home, as well as assign a designated risk status. Based on the risk status of the patient, a pathway has been developed to connect patients with the appropriate resources and tools in the community.  This presentation will also provide insight in regards to clinician training topics and materials including duty to report for RNs and physicians, creating a safe space for the patient, privacy protocols associated with virtual care screening, safety planning, and considerations for when and how often to screen for DV.  
    2 1. Beyond our walls: expanding access to interprofessional team-based care Covid@home:  building patient empowerment using digital health and expanding inter professional care access in Mississauga
     
    The CVFHT, together with Summerville FHT, CarePoint Health, and Home and Community Care Support Services (HCCSS), participated in a Mississauga OHT initiative: The Mississauga covid@home program. A remote-access care provided in part by the Interprofessional care team designed for patients dealing with a covid-19 diagnosis.   The Credit Valley Family Health Team (CVFHT) participated in the Covid@home. A program that would provide follow-ups for patients dealing with a diagnosis of covid-19. Patients with a positive Covid-19 test were referred to the program by their MRP at the CVFHT or by a community Physician in Mississauga and Peel Public health.   The program comprised:  intake by HCCSS; pulse oximeter delivery by community partners; initial assessment is done either by an NP or RN from the Monitoring team. Remote monitoring and patient education based on the BMJ tool. Provision of safety netting advice including awareness given about red flag symptoms, proper hydration, and access to caregiver help.  Patients would regularly self-assess. They were invited to record their vital signs. It was identified that patients could better express how they felt, identify worsening symptoms, and reported it to the IHP or MD in a timely manner.   Depending on their level of severity patients were assessed by an interprofessional team. This program allowed in-depth care and prompt follow-ups of the patients. It also allowed to shed light on patient needs and pushed the envelope of what was possible with virtual care.  This has lead to the creation of the Covid@home social support group and the future development of an App.   The success of the covid@home program prevented unnecessary visits to the ER.  
    3 1. Beyond our walls: expanding access to interprofessional team-based care Taking Vaccinations on the Road: Mobile Clinics for Congregate Settings and Homebound Patients 
     
    Health For All Family Health Team (HFA FHT) successfully executed multiple mobile flu shot clinics in the Fall of 2020 to high-risk populations living in congregate settings, as well as a mobile Moderna vaccination initiative for homebound patients within Eastern York Region from June to July 2021.      Our Fall flu shot clinics involved forming key relationships with 6 local organizations to partner in the coordination and administration of vaccine. By harnessing the power of partnerships not only were we able to improve access to flu shots for a high-risk population, but we were also able to develop a foundation for ongoing organizational collaboration.      The mobile initiative for homebound seniors introduced new logistical challenges unique to the Moderna vaccine. Special consideration of location, driving routes, time limits and doses per vial were necessary to the success of this clinic and to ensure no doses were wasted. The addition of a dispatcher role was crucial to this initiative. This clinic also leveraged key partnerships within the community to both provide and receive support during the planning and execution phases.  These partnerships include the Eastern York Region North Durham Ontario Health Team, York Region Public Health, Markham Stouffville Hospital, CHATS, Carefirst Family Health Team, Stouffville Medical, Paramedic Services and Markham Family Health Team. 
    4 1. Beyond our walls: expanding access to interprofessional team-based care

    Improving Access to Primary Care in Toronto’s Community Housing for Seniors during the Pandemic
     

    A diverse group of health and social service providers in North Toronto joined together in March 2020 to develop a process for connecting with nine seniors’ buildings to identify and provide needed supplies and primary care. On-site clinics were established, a communication strategy and manual and toolkit were created. Building huddles and cross-building hddles occurred weekly to share and problem solve. Both influenza and COVID 19 vaccines were administered to the residents at their doorstep, addressing vaccine hesitancy.  Two of the nine buildings have continued to provide on-site and in-home primary team based care post COVID 19 vaccination with the support of the Sunnybrook Academic Family Health Team and Baycrest Health Science Centre. In person visits as well as virtual connections to local primary care providers and specialists have promoted timely access to both primary care and specialists. This model uses new connections and relationship building to provide efficient and accessible team based care on an as needed or regular basis depending on need. 
    5 1. Beyond our walls: expanding access to interprofessional team-based care

    Stepping Up During A Pandemic to Keep the Message Alive: Changing from an In-person Education Event about Advanced Care Planning to a Webinar Format.
     

    As part of a Quality Improvement initiative, the STAR Family Health Team has undertaken to engage our patients in understanding the Ontario legal framework for ACP, and to encourage them to start their own planning.  There was also an interest to reach out to the broader community and share this expertise. We conducted live in-person educational events about ACP, held in our local communities, inviting both our family health team’s patients and the general public. Attendees to this live event took part in a Q &A session, provided with hardcopy resources, and an evaluation survey. We noted a very high satisfaction rate among the attendees, overall, valuing the information they received to commence their own Advanced Care Planning.     With the onset of the COVID-19 pandemic, it provided an opportunity for innovation as we adapted the in-person presentation to a live webinar about ACP. The audience attending this event were able to ask questions to the facilitators and was given an online survey to rate their learning experience at the end of the presentation which provided valuable feedback to make improvements. The revised webinar was then available on the STAR FHT website. This is linked to a feedback tool to allow those who view it to provide additional feedback and augment the data already collected. This data has been effective to refine the team’s ACP presentation, and the information gained will be shared with other organizations involved in public education about ACP.     
    6 1. Beyond our walls: expanding access to interprofessional team-based care

    Coaching and supporting people to reduce the risk of diabetes through dynamic digital engagement.
     

    Over the last 2 years PCDPP Master Trainers have been working in partnership with IMBA Medical, to develop a virtual care model for increasing care giver capacity as well as patient access to the Primary Care Diabetes Prevention Program.  In this poster we will introduce Take Action, a cloud-based platform to enhance patient engagement.  Share how using Game and Nudge Theories can enhance the virtual care experience and improve patient participation as well as outcomes.  We will also discuss how we used community partners to meet more people where they are and connect them to Diabetes Prevention education and support.    We will demonstrate how Engagement and Success can be tracked differently within a virtual care model. Including how engagement over time can be leveraged to build more personalized success experiences that enhance their ability to guide themselves from pre-contemplation to action. We will illustrate 3 different approaches to Diabetes Prevention Care by sharing the stories of three individuals and the benefits they experienced within this digitally leveraged model of care.  We will review, how the value proposition of this approach is especially impactful when considering its ability to improve equity and access, without compromising provider capacity.  
    7 1. Beyond our walls: expanding access to interprofessional team-based care You are not alone- expanding Postpartum care and education into a new virtual world!
     
    It has been recognized that throughout the COVID-19 pandemic the mental health of many has declined. This is also apparent within the population of pregnant women and their families.  With this in mind we have developed this virtual program to provide Postpartum education as well as mental health support to all parents and guardians inclusively. This provides participants with real-time access to support as well as the opportunity to share lived experiences with other new families among this pandemic. Participants can include either our patient or the guardian of the patient with guests being welcomed. Confidentiality is a priority and this is addressed prior to the start of the program. We have also integrated our Interprofessional team with our Nurse Practitioner, Registered Nurse, Dietitian, Social Worker and Occupational Therapist all having a role in the program agenda. Each session focuses on a unique theme and is led by a different clinician. Topics include breast feeding (latch, requirements, technique), self-care and medication safety, however it is not limited.  Handouts with essential resources are electronically sent to the participants and follow-up is done as requested/needed. Given the versatility of this virtual education series, this program can be offered among multiple Family Health Teams across Ontario simultaneously. 
    8 1. Beyond our walls: expanding access to interprofessional team-based care Leveraging an Interprofessional, Primary Care Team-based Approach to Providing COVIDCare@Home: Enablers, Outcomes, and Satisfaction with Care During the pandemic third wave of the COVID-19 pandemic, the SMHAHFTour FHT responded to a rising rate of symptomatic COVID-19 in our community through an initiative called COVIDCare@Home.  , a systematic and team-based approach to monitoring our FHT patients.  This wasThis was prompted by a directive from the Ministry of Health for primary care teams to assist with proactive monitoring of COVID-19 patients in the communityand built upon the work of COVID@Home programs run elsewhere in the province. . Notably, we sought to create a systematic and team-based approach that was integrated into our day-to-day clinical workflows and that empowered all staff (clerical, nursing, health disciplines, primary providers and learners) to participate in an ‘all hands on deck’ approach to care.      Prior to COVIDCare@Home – in waves 1 and 2 – FHT patients with symptomatic COVID-19 were followed on an ad-hoc basis. Early on in the pandemic, not all care providers across the FHT felt equally comfortable monitoring patients at home with COVID-19. We also struggled to accurately identify patients who would benefit from required escalations in care, and heard fears from patients about the uncertainty in their illness course.  Practice improvements - led by an interprofessional working group that met weekly to develop materials on an iterative basis and spread learning across all 5 of our clinical sites - included:     In April 2021, COVIDCare@Home was launched in an attempt to improve our internal ability to proactively monitor FHT patients with symptomatic COVID-19, including:    • Creating structured assessment templates for clinicians to use with patients to better ascertain risk of severe illness and follow clinical course over time    • Distributing of oxygen saturation monitors and/or thermometers  to patients to enable monitoring tracking of vital signs at home    • Providing and creating patient friendly education materials on expected clinical course and ‘red flag’ symptoms to prompt escalations in care     • Developing structured assessment templates on medical and social / contextual factors to better ascertain risk of severe illness and follow clinical course over time    • Making up-to-dateCOVID-19 resources for clinicians easily accessible on our EMR, such as evidence-based medication management, complications of and recovery course for COVID-19 and providing FHT-wide education on the benefits of proactive monitoring to identify potentially serious complications     • Providing FHT-wide education on the COVIDCare@Home processes and the benefits of proactive monitoring patients with COVID-19 to identify serious complications such as silent hypoxia and blood clots.   
    9 1. Beyond our walls: expanding access to interprofessional team-based care

    Beyond Our Walls: Community COVID Crisis Response
     

     With the need to support primary care services in the community during the pandemic, Queen Square FHT responded by establishing a community based COVID Response Centre that focused on assessments, COVID-19 Testing and vaccine administration.   This Centre included two clinics, our COVID Cold and Flu (CCF) Clinic and a COVID Vaccination Clinic (CVC).  Success of both clinics is attributed to engagement with community partners and the use of quality and process improvement.  Creating the CCF and CVC clinics required new and diverse partnering including non-affiliated community family physicians, Ontario Health, the City of Brampton and Peel Public Health. The relationships built during this time were fruitful and will hopefully continue post-pandemic to better support integrated community care for all clients.  Initial iterations of both the CCF and CVC began small, starting operations with less than half their projected client capacities. As the pandemic evolved, so did the processes at the clinics. Iterative improvements to both the CCF and CVC supported their evolution to their current streamlined states. From increasing testing capacity by creating a symptomatic and asymptomatic stream to ensuring minimal vaccine wastage through the management of the   The Centre was established with an equity lens ensuring anyone in the community had access to our primary care services. In particular, the neighbourhoods which we served included many who are new to the country, who did not have a primary care provider – or one that was not accessible during the pandemic for in-person care, and the uninsured. The Centre provided an alternative to these individuals than going to the hospital to address any symptoms related to COVID-19, ensuring hospitals could focus on providing care for those who needed more acute services.  These initiatives have supported the extension of our reach outside of our walls into the surrounding community. This has allowed us to see first-hand, the diversity, the proliferation, and the need for increased team-based primary care services within our community.  
    10 1. Beyond our walls: expanding access to interprofessional team-based care Maintaining Excellence During the COVID-19 Pandemic: The State of Care Coordination in Ontario Multidisciplinary Health Teams
     
    Care coordination is an essential function of primary care providers. Research conducted prior to the start of the COVID-19 pandemic demonstrated inadequate care coordination in patients with multiple chronic conditions. Ideally, multidisciplinary healthcare teams (MHTs) in Ontario are equipped with resources to handle the increased demand for care coordination, however, there is a paucity of studies examining care coordination practices within MHTs. The purpose of this study was to determine team leads’ perspectives on care coordination in Ontario MHTs prior to and during the COVID-19 pandemic. An online survey of Ontario MHTs was conducted using the validated Medical Home Care Coordination Survey for Healthcare Teams (MHCCS-H). The study outcomes (prior to and during COVID-19) included team leads' perspectives on various domains of care coordination such as: 1) accountability – the MHT is made up of members with clearly defined roles such as patient self-management education, proactive follow up and resource coordination, 2) IT capacity – the MHT uses electronic data to identify patients with complex needs, 3) self-management – the MHT has peer support readily available for patients as part of routine care, and 4) perceived care coordination – rated as poor, fair, good, very good, or excellent. 
    11 1. Beyond our walls: expanding access to interprofessional team-based care Join the movement: Access to Kinesiologist lead exercise programming leads to high quality patient outcomes We highlight the value of including Registered Kinesiologists (RKins), as exercise experts, into the interprofessional care team by showcasing patient outcome results from RKin delivered programming within the Guelph Family Health Team. Within the Guelph Family Health Team, RKins work as part of interprofessional care teams, providing enhanced access to sustainable programs including Diabetes Management, Pulmonary Rehabilitation, and Chronic Pain Management. Within these programs RKins provide evidence based exercise prescription and education to help patients manage their chronic conditions and improve their quality of life. Since April 2020, two RKins have provided patient-centred care for nearly 800 patients. Across all three programs, exercise prescriptions were effective first line treatments for nearly 80% of those patients. Exercise prescriptions targeted aerobic (44%), strength (41%), balance (2%), and flexibility (12%) depending on each patient’s unique circumstances and presenting conditions. A SMART goals framework was often used to strengthen exercise adherence, where nearly 55% of current patients have recently established new SMART goals as they’ve successfully progressed through their treatment and initial SMART goals thus far.      Exercise remains an potent and powerful medicine to prevent and mitigate chronic conditions like diabetes, chronic obstructive pulmonary disorder, and others. Our Guelph Family Health Team example showcases how expanded access to RKins as part of the interprofessional team-based care available for Ontarians provides sustainable and high quality opportunities to best leverage exercise as medicine. RKins can play an important role within the interprofessional family health care team, building and leading sustainable programs to enhance access exercise-based therapies. 
    12 1. Beyond our walls: expanding access to interprofessional team-based care Virtual Cognitive Behaviour Therapy for Insomnia (CBTi) during a pandemic  Introduction:  Cognitive Behaviour Therapy for Insomnia (CBTi) is the first-line therapy for insomnia and can be given in group or individual sessions. The COVID-19 pandemic created some challenges for in office group sessions. The Health For All Family Health Team interprofessional team proposed brief CBTi group and individual sessions using virtual resources.    Objective:  To discuss a model CBTi consisting of a group didactic presentation and individual follow-up assessments using virtual care by the multidisciplinary team.  To review the process required to maintain group and individual CBTi.  To assess the efficacy of CBTi on sleep improvement and changes in sleep medication.  To review the resources used for CBTi.    Inclusion criteria:  Individuals in the East York Region interested in improving sleep with access to internet or phone (self-referral or physician referral).    Outcome:  Insomnia Severity Index prior to the presentation and individual sessions.  Number of medications used for sleep prior to presentation and during the follow-up sessions.    Intervention:  One hour group presentation and two individual follow-up appointments (2 weeks apart) starting 1-2 weeks after the presentation with the pharmacist or social worker.  Further follow-up appointments were made if necessary.    Results: see below    Summary:  CBTi consisting of a group presentation and 2 individual follow-up sessions with a pharmacist or social worker improved sleep, reduce insomnia severity index and reduced sleep medications after four weeks.
    13 1. Beyond our walls: expanding access to interprofessional team-based care Get a Pap (GAP) Teaching Clinics Since the pandemic began, Pap tests have been the most delayed screening test in our practice, as they require an in-person appointment (compared to FIT and mammogram requisitions, which can be emailed to the patient). Our most recent estimate is that the number of patients due for Pap tests has increased by roughly 40% this year (about 4100 patients due).    Given the academic nature of our practice, we have a simultaneous goal of teaching family medicine residents and other health disciplines learners. Incoming family medicine residents may not have had much experience in performing Pap tests, as their clerkships were interrupted by the pandemic. Combined with anticipated upcoming changes to Pap test guidelines (to start at 25 years of age), family medicine residents and Nurse Practitioner students are at risk of limited opportunity to consolidate this skill.    To enhance opportunities for family medicine residents to consolidate Pap test skills, our team has developed GAP (Get a Pap) Teaching Clinics. In these clinics, the Nurse Practitioner (NP) teaches, observes and evaluates family medicine residents on Pap skills. These clinics also serve as an opportunity to train Registered Nurses (RNs) to perform Pap tests under a medical directive. Only Pap tests are booked during these clinics to optimize patient flow. However, charts of patients booked are pre-screened by RPN students to identify any additional preventative care gaps that can be filled during the appointment (i.e. mammogram and FIT requisitions prepared in advance). Additionally, overdue immunizations and blood pressure checks can be added efficiently to the appointment if needed.    We anticipate that the GAP Teaching Clinics will help build capacity of the health workforce (residents, NPs, RNs, RPNs) in offering cervical cancer screening as part of their future practices.
    14 1. Beyond our walls: expanding access to interprofessional team-based care

    Low Back Pain - Surgery Without The Wait 
     

    The Low Back Rapid Access Clinic (RAC) provides a ticket to the fast lane for patients experiencing unmanageable low back pain. The program acts as a valuable resource for primary care physicians throughout the province who are struggling with the ongoing dilemma of low back pain management. We provide a solution by offering expedited evidence-based strategies to help educate, manage and triage patients to receive either conservative exercise, diagnostic testing, therapeutic injection or surgical intervention.     The Couchiching Family Health Team (CFHT) in Orillia is the only central hub site in the province that offers this program outside of a hospital setting which, during the pandemic, has allowed for a safer and more accessible pathway of care. Without access to in-person assessments, the RAC program showcased innovation by developing a virtual care toolkit which was implemented province-wide. This prevented a significant backlog of patients waiting to access appropriate care. 
    15 2. Primary care leading in health system transformation

    Primary Care Data Leading the Way in Population Segmentation with the Chatham-Kent Ontario Health Team. 
     

    This presentation will cover the process of how 3 Family Health Teams, who are partners of the Chatham-Kent Ontario Health Team, used their data to inform population segmentation work for integrated care design. Primary care can be seen as a small partner in an Ontario Health Team. However, the relationships that we have with our patients and our ability to follow them through their health journey is unmatched. The data in the EMRs reflects this and can help to uncover a focus for the Ontario Health Team. We will go into detail about the data package that was created by compiling data from 3 Family Health Teams’ EMRs – Accuro and Telus PS Suite. It included: identifying the CKOHT’s Year 1 Population with diagnosis and billing codes; retrospectively analyzing their hospital activity with HRM eNotifications; and their primary care activity with appointment types. In collaboration with the local hospital’s data and other community partners input, we were able to provide a compatible story of the Year 1 Population and their utilization of health services. With this information, the CKOHT’s Integrated Care Design working group was able to make data informed decisions for population segmentation and solidify a direction for their work. This presentation will also cover the strengths and weaknesses of the data that was used and how we can continue to evolve primary care data.  
    16 2. Primary care leading in health system transformation Collaborative Pandemic Response: A Cough & Flu Clinic for Mississauga
     
    During early stages of the pandemic, primary care physicians (PCPs) faced numerous barriers in providing patient care including PPE, staffing and being able to adhere to best practices for infection prevention and control. In winter 2020, the Mississauga Ontario Health Team (M-OHT) established a clinic where patients with COVID-like symptoms could be assessed and treated by a PCP in a safe environment. Patients can be referred by their own PCP or self refer.  This Cough & Flu Clinic is a partnership of the OHT’s founding primary care members, the Primary Care Network (PCN) in this region, the local hospital, and represents a cross-organizational partnership response to COVID-19. Summerville Family Health Team manages the clinic and provides Nurse Practitioners, Nurses and administrative staff. Space and equipment are provided by CarePoint Health and physician leadership is provided by Credit Valley Family Health Team and the PCN. On site physicians are also identified through the PCN. The clinic is established as a satellite of Trillium Health Partners’ COVID assessment clinics and receives funding through the Central Region of Ontario Health.  When the High Priority Neighbourhood Initiative was launched, Peel CMHA provided additional support. Throughout the planning and implementation phase, Ontario Health’s Community of Practice members were vital in adapting the clinic to manage changing demands of COVID-19. The team’s strategy shifted over time in response to the data. When a decrease in demand was noted, the clinic allowed any patient that met certain symptom criteria to visit, thereby expanding availability to additional populations.
    17 2. Primary care leading in health system transformation Capturing Pregnancy History in the Electronic Medical Record: An Opportunity to Improve Women’s Future Cardiovascular Health 
     
    Women who experience pregnancy complications- including preterm birth, gestational diabetes mellitus and hypertensive disorders of pregnancy - have an increased risk of future cardiovascular disease (CVD). Pregnancy complications are often not captured in patients’ electronic medical records (EMRs), and many family physicians (FPs) are unaware of their implications for future cardiovascular health.    Due to the lack of awareness, and since many of these women have no other cardiovascular risk factors, effective prevention strategies that exist for CVD are often missed in this population. We are conducting a study to design and evaluate a new EMR feature that will support FPs in documenting pregnancy history and initiating preventative care for patients at risk of CVD. The new feature will be integrated within the Telus PS Suite and piloted with the Sunnybrook and Toronto Western Family Health Teams.     The study will be conducted in four phases:   1-Needs assessment  2-Design  3-Develop the prototype  4-Evaluation using user-testing     The research team has completed Phase 1, preliminary data collection of 6 FPs at Sunnybrook. Physicians were asked if they find value in the proposed EMR feature. They were also asked to report on their current EMR documentation practices, to identify existing barriers, and to offer recommendations. Currently at Phase 2, we seek to inform the design of this EMR feature through additional interviews of FPs at Sunnybrook and Toronto Western FHTs.      A well-designed EMR feature has the potential to bridge care transitions for pregnant women and prevent chronic disease for a large population of at-risk patients.
    18 2. Primary care leading in health system transformation

    Understanding the impact of flash glucose monitoring on self-management & glycemic control in those with type 2 diabetes requiring insulin therapy.
     

    Our initiative aims to improve the glycemic control of those with type 2 diabetes, reducing the risk of long-term complications. Our aim is to ensure all patients eligible, are offered flash glucose monitoring as a means to monitor their glucose, and provide them with more insight over lifestyle factors impacting their glycemic control. We look at the initial change, both through glycemic change, and patient's self-management, as well as the change over time in using flash glucose monitoring. Our aim, is that if this monitoring system does improve indices, that all patients requiring insulin therapy are offered this as an option, to improve their quality of life and reduce the risk of long-term complications.
    19 2. Primary care leading in health system transformation Climate action through prescribing practice: the Metered Dose Inhaler (MDI) problem Metered dose inhalers (MDIs) are significant contributors to global warming potential (GWP), which threatens the health of our population. Many healthcare providers are unaware of this impact on the environment, and prescribe MDIs despite the ready availability of more environmentally sustainable options. Our quality improvement initiative aims to educate healthcare providers and patients on the environmental impact of MDI inhalers, and present them with the opportunity to switch to non-MDI alternatives. By equipping primary care providers and pharmacists with this knowledge and the appropriate resources, they are in an optimal position to educate their patients with whom they share decision making. It is the responsibility of the healthcare provider, in whom patients trust, to help them make informed choices. We will use quantitative measures to assess the capacity for prescription change, receptivity to change, and actual change from MDIs to non-MDI alternatives.  
    20 2. Primary care leading in health system transformation Environmental Impact of Metered Dose Inhalers: A Call for Professional Practice Change Climate change has been identified as “the greatest health challenge of the 21st century”.[1] Respiratory health is threatened by extreme heat events and air pollution from the combustion of fossil fuels for energy, industry, and transport, and by an increase in forest fire smoke.[2] Metered-dose inhalers (MDIs) are a common medical device used to deliver inhaled medication for respiratory conditions.[3] [4] MDIs contain high levels of hydrofluorocarbons (HFCs) that act as potent greenhouse gases (GHGs) when released into the atmosphere, cumulatively contributing to a large GHG burden. [5] Data from the UK found a single (100 dose) metered-dose inhaler contributes the carbon footprint equivalent of a 180-mile (289.682 km) car journey, and that metered dose inhalers account for about 3.1% of the carbon footprint of the entire UK health system. [6] [7]     The Canadian health sector contributes 4.7% of Canada’s greenhouse gas emissions. [8] Primary care providers can effectively lead the reduction of MDI-induced GHG emissions and ultimately improve the health of patients, populations, and the planet. When prescribing metered dose inhalers, primary care providers are often unaware of their environmental impact, making education and other quality improvement (QI) initiatives an important strategy that can be scaled up to transform the provincial and national health landscape. [9]     Our poster/presentation is an interdisciplinary education initiative that allows participants to explore the environmental impact of prescribing MDIs and consider equivalent alternatives that limit the carbon footprint. The poster/presentation includes a QI toolkit that outlines strategies, electronic (EMR/PSS) reminders, posters, prescribing support charts and other tools for a primary care practice setting.       References:  1. Costello, A., Abbas, M., Allen, A., Ball, S., Bell, S., Bellamy, R., Friel, S., Groce, N., Johnson, A., Kett, M., Lee, M., Levy, C., Maslin, M., McCoy, D., McGuire, B., Montgomery, H., Napier, D., Pagel, C., Patel, J., … Patterson, C. (2009). Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. The Lancet (British Edition), 373(9676), 1693–1733. https://doi.org/10.1016/S0140-6736(09)60935-1    2. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., et al. (2021). The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet (British Edition), 397(10269), 129–170. https://doi.org/10.1016/S0140-6736(20)32290-X    3. Bourbeau, J., Bhutani, M., Hernandez, P., Aaron, S. D., Balter, M., Beauchesne, M.-F., D’Urzo, A., Goldstein, R., Kaplan, A., Maltais, F., Sin, D. D., & Marciniuk, D. D. (2019). Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD - 2019 update of evidence. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 3(4), 210–232. https://doi.org/10.1080/24745332.2019.1668652    4. Global Initiative for Asthma. (2020). Pocket guide for asthma management and prevention: (for adults and children older than 5 years). https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020…    5. Janson, C., Henderson, R., Löfdahl, M., Hedberg, M., Sharma, R., & Wilkinson, A. J. K. (2020). Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax, 75(1), 82–84. https://doi.org/10.1136/thoraxjnl-2019-213744    6. Wilkinson, A. J. K., Braggins, R., Steinbach, I., & Smith, J. (2019). Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open, 9(10), e028763–e028763. https://doi.org/10.1136/bmjopen-2018-028763    7. Asthma inhalers as bad for the environment as 180-mile car journey, health chiefs say. (2019). Telegraph.co.uk. https://www.telegraph.co.uk/news/2019/04/08/asthma-inhalers-bad-environ…    8. Eckelman, M. J., Sherman, J. D., & MacNeill, A. J. (2018). Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLoS Medicine, 15(7), e1002623–e1002623. https://doi.org/10.1371/journal.pmed.1002623    9. Brooks, S., Cheung, A., & Wintemute, K. (2020, August 25).  Low carbon inhalers: Choosing wisely for patients and the environment. Canadian Family Physician.  https://www.cfp.ca/news/2020/08/25/08-24   
    21 3. Harnessing the power of relationships South Georgian Bay Unified Community Response to COVID-19 The South Georgian Bay Ontario Health Team (SGB OHT) are a team of local health professionals, organizations, and community members working to create an integrated health and social system. SGB OHT partners collaborate with patients, families, caregivers, and the community to co-design the best possible care for our region during and beyond COVID-19. To keep our community safe and healthy during COVID-19, we are committed to leveraging our strong cross-sectoral relationships to provide our community with integrated services. This integration is exemplified by the high percentage of our patients with a COVID-19 vaccine recorded in their medical chart, regardless of where they received their vaccine. When a patient is administered a COVID-19 test or vaccine or enrolled in the COVID-19 Home Monitoring Program, this is immediately recorded in the patient medical chart. This provides up to date health information and enables bidirectional communication with the patient’s primary care provider. This effort speaks to our ability to be proactive, identify those who need support to be tested or vaccinated, and stay engaged with this essential aspect of patient’s care. Our commitment to this adaptive approach has been formalized by the SGB OHT, as a shared response to COVID-19 is a key strategic priority. Through the OHT, we will continue to build on these existing strong relationships to best support our community in COVID-19 recovery.  
    22 3. Harnessing the power of relationships “Only Possible Together”: A FHT Led Community Collaboration to Provide Integrated Evidence-based Care for Individuals with Life-Threatening Behaviours through a DBT Program
     
    As a FHT serving within the County of Dufferin, specialized mental health programs, including outpatient and inpatient hospital-based services, have long existed outside our community requiring patients to travel to other communities to access these services – or, more often than not, patients being unable to access these services due to transportation or logistical barriers.  Moreover, patients struggling with suicidality and life-threatening behaviours are often referred to various local agencies unable to provide effective longer-term therapy beyond crisis support or situational counselling. Without inter-agency commitment, coordination, and patient-centred collaboration, this often results in disjointed care.    Since launching in 2019, the Dufferin DBT Program is an example of what is “only possible together”, including during Covid-19, when a FHT actively partners and collaborates with community mental health agencies to develop a specialized program, thereby increasing access for complex patients to evidence-based treatment. Moreover, the Dufferin DBT Program – now entering its 3rd year - has extended team-based care outside our roster, enhanced working relationships and care coordination, and reduced travel barriers for patients.     Given the huge commitment to providing a DBT adherent program – involving individual therapy, weekly skills group, phone coaching, and peer consultation to support clinical adherence – the program’s sustainability has been truly rooted in ‘our relationships’.     Led by DAFHT, the Dufferin DBT Program is a partnership with CMHA Peel-Dufferin, SHIP, and Family Transition Place.   
    23 3. Harnessing the power of relationships Enhancing the Healthcare Experience of Individuals with Intellectual Disabilities and their Families: An Ontario Perspective in Collaboration with Special Olympics Ontario

    "An intellectual disability, the most common developmental disability, is a limitation in cognitive functioning, including communication, social, and self-care skills. Intellectual disabilities can be caused by injury or disease but must happen any time before the child turns 18 years of age.     Based on national population estimates there are between 60,000-100,000 individuals living with intellectual disabilities in Ontario, however the experiences of this population in navigating our provincial healthcare system are poorly understood.     The Special Olympics is an international organization that provides both recreational and competitive athletic and healthcare opportunities to individuals with intellectual disabilities in our local communities. However, each Special Olympics athlete and caregiver has had a different experience with the healthcare system.    As a group of University of Toronto Medical Students, working with Special Olympics Ontario, we set out to understand and learn from the good and bad experiences of unique population. In this way, we can work with this community, along with their caregivers and healthcare team(s), to address identified challenges to ensure we provide quality and consistent care to these individuals.    To date, the results of an extensive survey of Special Olympics-affiliated athletes and caregivers as well as 4 focus groups have been analyzed, in an effort to understand:  

    1.    The systemic barriers that are faced in accessing health care

    2.    What are the tangible actions that any healthcare provider can implement to improve healthcare delivery to this population

    3.    How best to deliver both healthy living and sexual health education. "

    24 3. Harnessing the power of relationships
     
    Contemplation and Conversations About Driving and Dementia
     
    Thames Valley Family Health Team and Alzheimer Society Southwest Partners have collaborated for a number of years to provide an ‘in person’ presentation on the topic of Driving and Dementia. This presentation was moved to a virtual platform (Zoom)in fall 2020, because of pandemic restrictions. Participants with lived experience were also connected to researchers at Baycrest who are developing the Driving and Dementia Roadmap (DDR).   The DDR is an online resource for healthcare providers, persons living with dementia (PLWD) and their care partners.  PLWD and their care partners had the opportunity to attend this workshop virtually, which allowed for greater accessibility for people who work, for PLWD who can’t drive, and for participants from a wider geographical area to attend.  Researchers at Baycrest were connected with people with lived experience to contribute to the DDR, ultimately creating a better website for public use in the future. 
    25 3. Harnessing the power of relationships
     
    Partners in Care: Recognizing, Supporting and Including Caregivers as Part of the Care Team. Building partnerships with caregivers to improve patient health outcomes This poster will describe strategies and tools for care providers to build partnerships with caregivers to improve patient health outcomes.     Caregivers provide an estimated three quarters of care in Ontario, supporting care recipients with physical and mental health needs. Identifying the caregiver is an important step to establish a relationship that can yield better care outcomes, and better care experiences for patients, caregivers, and staff. Care providers can support caregivers to identify needs and solutions, develop care plans and refer to appropriate supports. Including caregivers as part of the care team provides caregivers the opportunity to share their knowledge, build supportive transitions and improve health outcomes.     The Ontario Caregiver Organization (OCO) has adaptable tools and resources for healthcare organizations to support strong partnerships with caregivers.     Co-designed by care providers and caregivers, The Time to Talk Toolkit provides front-line staff with meaningful ways to recognize, engage and support caregivers.     The Partners in Care Toolkit, which includes the Caregiver Identification card (Caregiver ID) supports healthcare organizations to formally recognize caregivers as part of the care team. Caregiver ID has been recognized as a key part of caregiver presence programs and helps build a culture that engages and welcomes caregivers to be more active as partners in care and can help caregivers to feel more confident and supported in their role.     Caregivers as Partners e-learning modules gives care providers the tools to understand the caregiver perspective and work with caregivers as partners in care.     These strategies supported by OCO’s adaptable resources, are important tools for care providers to consider as they work to create a positive patient and caregiver experience and improve health outcomes.  
    26 3. Harnessing the power of relationships Exploring patient preferences and goals for ACP discussions in the primary care context: An IQ project at St. Michael’s Hospital

    "Advance care planning (ACP) refers to a process where a person communicates their values, goals, and preferences to prepare for future medical care. Recent Canadian research highlights the need for family physicians to take leading roles in these conversations.    Despite evidence of the importance and benefits of ACP, ~47% of Canadians have not had a discussion with a loved one about their preferences for care and end of life planning. While there are many barriers that contribute to these low rates of ACP conversations, a lack of understanding of patient perspectives is a key contributor.     This IQ project involved both online surveys (N=24) and in-depth phone interviews (N=12) with patients >65 years old at St. Michael’s Hospital 80 Bond clinic about their opinions on ACP.    This IQ project addresses the IHI triple aim of better care, better health, and better value. There are many benefits of this IQ project:  

    ●    For patients - the project proved useful in encouraging participants to reflect on this important topic. Ultimately, patients will benefit from the development of a more holistic and patient-centred process for engaging in ACP within primary care  

    ●    For the healthcare team - developing a streamlined process for how to engage in ACP with eligible patients will improve workflow, support what can be a challenging clinic encounter, and ultimately improve care provision  ●    For the system -  increasing uptake of ACP in primary care will reduce healthcare system strain at end-of-life and contribute towards improving equity in dying with dignity "

    27 4. Right care at the right time: building digital models of care
     
    Proactive Diabetes Care during COVID 19: Fostering patient self management, improving organization of care and optimizing digital tools for better patient health outcomes 
     
    COVID-19 disrupted the continuity of care for patients and propagated deterioration of chronic conditions such as diabetes. The Credit Valley Family Health Team (CVFHT) proactively assessed the impact of the pandemic on their diabetes patient care using a triangulated approach comprised of a clinic survey, EMR query, and a patient survey. The patient survey (286 responses) identified needs related to diabetes management during COVID-19. The investigations validated problems, needs, and motivation for improvement. The problems identified were: 1. Disruption of continuity of care; 2. Decrease in lab tests completed by patients; 3. Increase risk of comorbidities. Identified needs were: 1. Digital tools for virtual education; 2. Patient self-management support 3. Implementation of a recall process. The CVFHT prioritized the needs, creating a Just in Time intervention which was a proactive virtual educational strategy designed to reduce deterioration of diabetes outcomes, foster patient engagement and improve patient self-management. The 2-part education intervention utilized a team-based approach and was grounded in principles of learning and behavioural psychology with the goal of promoting behaviour change. The design strategies incorporated active learning for high-level engagement, promotion of memory retention, peer learning using patient “Bright Spots” and small breakout discussion groups.  Key learnings for patients included: 1. Discovering the impact of their own lifestyle factors on their glucose levels;  2. the importance of increasing Time in Range to improve diabetes management; 3. Utilization of glucose data in decision making;  4. Sharing glucose data with the CVFHT team to prepare for virtual consultations.
    28 4. Right care at the right time: building digital models of care Virtual Care: A Legal Checklist
     
    COVID-19 lockdowns across Canada have restricted access to in person healthcare services and accelerated the adoption of virtual means to deliver services to persons in need. Virtual Care is the delivery of healthcare services to patients/clients remotely using information and communication technologies asynchronously or in real time. The IPC has recently released new guidelines for safeguarding the security of information in virtual care and to advance these considerations some provinces, Ontario for example, have developed centralized provincial portals for vendor verification. With new innovations come new risks for providers to identify, mitigate and manage. This Poster will provide a legal checklist for Virtual Care, which will cover:     1. Considerations for determining virtual care use, including which modality, client and services   2. Legal/Regulatory obligations regarding consent, privacy and professional regulations   3. How to assess Operational Readiness including system infrastructure   4. Managing Virtual Care risks through policies, vendor contracts, insurance and consent processes       
     
    29 4. Right care at the right time: building digital models of care
     
    Primary Health Care Mental Health Program Meets Public Art Gallery Space (AGO) Virtually to support socially isolated patients during COVID19 pandemic
     
      The significance of this study is to address social isolation risk factors for young adults with pre-existing or existing mental health concerns during COVID19 in North Scarborough. In particular, the literature shows after the SARS pandemic the negative mental health impacts. For instance, psychological distress includes: “Irritability, insomnia, emotional and mood issues, panic, depression, anxiety, frustration, boredom, loneliness, lack of physical resources, and poor communication.” (Goodman et al., 2001). Our mental health team identified similar symptoms in patients (over telephone) during COVID19 pandemic 2020; and noted the importance of creating a digital model of care to prevent patient needs from worsening or falling through the “cracks.”     In this uncontrolled pilot study (single system research design), the Cognitive Behavioural Therapy modality was chosen because of its strong evidence in improving patients’ outcomes with mild-moderate depression and anxiety symptoms. Based on prior group programing, our social work team found that engaging people in creative practices within a supportive environment encouraged greater self-expression and engagement, especially those from marginalized communities. Subsequently, this brainstorm session led, Cherish Picklyk, RSW, to liaise with a suitable partner with art specialize - the Ontario Art Gallery (AGO).     Relevance for Organizational Implementation     The success observed thus far is encouraging for Ontario mental health clinicians to design similar innovative group programming while continuing to provide the foundational CBT strategies. It is relevant in order for organizations to have the digital option to support continuity of care and increase interest from a greater pool of participants with varied interests or apprehension to joining a mental health group.       
    30 4. Right care at the right time: building digital models of care
     
    Adolescent perspectives on virtual care 
     
    Amidst school shutdowns, sheltering in place, and social distancing, the COVID-19 pandemic uniquely affected adolescents.  Understanding the experiences of adolescents with respect to social distancing, health changes, information sources and virtual care can inform effective health care for adolescents both during and after the pandemic. Objective: An exploration into their health care experiences during the beginning stage of the pandemic was undertaken to increase knowledge among family physicians to enable adjustments to the provision of care, primarily done virtually.
    31 4. Right care at the right time: building digital models of care
     
    Reflections on a Journey into the Process of Implementing Virtual Group Programs in Primary Care
     
    Digital healthcare solutions are increasingly widespread and available, and offer patients the opportunity to utilize virtual methods to enhance access to care. During the COVID-19 crisis, a need to rapidly embrace virtual care arose to meet patient care needs and improve timely access to care.   Interactive group programs offer a rewarding opportunity for patients to learn, reflect, discuss and connect with other patients and caregivers in a safe environment.     The North York Family Health Team (NYFHT), one of the largest community multi-site FHTs, mobilized their primary care team to offer virtual group programs in order to continue supporting the health and wellness of their patient population. This transition was supported by the creation of organizational policies, privacy considerations, clinician training, and data measurement. Provision of virtual group programming warranted additional considerations related to privacy legislation compliance and confidentiality of patient health information into clinical practices, and assessment of potential privacy risk.   This presentation aims to provide insight into one organization’s journey of planning, developing, implementing and evaluating virtual group programs into practice. An exploration into the process of implementing virtual group programs on a secure platform, and while ensuring patient privacy and confidentiality amongst program attendees was of utmost importance. A number of benefits and challenges to virtual care were uncovered. Enablers and barriers to implementing virtual group programs amongst a team of multidisciplinary team members will also be shared.  
    32 4. Right care at the right time: building digital models of care
     
    Maintaining Patient Access During a Virtual Revolution: A Communication Tool Quality Improvement initiative
     
    COVID-19 required family physicians to rapidly shift how they provided clinical care to their patient. Early on in the pandemic, we identified that some patients were being seen virtually for the same issue repeatedly, when the issue could have been addressed in a single in-person visit.  As we provided more virtual care, an understanding of what presentations are more easily and better addressed in person evolved.  Therefore, we developed a booking matrix tool to help reduce this appointment redundancy to maintain access, while allowing flexibility and patient choice where possible.  The matrix included appointment type (virtual, phone, in person) as well as time allocated to allow for appropriate PPE, pre-screening and manuvers to occur and accounted for provider type (resident, physician, NP, PA) based on patients presenting complaint.  It also provided guidance for the reception staff regarding “urgency” of visit scheduling.    To evaluate this booking matrix, we surveyed reception staff, physicians and providers for satisfaction and perceived impact on workflow.  Same day access and  continuity appointments were monitored during the implementation period and available appointment times increased due to lack of duplication.  
    33 4. Right care at the right time: building digital models of care
     
    Electronic patient portals: How do they affect traditional health care usage and provider clerical workload
     
    Electronic patient portals are online applications that allow patients access to their own health information. There has been a great deal of recent interest in patient portals, accompanied by increasing technology adoption by both clinicians and patients. The COVID-19 pandemic has highlighted the importance of virtual care, an area already identified as a national health care priority. Electronic patient portals are a form of asynchronous virtual care. Patients may access health portals via their home computer or on a mobile device, depending on the specific portal. Portals are also referred to as personal health records, and their features vary widely. Examples of features include the ability to view test results and other aspects of the health record. Portals may also provide alternative ways for patients to obtain services traditionally provided in person, such as renewing prescriptions, sending and receiving secure messages, and booking appointments. Portals are expected to contribute to more authentic collaboration between clinicians and patients.     Many primary care providers have expressed interest in patient portals but also concerns that responding to patient messages may increase clerical workload. Prior to incorporating electronic patient portals more widely, it would also be valuable to understand how they might affect the use of traditional health care services such as in-person encounters or phone calls, especially in a family health team capitated payment model. To our knowledge, no long-term evaluation of the impact of patient portals on traditional health care usage has been conducted to date. The clerical burden associated with patient portals has also not been evaluated. Because the impact of portals is expected to take place over a prolonged time period, we used a longitudinal approach to investigate the effect of a portal system on health care usage. We also tracked the time providers spent responding to portal messages to estimate the impact of an electronic patient portal on provider clerical workload. 
    34 4. Right care at the right time: building digital models of care
     
    Deconstructing the Memory Clinic: A new digital model of care during COVID-19 and beyond
     
    After working with a MINT model memory clinic for eight years, numerous challenges were arising that prevented efficiencies in care, including difficulties with scheduling multiple providers, long wait times for patients and difficult engagement with family physicians. We could no longer deliver our fully office-based assessment and care planning in the face of a pandemic. The COVID-19 pandemic provided a green light for something already being considered – deconstructing the “clinic.” This presentation will explain and highlight a new approach in assessing, treating, and managing cognitive impairment, which has drastically improved team efficiencies at the Dufferin Area FHT, including significantly reduced wait times from 120 days to 23 days and doubling volumes of patients seen in one year. In the first six months of implementing this program during a pandemic (August 2020-March 2021), we had seen more patients than we had in the previous 12 months pre-pandemic! We will share our program flow, its strong outcomes, and the perspectives of this model of care from physicians, providers, patients and caregivers.
    35 4. Right care at the right time: building digital models of care
     

    A Method of Tracking Foot Ulcers
    Wound documentation using a validated tracking tool in combination with proper wound care product selection is a best practice. Wound tracking alone has been demonstrated, by Khalil et al., to speed wound healing and reduce the cost of care.  Using the existing electronic medical record (EMR) at the Elliot Lake Family Health Team we are able to track wounds and able to predict which wounds will heal and which wounds will be hard to heal.  Wounds in Ontario are trackable if researchers gain access to the various EMR's and/or data collection methods that are currently used to record that data. One provincial EMR across health care settings would simplify data collection. 
    36 4. Right care at the right time: building digital models of care
     
    Creating an EMR Embedded exercise prescription app for family medicine  "Context:  Musculoskeletal disorders (MSDs) are the leading cause of disability globally and the number reason for patients attending their family physicians.  Exercise is efficacious in the treatment and management of MSDs however the prescription of individualized exercise programs for patients is difficult for primary care practitioners. To help improve the prescription of exercises and increase utility by department providers, an exercise prescription app was developed, and pilot tested in our family medicine department.     Objectives:   1.    To evaluate utility of the exercise prescription application for use by primary care practitioners  2.    To evaluate usefulness of the exercise prescription app from the perspective of patients    Design: The application was created utilizing a quality improvement approach, with pre-testing feedback by a small group of providers, followed by pilot testing. Pilot testing included questionnaire feedback completed by both providers and patients.     Setting: Unity Health Toronto, St. Michael’s Hospital Academic Family Health Team (AFHT)    Participants: AFHT health professionals who utilized the app and patients who received an exercise prescription through the application.     Intervention:  An exercise prescription application was developed and embedded in the department’s internal website to facilitate provider prescription of individualized exercise programs to patients.  Team members pre-tested and provided feedback. The app was then finalized for pilot testing through use by a broader group of department health professionals who were trained in its use.   "
    37 4. Right care at the right time: building digital models of care
     
    Building an equitable framework for the virtual triage of musculoskeletal complaints in primary care during the COVID-19 pandemic A rapid increase in the provision of virtual care in Ontario has occurred as a result of the COVID-19 pandemic. Virtual care, in some form, is likely here to stay. The continued use of virtual appointments in primary care should be informed by patients’ and providers’ experiences over the course of the pandemic.   The physiotherapy team at the St. Michael’s Academic Family Health Team developed and implemented a telephone triage framework to assess patient appropriateness for the virtual assessment and management of musculoskeletal complaints.   Access to the internet, a device to facilitate the virtual video appointment and patient comfort level with technology were significant factors which determined whether virtual or in person appointments were booked as provider comfort level with video appointments improved over the course of the pandemic. Patient-specific factors, such as cognitive status and beliefs/ideas about virtual appointments, also impacted these decisions. Additionally, providers found that some patient presentations were not appropriate for virtual appointments. In order to optimize the patient experience and promote equity, patient preferences as well as access to and comfort level with technology should be considered in virtual care implementation in the management of musculoskeletal conditions in primary care.
    38 5. Equity as the foundation in delivery of care
     
    Ensuring equitable access to primary care in a virtual world
     
    In order to understand patients’ care seeking behaviours during the pandemic, a multi-site cross sectional patient experience survey was conducted across 13 academic primary care teaching practices (including 12 Family Health Teams) affiliated with the University of Toronto. The survey explored patients’ use and views of virtual care (phone, video, and email/secure messaging) and whether these differed by sociodemographic factors including age, gender, education level, immigration status, self-reported financial difficulties, self-reported health, and preferred language. Questions were also asked about seeking and delaying care during the pandemic, use and comfort with virtual care, urgent care access, and patient centredness.  Patient responses to these sets of questions were compared by sociodemographic characteristics.     The results of these analyses show some commonalities among all participants, but there were statistically significant differences in a number of care and access questions based on sociodemographic variables.  We will present the key findings and discuss how clinicians and system decision makers can integrate virtual care in a way that ensures equitable access to primary care.   
    39 5. Equity as the foundation in delivery of care
     
    Transgender Care IS Primary Care – Lost in Transition 
     
    Our presentation will include group participation, didactic learning and video patient testimonials. To begin, participants will be invited to share their misconceptions/fears related to providing transition related care. These myths will be dispelled throughout the presentation. We will provide an overview of our clinic model at North Simcoe Muskoka Trans Health Services, which includes a peer navigator, mental health therapist and nurse practitioner. We will explain how we have had to adapt to meet the growing demand for transition related care in our region – with examples of how aspects of our clinic can be incorporated into every day primary care. A case study will highlight the patient experience in accessing our services. A didactic learning session will follow, providing the introductory knowledge required to care for this population, with emphasis on the diagnosis of gender dysphoria, the informed consent approach to hormone therapy as well as a discussion on preventative health care. Resources will be discussed. If time allows, we would invite participants to work in pairs to describe their own gender history, bringing to light the difference in how we communicate with cis and transgender patients. A short video of patient testimonials will close out the presentation. Participants will be provided with a handout summarizing the key points they can incorporate into their practices.        
    40 5. Equity as the foundation in delivery of care
     
    Building a Community of Care for a Community in Need
     
    Carefirst has a core value to improve health equity. One of the ways that Carefirst strives to achieve our mission is by promoting in the broader community an awareness of our clients’ needs for social, health care and support services. The community of South East Markham was identified as a COVID hot spot and saw many hospitalized, without income and in panic. The introduction of COVID to a community that already had high levels of material deprivation, dependency, residential instability and racialized, left many ravaged and worse off.   An eager and passionate group of 20+ partners came together, led and coordinated by Carefirst, in late 2020 to support the South East Markham community through the development of the “High Priorities Communities Program”.     Primary care played in integral role in this partnership. Carefirst integrated two physicians from the Carefirst Family Health Team (FHT) and a Nurse Practitioner from the Health For All (FHT) to support the screening, interpretation and timely delivery of COVID-19 results to the clients. Clients who had tested positive for COVID-19 were given their results, counselled and enrolled in the wraparound support program through an interprofessional team at the FHT. This was not only efficient but also tremendously effective in convincing uncertain clients to participate in our programs. Carefirst’s wraparound support program with the involvement of the FHT’s nurses, social workers and the partner agencies was timely and did not stop when the infection cleared. The clients were followed up with after six months to ensure that they received adequate social, financial and health support and received vaccines at the earliest recommended time after infection.     Carefirst consciously anchored partners that were diverse and rooted in the community. All initiatives formed under the Program were designed with cultural contexts and languages, locations and times of day in mind. For example, leveraging community partners effectively enabled each swab clinic to be staffed by individuals who specialized in different languages and possessed diverse cultural knowledge. Our primary care partners at the Health For All FHT were instrumental in staffing the swabbing clinics at the YMCA. 
    41 5. Equity as the foundation in delivery of care
     
    The Power of Asking: Screening for Intimate Partner Violence 
     
    The COVID-19 global pandemic has given rise to an alarming rate of Intimate Partner Violence (IPV) across the globe, and it is now more than ever we need to address the barriers that are jeopardizing the health and safety of those affected by abuse. According to Statistics Canada (2020), approximately 54% of victim services reported an increase in the number of domestic violence victims being served between mid-March and early July of 2020. An emerging but complicating factor to this is the transition to virtual care in the primary care setting that has evidently made it more challenging to screen for IPV in a confidential and safe space. While it is known that abuse is not exclusively experienced by women and children, this initiative focuses on extending the current cervical cancer screening visits done by RNs to include screening for abuse suffered by women in a safe and confidential space using the validated HARK screening tool. Safety assessments were completed based on screening results and patients were connected to FHT social workers and/or community resources for additional support. 
    42 5. Equity as the foundation in delivery of care
     
    Promoting 2SLGBTQI+ Health Equity: A Best Practice Guideline
     
    The Registered Nurses’ Association of Ontario (RNAO) will share recommendations and details from the newly published Best Practice Guideline (BPG) Promoting 2SLGBTQI+ Health Equity. The RNAO is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. The BPG Program is a signature program of RNAO.    RNAO has published a BPG to address the unique care needs of Two-Spirit, lesbian, gay, bisexual, trans, queer, intersex and other sexual or gender minority people (2SLGBTQI+). Developed using an anti-oppressive lens, intersectionality framework and reconciliation, the BPG provides evidence-based recommendations for nurses and other health professionals on foundational and inclusive care practices, health promotion and health care.    RNAO assembled an expert panel including persons with lived experience and individuals experienced in clinical practice, education, research, policy and activism.  The expert panel identified research questions on communication, education, risk screening, safe spaces, group-based interventions and care for older adults. The RNAO research team completed eight systematic reviews of qualitative and quantitative literature. GRADE and GRADE-CERQual methodologies were used to determine certainty and confidence in the evidence, and the expert panel voted on the strength of recommendations.     Ten recommendations were drafted based on this work along with one good practice statement. Each recommendation includes a discussion of evidence, practice notes detailing important considerations and resources to support implementation. The BPG also includes background information and guiding principles, research gaps, evaluation and monitoring details, implementation considerations and appendices providing further detail on some recommendation areas.   

     

    Online Poster Gallery

    To share your initiative with as many of your peers as possible, an online gallery of posters will be made available to members through AFHTO’s website after the conference. To participate, please upload a PDF of your poster to the presenter management portal by October 13, 2021. Your poster PDF will also be uploaded to AFHTO’s website in the member section after the conference.

     

    Registration

    AFHTO’s policy is that all who attend the AFHTO conference, including poster presenters, must register for the conference at the appropriate rate. Please click here to register if you haven’t already done so.

     

    Poster Display Guidelines:

     

    Tips for a Memorable Poster

    There will be about 40 posters at the conference, which means no attendee will be able to engage deeply with all of them. You need to have an attention-grabbing poster that will draw people in and make a big impact on them in a small amount of time. Thomas Erren and Philip Bourne have published a great list of ten simple rules for a good poster presentation; below are just a few of the highlights:

    • Determine the purpose of your poster before you start preparing it. 
      • “…ask yourself the following questions: What do you want the person passing by your poster to do? Engage in a discussion about the content? Learn enough to go off and want to try something for themselves? Want to collaborate? All the above, or none of the above but something else? Style your poster accordingly.”
    • Sell your work in ten seconds. Prepare a quick “elevator pitch” that starts with an attention-grabbing statement or questions and then follows up with the thesis or major finding explored in your poster.
    • Choose your title wisely. It may be the only thing attendees see before deciding whether to visit.
    • Good layout is essential: 
      • Leave plenty of white space, which puts a reader at ease. 
      • Guide the reader through the information using arrows, numbering, or whatever else makes sense for your data. 
      • Never use less than 24-point font, and make sure the main points can be read at eye level, at a conversational distance
    • Be concise! Remember that a (good, carefully chosen) picture (graph/ table/ diagram) is worth a thousand words. Use graphics that can be understood at a glance but provide more detailed information upon closer inspection.
    • Be friendly, personable, and responsive to readers’ questions, but allow them to read your poster at their own pace. Provide business cards or handouts with your contact information in case they wish to follow up later.