Poster Displays

Posters at the AFHTO 2022 Conference:

2022 Key Dates:

  • Hotel group rate deadline:                            September 19, 2022
  • End of early-bird registration:                       September 28, 2022
  • Date to submit PDF for online gallery:         September 28, 2022
  • AFHTO 2022 Hybrid Conference:                October 12, 2022
    •  Install poster:                                        7:00 to 7:45 AM, October 12, 2022
    •  Remove poster:                                 5:00 to 6:00 PM, October 12, 2022

 

Poster Display Guidelines:

  • The maximum size for posters is 46” (vertical) x 70” (horizontal)
  • Posters are to be put into place before 7:00 AM on Wednesday, October 12, 2022, and to removed between 5:00-6:00 PM on Wednesday October 12, 2022
  • For Virtual Posters -  PDFs should be a single page in the form of a PDF
  • Poster presenter FAQs are available here
  • Poster Information Kit

Online Poster Gallery

An online gallery of posters will be made available to attendees during the conference. In order to share your initiative with as many of your peers as possible, please email a PDF of your poster to conference@afhto.ca by September 28, 2022.

Posters available at the conference:

Physical posters

    Poster # Theme Title Summary
    1 1. It takes a team: collaboration inside and out

    Championing Integrated Care: Primary and Community Care Response Teams

    Primary and Community Care (PCC) Response Teams is an integrated care planning program focused on supporting system navigation and service connection for vulnerable adults living in East Toronto. The virtual interdisciplinary teams are comprised of health care and social services providers and volunteer community health ambassadors who participate in the localized, cross organizational, cross-sector care planning. Prior to COVID-19, health care and social service providers had recognized the need to come together across organizations to coordinate care for adults with complex needs (with an initial focus on homebound clients unattached to primary care). With the onset of COVID-19 in March 2020, health and social needs were exacerbated by increased isolation and pandemic-related changes to health and social services. This program began as an urgent response in April 2020 to strengthen collaboration among primary care, other local health care providers and social services workers to pool knowledge, expertise and resources to develop coordinated care plans for the people who needed them most.

    2 1. It takes a team: collaboration inside and out The Importance of Interdisciplinary Care in the Treatment of Diabetic Foot Ulcers
     

    Integrated, team-based care provided with the appropriate care partners ensure optimal care outcomes for patients. The North York Family Health Team (NYFHT) is a large, academic, multi-site family health team (FHT). In the treatment of diabetic foot ulcers, a team of NYFHT providers collaborate in the patient’s care plan.  The NYFHT physicians and nurses are distributed throughout the North York area providing their expertise in assessing and educating their patients. The NYFHT chiropodist is responsible for providing assessments, treatment and education for patients with high-risk foot conditions including those that are limb threatening.    3 to 4 case studies of patients with diabetic foot ulcers seen by the NYFHT physician, nurse, and chiropodist will reflect how integrating providers both within and outside the FHT improve patient outcomes, including the wound size and the patient’s overall DM status. Patients were then referred to internal FHT providers such as the Diabetes Education Program (DEP) and pharmacy team, and external organizations such as the Home and Community Care Support Services for nursing support in providing regular dressing changes and the Centre for Complex Diabetes Care (CCDC) for offloading devices. By building a team around the patient’s needs, this led to wound closure in all cases and improved a1c.   

    3 1. It takes a team: collaboration inside and out Sharing and learning from each other to improve clinic phone wait times A common patient experience survey delivered at 13 academic family health teams from November 2021 to February 2022 highlighted a shared improvement opportunity for phone wait times. Of patients who reported their booking experience as fair or poor, the majority reported waiting too long on the phone and needing to call the clinic multiple times. Since over 70% of patients book their appointments by phone, this indicates that patients are having difficulty accessing care due to phone wait times.    The Quality Practice Committee (QPC) at the Department of Family and Community Medicine (DFCM) at the University of Toronto created “Share & Learn” sessions as an innovative and easily accessible way to engage clinicians, administrative staff, and patient partners in improving phone wait times. Three 1-hour sessions were held in the Spring/Summer 2022 virtually over Zoom webinar. At each session, there were presentations from two DFCM teaching sites on phone wait-time projects currently underway or completed.    This poster will highlight how practices worked to understand the problem, some common change ideas, and lessons learned. Themes that emerged from early presentations included staff ratios, use of online booking, and unintended consequences of e-innovations. Our sessions brought together clinicians, staff, and patients, from more than 13 clinical sites, including community sites. Post-session evaluations indicated that attendees felt they could implement the change ideas they heard about at their own sites.
     
    4 1. It takes a team: collaboration inside and out Diabetes -  It Takes a Village

    The number of Canadians diagnosed with diabetes is on the rise each year, with 1 in 3 Canadians living with gestational diabetes, diabetes or prediabetes. Our team realized the need to enhance our program to ensure all eligible patients are screened for diabetes, and if diagnosed, have access to prompt education, pharmacology, physical assessment and laboratory follow up, as needed. Our Diabetic Program demonstrates the importance of having multiple Inter-Health Professionals involved. Prevention in Primary Care is key, and our program was built to prevent the many adverse outcomes that can accompany a diagnosis of diabetes. Not only can our Diabetic Program positively affect glycemic control, it can also have a direct lipid lowering affect, and assist in blood-pressure management. Virtual and in-person appointments are scheduled as needed for blood pressure review, insulin starts, proper glucometer use, and continuous glucose monitoring, along with foot exams and retinal exams as recommended. We encourage all DM patients to attend our Diabetes 101 online class, Carbohydrate Counting and food label reading education as well as our interactive Eating the Mediterranean Way class to ensure our patients feels empowered to manage their diabetes and prevent complications.   

    5 1. It takes a team: collaboration inside and out

    Leveraging Primary care Ontario Practice based Learning and Research (POPLAR) Network to Improve Quality in Primary Care: the SPIDER study
     

    Polypharmacy and “Potentially Inappropriate Prescriptions (PIPs)” are associated with persistent higher care needs, elevated care costs, lower quality of life and lower physician satisfaction. Medication such as proton pump inhibitors, benzodiazepines, antipsychotics, and long-acting sulfonylureas are commonly prescribed for prolonged periods, sometimes without adequate indication. Eliminating these PIPs is a priority.     We established a Structured Process Informed by Data Evidence and Research (SPIDER) to support quality improvement (QI) in primary care practices.  We are studying SPIDER in a randomized controlled trial across Canada to reduce PIPs in individuals 65 and older with polypharmacy. Practices randomized to the intervention arm participate in Learning Collaboratives, receive the support of a quality improvement coach, and are given data on the PIPs prevalence.  They receive a list of their patients with these PIPs using data from their Electronic Medical Record (EMR).     In Ontario, the Primary care Ontario Practice based Learning and Research (POPLAR) Network, a coalition of seven practice-based learning and research networks (PBLRNs) under one governing structure has centralized and standardized the SPIDER process to enhance efficiency and potential for impact. POPLAR securely collects and de-identifies EMR data to support practices in delivering optimal care across Ontario and strengthen practice-based clinical research and quality improvement processes.     In this presentation we will describe how POPLAR can be used to support quality improvement in primary care practices by describing how it was leveraged for SPIDER’s study conduct. Our intent is to support primary care quality improvement activities more broadly.  
    6 1. It takes a team: collaboration inside and out

    Building Resilience Individually and as a Team 

    This poster will look to highlight the importance of resiliency and team support.  It will highlight the key areas that SETFHT has implemented in order to support the staff both individually and as a team.  This will help out teams to customize these strategies to help support their own teams.     By supporting the individual person, they are better equipped to work together as a team, which in turn has allowed for consistent in person and virtual care during the pandemic, as well as improved team dynamics.  The goal it to carry these lessons and strategies through to the other side of the pandemic and build momentum to grow our team strength, resilience and dynamic.    Poster will also look at the outcomes and evidence including lower absenteeism, even during a time when there is greater risk of sickness, lower staff turn over, higher productivity rates and higher staff morale and team spirit!      

    7 1. It takes a team: collaboration inside and out

    Primary Care Occupational Therapy: The Value of Access for Patients

    Occupations, or daily activities, bring meaning to people’s lives. Using the full scope of  occupational therapy services, clients can  optimize their ability to participate  in meaningful activities, thus reducing disability and improving health.     The scope of practice of occupational therapy is well aligned with the objectives of Primary Care. “There is growing evidence that occupational therapists’ unique lens (focus on occupation) supports individuals with or at risk of disability in a primary care environment. The scope of occupational therapy goes well beyond traditional rehabilitation to include health promotion, disability and disease prevention, and community development..” (Donnelly et al 2022).    Occupational therapists in FHTs provide services longitudinally, providing comprehensive and coordinated care .     We will review the evidence about the benefits of the broad range of interventions that occupational therapists provide and how this improves patients’ participation in meaningful activities with impacts on overall health outcomes. Examples include: Aging in place, brain health, falls prevention, driving retirement, support to stay at work/ return to work, managing pain and/or  mental health conditions, chronic disease management, and developmental screening for young children.     Occupational therapists have worked in Family Health Teams for 12 years.  With OTs in approximately 65 of Ontario’s 184 FHTs , approximately 65% of Ontarians rostered with FHTs are left without access to Primary Care Occupational Therapy services. Opportunities to increase occupational therapy’s presence in FHTs will be discussed.  

    8 1. It takes a team: collaboration inside and out Team-based Opioid Stewardship in Ontario: A Pharmacist Perspective
     

    7.63 million Canadians suffer from chronic pain. Opioid medications can help relieve chronic pain and improve health-related quality of life. Canada ranks third globally for prescription opioid use. During 2016-17, Ontario witnessed 73% increase in hospitalizations attributed to opioid misuse. Team-based primary care, of which pharmacists form an integral part, serves nearly 25% of Ontarians. This project explores pharmacists’ perspectives on team-based opioid stewardship in Ontario. Pharmacists working in team-based primary care settings across Ontario who participated in a provincial survey about chronic pain management and opioid stewardship (N=88) were invited to follow-up individual semi-structured interviews that explored pharmacist perspectives on the functioning, challenges, opportunities, and best practices in team-based opioid stewardship. Understanding these factors can optimize team dynamics and lead to more effective use of the pharmacist as a resource in opioid stewardship.  

    9 1. It takes a team: collaboration inside and out How ECHOs amplify: the power of Project ECHO Rheumatology in your FHT in managing inflammatory arthritis and autoimmune diseases

    Project ECHO is a guided practice model that increases workforce capacity to provide best-practice specialty care and reduce health disparities. It is well-suited to rheumatology care delivery in Ontario, as the number of rheumatologists in the province has remained static despite the growing prevalence and burden of rheumatic disease. Consequently, there remain striking disparities in access to care, particularly in rural and remote areas across the province.     ECHO Ontario Rheumatology began in 2017 and facilitates knowledge sharing and the evolution of a community of practice for rheumatic disease care. In doing so, ECHO fosters and supports rheumatic disease care champions within a Family Health Team (FHT), impacting the access and management of these diverse rheumatologic presentations – often with high morbidity, mortality, and decreased quality of life. ECHO not only impacts the direct participant and clinician, but also offers rich learning opportunities for colleagues within clinics and improved care delivery across organizations.     In this session, we present experiences of ECHO Rheumatology participants from FHTs to demonstrate how the Project ECHO model is adapted to effectively share knowledge and support complex rheumatic disease management. We also highlight the development of a virtual community of practice (VCoP) through ECHO Rheumatology and present metrics regarding uptake and effectiveness of the program.   

    10 1. It takes a team: collaboration inside and out

    From Silos to Success: Collaboration of Primary Care Models Tackling Community Needs 
     

     - Well developed relationships are the foundation of innovative work  - Through covid work 1) testing 2) respiratory assessment 3) vaccines 4) treatments (antivirals - oral, IV) primary care has worked cohesively to be the only primary care based model in the province  - Close working partnerships with hospital, public health, lab, pharmacy, municipalities, even a fire department,  Ontario Health and our newly formed Sarnia-Lambton Ontario Health Team; our community has been able to successfully respond to the needs throughout the last 2.5 years and still going strong.   - Daily reporting of stats (7 days a week) has provided data to support our model and show our success  - Rural and urban partnerships translated into coverage across the entire county   - Overlap of teams and care created one team, no matter the primary care model (ie. FHT vs CHC) in which partners co-lead sites utilizing staffing from both models as one team - it can be done!   - Our model was showcased on Ontario West region meeting May 25, 2022

    11 1. It takes a team: collaboration inside and out Sustainable, ongoing collaborations for practice-based, data driven QI:  thirteen years of experience
     

    Our small community-based family practice is part of the large, distributed North York FHT.  Our practice participated in a large-scale provincial QI initiative, the Quality Improvement and Innovation Partnership in 2009; we have had QI meetings and ongoing activities since then.  Our QI team includes physicians in the practice, Interprofessional Healthcare Providers (IHPs), our Office Manager, a Front Staff member and a Patient Partner.     The QI Team is ably led by the NYFHT RN in the practice.  Central NYFHT IHP members (clinical pharmacist, dietician, social worker) join remotely. Meetings became fully virtual during the Pandemic and are currently hybrid.    The meetings are structured and include agendas and minutes.  Data by physician practice are collected ahead of each meeting, presented, reflected on and discussed at each meeting.  PDSAs have been used for many years to drive improvement, with measurable and measured impact.    We measure quality of care for several conditions, including diabetes and asthma.  Findings and activities of interest are communicated back to the NYFHT, which then decides whether to spread to multiple other practices.  The entire practice meets to discuss practice management once a month, and selected activities and results are shared by the QI team with all physicians and staff.    We conclude that QI activities in small community practices can be sustained over long periods of time.  Successful QI work can be spread and scaled beyond the practice.  We will present examples of data that is measured, examples of agendas and minutes, and discuss how we sustain QI efforts.   

    12 2. Health equity at the centre ‘Housing for Health’: Caring for and Prioritizing Vulnerable Community Members Experiencing Chronic Homelessness in Dufferin County

    Recognizing homelessness as a significant barrier for maintaining or improving health, the Dufferin Area Family Health Team - over the past two years - ‘stepped forward’ to take a lead in our community by focusing on ‘housing as a health need’.  This vision to provide care for health needs created by chronic homelessness through actively supporting and prioritizing housing stability presented new ways of working in community and new partnerships with social care organizations. Funding through a federal program (Reaching Home), supported by a local Community Advisory Board and additional Covid relief support, allowed for the hiring of 2 Housing Support Workers from June 2020 to May 2022.      During this challenging time and through the impact of Covid on access to resources, including affordable permanent housing, 93 individuals struggling with chronic homelessness (defined as at 6 months of homelessness over the past year or recurrent experiences of homelessness over the past 3 years) were supported by this project.  Of these individuals, 58 (or 62.4 %) individuals were successful in acquiring and maintaining housing.      Throughout the project, as a health care organization, we became much more aware of the barriers to accessing affordable housing, the significant impact of mental health and addiction for homeless individuals in seeking housing, and the challenges faced by community partners working to address homelessness and poverty.  
     

    13 2. Health equity at the centre Accountable Spaces: Improving Service Provider Readiness to Serve 2SLGBTQI+ Clients in the Community

    "This project was conducted between September 2021 and March 2022 with VHA’s Toronto Central rehab team in a community care setting. Opportunity to engage with interventions was made available to all members of the team which included approximately 80-90 providers.  Client partners and community organizations who work with 2SLGBTQI+ populations and provide education in this area were consulted. These stakeholders reviewed the content developed through literature review and an environmental scan of available training in the community.   The interventions developed during this project included:   1.    An educational intervention 30 minutes to one hour in length delivered virtually and recorded.  2.    A resource hub launched on VHAs intranet containing community resources, access to wider training resources, and the recorded educational session.  3.    Practice tools in the form of pronoun buttons to be worn by providers to serve as a visual representation of openness to provide an accountable space for clients.  4.    Weekly emails delivered in February and March sharing practical tips to incorporate into daily practice.    This project has increased awareness of unique needs of 2SLGBTQI+ clients, and has improved provider knowledge, skills, and attitudes. Attitudes are very challenging to change, however in this project with an improvement in knowledge there appears to be an improvement in attitudes too.   Resources are now readily available for providers to consult. There is still a significant opportunity for more frequent education opportunities. This project has highlighted that VHA providers would like to continue learning so that they can provide inclusive, equitable, and safer care.     "

    14 2. Health equity at the centre

    Serving the Underserved: Bringing Interprofessional Primary Care to High Needs Communities

    The Taylor Massey neighbourhood has very little access to primary care services. This “high-needs” neighbourhood currently has a scarcity of family physicians paired with a high number of poorly served individuals with multiple emergency department visits and return inpatient admissions.   The proposed services provided to this population will build upon the success of the South East Toronto Family Health Team (SETFHT) by expanding into a neighbourhood with an immediate need for investment in primary care. By responding to the specific population needs of these communities, the expanded SETFHT services will ensure that those individuals who are complex and poorly served have improved access to team- based primary care that is integrated across the care continuum.  The service will focus on providing program-based care that will provide a higher level of service to a greater number of complex and at-risk patients.  Furthermore, this proposal will evolve the FHT model by incorporating learnings from the initial investment in FHTs and responding to the specific needs of each community and the emerging mandate of our Ontario Health Team (OHT). Development of this service represents significant collaboration with partner organizations in the East Toronto Health Partners OHT and the residents of the communities that will be served. This collaboration and co-design represents the future of efficient and effective primary care reaching priority populations in underserved geographies.     
     

    15 2. Health equity at the centre

    Promoting Smoking Reduction and Cessation with Indigenous Peoples of Reproductive Age and their Communities: A Best Practice Guideline
     

    The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. The RNAO will share recommendations from the newly published Best Practice Guideline (BPG), Promoting Smoking Reduction and Cessation with Indigenous Persons of Reproductive Age and their Communities.     The BPG focuses on smoking reduction and cessation that address the needs of Indigenous peoples of reproductive age and their communities. Developed using cultural humility, a cultural safety approach and trauma-informed practices, the BPG provides evidence-based recommendations for nurses and other health and social-service providers.    RNAO assembled an interprofessional panel of individuals with lived experience and knowledge in clinical practice, education, research and policy across a range of health and social-service organizations, academic institutions, practice areas and sectors. The panel included urban and rural representation with First Nations and Inuit community members from across Ontario. The panel identified research questions on cultural safety, counseling, pharmacotherapy, Indigenous health education and integrating smoking cessation into broader wellness programs. The RNAO research team completed five systematic reviews of qualitative and quantitative literature. GRADE and GRADE-CERQual methodologies were used to determine certainty and confidence in the evidence, and the panel voted on the strength of recommendations.    Nine recommendations were drafted, along with one good practice statement. Recommendations include a discussion of evidence, implementation tips detailing important considerations and resources to support implementation. The BPG includes background information, guiding principles, research gaps, evaluation and monitoring details, implementation considerations and appendices providing further detail on some recommendation areas.   
    16 2. Health equity at the centre Practical Applications for Equity, Diversity and Inclusion Work in Primary Care: Ideas on where to start
     

    Equity, Diversity and Inclusion (EDI) work at the Guelph FHT is in its infancy. As a Best Practice Spotlight Organization, the Guelph FHT works hard to continue to provide best quality care to patients. In 2022, EDI has become a strategic focus, and this poster presentation will provide a snapshot of the planning phase of EDI related work. The content will be divided into three categories: 1) identification of current state and future state, 2) development of an EDI Council and 3) strategies toward creating cultural competency in healthcare.   Early work has included a needs assessment through an employee opinion survey process using the Global Diversity, Equity and Inclusion Benchmarks. As a partner organization to the Canadian Centre for Diversity and Inclusion (CCDI), using resources to help develop an effective and sustainable EDI Council has been instrumental in this process. Finally, moving toward creating cultural competency has been broken down into both individual and organization recommendations that will be highlighted in both current and future state examples.    In summarizing learnings from the above healthy equity activities, applied against the GDEIB framework, the Guelph FHT aims to offer recommendations and general directions on practical and impactful applications of EDI work in a primary care setting.   

    17 2. Health equity at the centre

    Road to Recovery: A Multi-Pronged Approach to Support COVID-19 Vaccinations and Beyond in North York
     

    During the COVID-19 crisis, a need to rapidly support community vaccination needs and encourage uptake arose. A person-centered approach to address vaccinations in specific populations was required to meet patient care needs and improve access to care. Factors to consider were location and timing of clinics as well as the creation of a comfortable and easily accessible clinic which was able to uphold high standards of infection control.         The North York Family Health Team (NYFHT), one of the largest community multi-site FHTs, mobilized their primary care team to offer a multimodal strategy to support the region’s vaccination-related efforts; wherein we provided support not only to our FHT patients but also to anyone in the community. Specifically, the NYFHT offered family-focused vaccination clinics and senior friendly drive-throughs; we also offered combination COVID-19 vaccination clinics alongside influenza and childhood catch-up vaccinations, in response to our community’s needs. Vaccination distribution and support for primary care providers in their practices as well as towards homebound efforts were also approaches to ensure access to vaccine were available to all. In addition to these efforts, FHT team members volunteered to support vaccinations in long-term care settings, community hubs, and large-scale vaccine efforts.    This presentation aims to provide insight into one organization’s journey of planning, developing, and implementing a vaccine strategy that supported various segments of our community’s population. An exploration into the process of implementing this population-based management approach will be shared. Challenges from offering these programs to non-FHT patients will be discussed, and strategies implemented to overcome those barriers will be highlighted. Lessons learned provide considerations for future vaccination related strategies, as well as insights into the scalability of increasing FHT access.   
    18 2. Health equity at the centre Addressing equity and efficiency with patient reminders The Carefirst Diabetes Education Program (DEP) has been providing culturally appropriate education services in Scarborough and Richmond Hill since 2007. Every year, the Carefirst DEP serves ~2000 people with diabetes, of which over 80% speak Cantonese or Mandarin with limited or no English language ability. One of the biggest challenges at the DEP is patients missing their appointments. Missed appointments reduces efficiency, lengthens wait times and can result in increased risk for patients. All patients receive a reminder phone call prior to their appointment to reduce missed appointments; however, calling this volume of patients can take at least three hours a day for the Team Assistant.  The DEP was keen to adopt a technology that automated this reminder; however, the language requirements for this patient population was limiting as this is not a feature for many products on the market. One product by Mikata Health did have this functionality and was implemented in March 2022. SMS reminders are now sent to all patients in English and Chinese thus reducing the hours needed to call patients, increasing attendance by ~50% and supporting the mandatory COVID-19 screening procedures. The adaptability of technology to cater to the unique needs of different patient populations, whether linguistic or cultural is needed across primary care. This ensures equitable access to care, increasing patient participation in their healthcare while improving their experience. 
     
    19 2. Primary care leading in health system transformation Reimagining HIV prevention and care in the ACB  communities through meaningful stakeholder engagement

    The disproportionate impact of HIV/AIDs in African Caribbean and Black (ACB) communities in Canada remains a problem that requires targeted efforts. In this session, we present qualitative findings from the African Canadian (AC) study of HIV behaviours, knowledge, and barriers to healthcare among ACB communities in Ontario. The study meaningfully engaged ACB community members in the interpretation of quantitative study findings and in the generation of best practices.  Qualitative data sources included a two-day World Café event where study findings were presented and 12 Focus Group Discussions (FGDs) involving over 107 ACB individuals from Toronto and Ottawa were held.  FGDs were transcribed verbatim and thematic analysis guided data interpretation. Credibility of data was established through data validation strategies.  Five key themes will be discussed:  1) Community perceptions of research importance and challenges, 2) Factors associated with HIV vulnerability, 3) Experiences with HIV testing, 4) Use of PEP and PrEP, and, 5) Community perspectives on how to address HIV in ACB communities. Fear and stigma remain one of the most frequently cited reasons why ACB community members don’t access HIV testing. Many participants were not aware and /or did not have direct experience with use of PrEP/PEP prevention treatments; one of the main reasons being because these treatments are marketed for white gay men. Participants identified numerous strategies to address the HIV needs in ACB communities, including education, community-level strategies and health provider capacity building strategies. We conclude that community based participatory research, co-led by community members, is an important strategy for identifying the multi-level individual, interpersonal, community, institutional and structural factors that increase HIV vulnerability in ACB communities, notably anti-Black systemic racism.

    20 2. Health equity at the centre Achieving More Equitable Complex Concussion Management: Lessons from ECHO Concussion, a telemedicine education program Concussions, a form of mild traumatic brain injury, are diagnosed in approximately 150,000 Ontarians annually, resulting in disruptions to work, school, and sport. Most patients recover within 2-4 weeks, but 15-30% of patients experience persisting symptoms that extend beyond this expected recovery window. Concussion management is complex for a number of reasons: addressing and correcting concussion misinformation, variable onset of symptoms, urban/rural health service disparities, and the number of healthcare and non-healthcare professionals involved in case management. There is often a lack of communication and continuity between professionals, or lack of access to treatment for marginalized patients, thus necessitating an integrated approach to concussion management.     The ECHO (Extensions for Community Healthcare Outcomes) model provides an ideal platform for dissemination of existing best practice guidelines and standards of care in common, chronic, and complex conditions. Using a one-to-many model, specialist experts at an academic “hub” connect with multiple learners in real-time through a teleconferencing platform, which provides equitable access to education and treatment suggestions. ECHO Concussion began in 2019 with the aim of teaching a comprehensive approach to concussion diagnosis and symptom management across the continuum.     In this session, we will present the evidence base for complex concussion management in Ontario. Using examples from our ECHO Concussion program, we will discuss some best practices and lessons learned regarding the tactful dispelling of misinformation as well as increasing complexity of concussion management due to the increase of affected populations, including intimate partner violence and elder abuse. 
     
    21 2. Health equity at the centre Using neighbourhood level measures of deprivation to support clinical care Social determinants of health (SDoH) affect the likelihood of suffering from both acute and chronic illness as well as premature mortality. Primary care (PC) can play an important role in addressing the SDoH and their consequences. Unfortunately, such individual-level data are not regularly collected in electronic medical records (EMRs). However, since previous studies have demonstrated that neighbourhood-level measures of vulnerability are strongly associated with health outcomes, we are studying the potential for these measures to be integrated in PC EMR records, to serve as a risk indicator to support clinical care.     The purpose of this work is to evaluate the association between several vulnerability (risk) measures and health measures in the EMR records. We use EMR data from almost 2 million Canadian patients in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Risk measures are available in, or derived from, census data and obtained using the patient postal code and Postal Code Conversion File+. EMR health measures include health behaviour, screening, incidence of disease, self-management, and clinical control. We will use regression analyses to identify the risk measures with the strongest ability to discriminate health measures for their application in clinical care. We will invite PC providers participating in the Primary care Ontario Practice based Learning and Research (POPLAR) network to incorporate these into their patients’ EMR records and apply this insight in care delivery and action on the SDoH.    Preliminary findings show strong associations between vulnerability measures and health measures. Analyses are ongoing and the results will be presented. This approach has the potential to make information on the SDoH widely available in PC and support action on health inequities.  
    22 2. Health equity at the centre Supporting Pregnant, Lactating, and Parenting People who Consume Cannabis in Ontario: An Interactive Workshop to Enhance Healthcare Practices

    Cannabis is the most commonly consumed substance during pregnancy; it is estimated that consumption will increase among pregnant individuals following legalization and the growing recognition of its health benefits. In healthcare contexts, cannabis consumption can be framed as risky for the fetus and infant. Limited research evidence available to understand the impact of cannabis consumption during the perinatal period has left health and social care providers grappling with how to adequately support those seeking care. Ongoing research centering the lived experiences of people who consume cannabis has highlighted numerous ways cannabis supports harm reduction and positive physical and mental health outcomes thereby redefining conventional conceptions of risk and expanding how cannabis is understood during the perinatal period and while parenting. An evidence brief outlining the current state of research and practice knowledge about cannabis, pregnancy, and parenting will be shared to highlight opportunities for practice and policy improvements that respond to the lived experiences of people who consume cannabis. Through dialogue sessions with health and social care providers and parents who consume cannabis, local and system-wide solutions have been identified that can support improvements in care for pregnant, lactating, and parenting people who consume cannabis through addressing practice and policy barriers. Through this session, interprofessional primary care organizations, with considerations for collaboration with service recipients, allied health and social service organizations, will be able to improve service delivery by employing approaches informed by harm reduction and anti-oppressive principles, and social justice-oriented community practice. 

    23 2. Health equity at the centre Out of Mind but not Out of Sight: Identifying, Reaching and Addressing Health Care Needs of Vulnerable Patients during Pandemic 
     
    In March 2020, Ontario declared a state of emergency and province wide stay-at-home order was placed. This meant reduced access to primary health care for many vulnerable patient populations.  Recognizing that health will be adversely affected by this lockdown, in April 2020, the Sunnybrook Academic Family Health Team, created an At-Risk COVID Initiative. Aim was to identify and reach patients who were at risk for health deterioration due to lockdown. Risk factors such as age, frailty, cognitive impairment, medical comorbidity, mental health and addiction, health equity (income, housing and food security), risk of domestic abuse and social isolation were considered when each physician/nurse evaluated their rostered list of patients and identified those at risk. Teams consisting of physicians, residents, nurses and either a care navigator, a nurse practitioner, a social worker or an occupational therapist made personal telephone contacts with all identified patients. Encounters were documented in an electronically created template to   ensure comprehensiveness, consistency and appropriate follow ups were in place. Team members assessed the need for interventions such as food, medical supplies, or medications, liaised with family members as appropriate, provided up to date information on COVID-19, liaised with other health care team members in patient’s circle of care to provide updates, ensured visiting health service providers self-screened and use appropriate personal protective equipment and identified new or emerging risks that may require home or office visit. Follow ups were scheduled as required either via phone, in person or home visit while ensuring continuity of care. 
    24 2. Health equity at the centre Clinical and Cultural Competencies for 2SLGBTQ Communities

    In this presentation, Rainbow Health Ontario will support your team in learning the clinical and culturally competent practices to provide welcoming and inclusive services to 2SLGBTQ patients.   
     

    25 3. Sustainable solutions to primary care problems Leveraging electronic medical record data to develop patient interventions: a pilot study

    Background: Segmentation, or the division of populations based on specific characteristics, is a common technique applied in marketing, but not fully explored in healthcare. New approaches to patient segmentation might help tailor primary care interventions and communication needs. Access to primary care electronic medical record (EMR) data repositories provides an opportunity to implement personalized primary health care solutions.   Objectives: To develop a virtual peer-to-peer workshop intervention for patients with type 2 diabetes (T2D) by segmenting participants based on medication use.    Methods: This mixed-methods pilot study used data from the Eastern Ontario Network, a practice-based research network and repository of EMR data drawn from primary care practices across south-eastern Ontario. Patients aged 40 and older with T2D were identified (n=825) and segmented based on medication data using k-means clustering. Patients with good and bad control of disease were classified based on A1c, LDL, and blood pressure. Moderated virtual peer-to-peer workshops were held with patients with good and bad control from within and across segments. Patient-reported outcomes were collected at baseline, immediately post-workshops, and at one-week and one-month follow-ups to assess patient T2D experiences, engagement, self-efficacy, motivation, and planned behaviour change. Thematic analysis will be conducted using recordings from workshops.  Outcomes: Results from six workshops will be reported (n=25). This pilot study will provide preliminary evidence to support the development and implementation of a data-driven intervention for patients with T2D in the form of virtual peer-to-peer support, based on patient segmentation on medication-taking behaviour.   
      

    26 3. Sustainable solutions to primary care problems
     
    We Are Here for You- Virtual Baby and Me support education series

    With the rise in the occurrence of post-partum depression and isolation during COVID, along with the positive feedback from our pilot Baby and Me program, our team felt it essential to continue to improve resources for our families with new babies. Data mining was done within our EMR to compile a list of families with newborns 0-6 months and 6-12 months. They were personally contacted and invited to join our program via Zoom. Our program was developed during the height of COVID, but it was quickly recognized that the format needed to continue post pandemic, realizing that Primary Care can be provided virtually, and actually improve our resources and supports. We reached out to our community partners to allow increased access to pelvic floor physiotherapy, mental health support as well as basic first aid and CPR training. We ask for feedback after each session, and update our information and delivery method as needed. Each session is a 4-part series hosted by the NP, RN, RD, SW and OT, and handouts are emailed to each participant after each session. Outside community participation is encouraged and advertised on our website and social media platforms to offer access and support to members of our community that may not otherwise have this collaborative approach available to them.

    27 3. Sustainable solutions to primary care problems Linking primary care electronic medical record data with hospital data to support Ontario Health Teams
     

    With no linkage between primary care data and hospital data, there is currently a disconnect in continuity of care. Creating a consolidated data repository could result in an improved understanding of the care journey and reduction of siloes in healthcare, supports for the healthcare needs in OHT priority populations, continuity of care improvements across sectors, and decreased burdens on emergency departments and primary care providers.     The primary objective of the project is to merge two key data sets, combining primary care electronic medical record (EMR) data from the Eastern Ontario Network (EON) with acute care, post-acute, community mental health and addictions, home care, and community support services data from the Shared Health Integrated Information Portal (SHIIP). This robust dataset will provide opportunities for quality improvement (QI) projects that can be undertaken by Ontario Health Teams (OHTs) to improve the approach to population health management.     To test the utility of a merged data set, a QI pilot project will aim to apply a physical health risk register to support the early identification of cancer screening opportunities in those with mental health concerns to improve the quality and continuity of care. Alignment with the Mental Health and Addictions working group of the FLA OHT will be central to see how this merged dataset supports population health management at the primary care level. Findings from this project can be applied to future QI work and can be shared with other OHTs interested in adopting a similar approach.         

    28 3. Sustainable solutions to primary care problems
     
    Telephone Follow-up Visits Offer a New Care Option for Patients with Hip & Knee Arthritis
     

    Background: Advanced Practice Providers (APPs) have improved equitable, evidence-based access to care for over 30,000 patients with hip and knee arthritis since the introduction of Sunnybrook’s Hip and Knee Rapid Access Clinic (RAC) in 2007.  Up to 40% of RAC patients do not proceed to surgical consultation, but benefit from an additional specialized touch-point to review management of their osteoarthritis. A RAC 3-month follow-up visit is offered to patients who require would benefit from evaluation of initial RAC treatment outcomes and re-assessment of their readiness for joint replacement.     A gap in care was created during the first wave of the COVID-19 pandemic, when 88 patients scheduled for in-person RAC 3-month follow-ups were cancelled or postponed.      Aim: The purpose of this quality improvement project was to conduct virtual RAC follow-up visits via telephone to identify patients who: did not require further care, felt ready for surgical consultation, or required urgent surgical consultation.   We also wanted to evaluate patient experiences in this context.    Methods: Two APPs attempted to contact patients (n=88) booked for a RAC follow-up visit. Telephone visits were conducted with patients who consented to a virtual visit and follow-up (n=82). After the visit, we emailed an anonymous, optional four-question survey to each patient. The survey contained three Likert-scaled questions and one open-ended question to gather further impressions about the patient experience. Those that could not be reached via email were sent a print version of the survey via Canada Post with a stamped return envelope.         

    29 3. Sustainable solutions to primary care problems
     
    Improving Experience of Virtual Rehab for Patients After Knee Replacement 

    Traditionally, in-person supervised rehabilitation has been the standard of care following total knee arthroplasty (TKA). During pandemic restrictions, our ability to offer in person postoperative treatment to our patients after knee replacement at the Holland Centre was significantly impacted. Thus, quick adaptation was needed in order to expand our rehabilitation services and provide reliable access to care. Technology such as Zoom provided us with an opportunity to deliver quality care to patients within the comfort of their home, while keeping them safe. Although virtual care was becoming a standard of care at the Holland Centre, it also had its own unique challenges that patients and rehabilitation team were confronting.  To better understand the patient’ perspective and address their needs; we modified an existing patient virtual care experience survey (developed by AFHTO), in collaboration with our patients and patient partners with an aim to develop mitigation strategies and provide patient focused care. Patient-related outcomes were: Patient Specific Functional Scale (PSFS) and P4-pain scale. Flexion and extension ranges were measured before and after treatment. A modified Primary Care Patient Experience Virtual Care Survey was used to examine barriers for virtual care and evaluate patient’s satisfaction. A well-designed post-operative virtual physiotherapy program continues to be an important part of our model of care as we normalize our activities. Clear understanding of barriers to virtual care and mitigation strategies will help us create virtual care standards, meet our patient needs and facilitate continuous postoperative care to patients despite pandemic restrictions and limitations in resources.

    30 3. Sustainable solutions to primary care problems
     
    Eliminating Barriers in Providing Care
     

    VPC has become more popular since the COVID-19 pandemic hit. As healthcare providers, we have had to adapt to the challenges that the pandemic brings while making sure that patients could still get the care that they need for their well-being. During the times when people were encouraged to stay at home, we have relied on either phone or video appointments in order to provide care that did not require an in-person consultation.  We also ensured that adequate in-person appointments were available for those who required a physical exam.   We do not anticipate VPC going away even after the pandemic as it has shown its effectivity in making healthcare more accessible to the population.  In addition, home visit program has also helped the vulnerable people who are no longer capable of leaving their homes get the care and support that they need which also includes COVID-19 vaccination. This is one way for us to show that we, as a healthcare facility, will find ways to provide continued care and support to our patients who are in need.    

    31 3. Sustainable solutions to primary care problems
     
    Data Management and it’s use in informing programs
     

    In 2020 Haldimand FHT began to focus on more targeted data collection as Schedule A was often onerous for IHPs, and the data collected did not help to inform the IHPs on the programs they were running. Time was spent identifying and understanding program pathways, program delivery, and gaps in data entry and analysis. Clearly defined program parameters have allowed more relevant data capture that better reflects the IHP work and capacity as well as the populations served.  This has allowed for IHPs to be more informed about their programs and has made the process of developing measures for Schedule A a significantly easier task. Clearly defining the numerator and denominator for process and outcome measures within the context of the program pathway has resulted in cleaner data that better reflect the care patients receive.  Additionally, IHPs now have a better understanding of their aggregate data, as it is more relatable to their delivery of care.  With the use of false billing codes it has made it easy and convenient to enter and track data without it being onerous or reducing clinical time. This implementation is fostering a culture of Quality Improvement amongst the IHPs as they have shifted the processes of program development to include a focus on data and improvement. 

    32 3. Sustainable solutions to primary care problems
     
    Clinical Practice in a Digital Health Environment: New Best Practice Guideline

    The Registered Nurses Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario, and the Best Practice Guideline (BPG) Program is a signature RNAO program. In partnership with Humber River Hospital, RNAO is developing the first BPG to address clinical practice in a digital health environment. This BPG will include evidence-based recommendations for nurses, organizations and health systems to foster nurses’ ability to maintain, advance, and strengthen professional practice in the context of a digital health environment. This BPG will be relevant to nurses practicing in all clinical settings, including primary care. RNAO assembled an interprofessional expert panel that included persons with lived experience and individuals with experience with digital health in the areas of clinical practice, education, research and policy. The expert panel identified priority recommendation questions for the BPG which focused on: integrating digital health competencies into the professional practice roles and responsibilities of nurses at all levels within an organization; leveraging predictive analytics; practical or hands-on professional development education; education about relational care and interpersonal communication skills; active involvement of nurses in all stages of the technology lifecycle; and, embedding digital health competencies into nursing entry-to-practice exams. RNAO’s research team is currently conducting systematic reviews on these questions that will inform the recommendations included in the BPG. Consideration is also being given to digital health equity and sustainability while developing the BPG. In this session, RNAO will describe the guideline development process and the recommendation areas of focus. 

    33 3. Sustainable solutions to primary care problems
     
    Implementing a patient portal in a province-wide smoking cessation program to address systemic barriers to accessing program treatment.  The Smoking Treatment for Ontario Patients (STOP) Program is a province-wide initiative working in partnership with 80% of Ontario FHTs to offer smoking cessation treatment, consisting of nicotine replacement therapy and behavioral counseling, at no cost to the patient.     The program currently uses an online practitioner-facing portal (STOP Portal) that supports practitioners with administering program assessments and delivering treatments. The STOP Portal also incorporates portal-based clinical decision support systems (CDSS) to help practitioners address various risk factors as part of smoking cessation treatment. However, since this portal is practitioner-facing, patients do not have direct access to the assessment and self-help resources that are available through the STOP Program. As well, the administrative requirements of the program (data collection and entry in portal) can present operational and time barriers for the practitioners.     The STOP Program has now implemented a patient-facing portal (My STOP Portal), which will make many of the functionalities of the STOP Portal accessible to patients without requiring a practitioner or other human intermediaries. Patients will be able to create a portal account and self-enroll into the STOP Program prior to their first appointment with their practitioner. Patients will also have a patient dashboard, which will provide them with direct access to their program information and treatment progress. With the implementation of My STOP Portal, we anticipate greater patient involvement from self-enrollment into the program, self-management of their participation, increased patient knowledge and autonomy in their treatment, and reduced data entry burden for practitioners.  
    34 3. Sustainable solutions to primary care problems
     
    Learning from adaptation: Primary care occupational, physical, and respiratory therapy practice in the first year of the COVID-19 pandemic 
     
    Introduction: Physical, occupational, and respiratory therapists (PORTs) working on primary care teams improves care comprehensiveness, especially for those with chronic and complex conditions. Little research exists on the roles of PORTs in primary care, and minimal guidance on possible adapted roles for PORTs in disasters, including for pandemics and other disasters. The pandemic required repeated periods of adaptation in primary care, to align services with changing public health measures. We can learn from these, to better support primary care delivery in the future.    Objective: We aimed to explore clinical adaptations made, and challenges experienced by primary care PORTs at the micro-level, meso-level, macro-level challenges during the first year of the COVID-19 pandemic.     Design/Methods: We collected data via a longitudinal diary-interview study, involving 16 PORTs from Ontario and Manitoba who completed 12 weeks of audiodiaries (Apr-Oct 2020), and two semi-structured interviews (Dec 2020/Jan 2021 – 13 participants; Apr/May 2021 – 10 participants). Analysis focused on change over time within each case, and cross-case comparisons.     Conclusions: Despite challenges, participants showed creativity and adaptability, testing and embracing new practices. This included broader use of technologies and an expanded scope that can positively contribute to patient outcomes in primary care. Moving forward, better understanding of PORTs’ contributions can improve primary care outcomes, as well as disaster response.  
      
    35 3. Sustainable solutions to primary care problems Primary Care, Specialists and Patients – Building a Better Workflow; Ensuring a Better Experience The Ontario eServices Program, funded by Ontario Health, is focused on improving the clinician and patient experience and reducing wait times for access to specialty care by fully digitizing the referral workflow.  Since its inception, over 600,000 eReferrals have been sent electronically through primary care clinicians’ EMRs, and 95% of patients report high satisfaction with their referral experience.  This provincial Program is changing the way clinicians communicate with one another and with their patients.  eReferral provides more complete and timely referrals and keeps the patient at the centre of their own care.   The Program’s regional deployment and adoption teams build sustained trust relationships with clinicians in their own communities.  A transparent wait time component is built into the solution, supporting equitable access to care.  To support the adoption imperative and facilitate migration to full eReferral digitization, an innovative eFAX migration solution, that uses secure automation and includes fax failure safety mechanisms, has also been implemented as a Proof of Concept.  This will test the effectiveness of a concurrent adoption strategy for clinicians who may not be aware of the benefits or are ‘still on the fence’ about adopting fully digitized eReferral.  Current data that supports the efficacy and real-life impact of eReferral on the delivery of care and the experience of patients is inarguable.  The Program is committed to ensuring that eReferral is seamlessly assimilated by primary and specialist clinicians, while quickly becoming ‘the only way we do referrals in Ontario’, and making fax referrals a thing of the past.  
           
    36 3. Sustainable solutions to primary care problems
     
    Digital First for Health Strategy: The Ontario Standards for Care Program 
     

    The Ontario Standards for Care (OSC) program, developed by the Centre for Effective Practice, the eHealth Centre of Excellence, and North York General Hospital, will translate evidence-based clinical and quality standards into decision support tools, digitally embedded into frontline clinical information systems. This program is part of Ontario Ministry of Health’s (MOH) Digital First for Health Strategy. The program will initially be delivered through a series of Use Cases, piloted in acute and primary care sites. Program deliverables will be met through stakeholder engagement, translation of quality standards into the Electronic Medical Record (EMR) and Hospital Information System (HIS), alpha and pilot testing, continued feedback gathering and tool modification. The first Use Case for the OSC program is a heart failure tool to be piloted in 1 EMR and 1 HIS, with targets of 125 primary care clinicians and 100 acute care clinicians across two Ontario Health Teams (OHTs). Subsequent confirmed Use Cases will be anxiety disorders, major depression, and diabetes within other OHTs.  In 2015, Ontario had roughly 250,000 people diagnosed with heart failure, approximately 1.8% of the province’s population. Heart failure is one of the five leading causes of hospitalization and 30-day readmissions, the most common cause of hospitalization for people over age 65. Opportunities to improve care for people with heart failure in Ontario and reduce the health system burden, include improving variations in clinical outcomes, reducing costs to healthcare systems, addressing adoption barriers and challenges, improving care coordination and patient care, which are rooted in quality standards.

    37 3. Sustainable solutions to primary care problems
     
    Integrated primary care workforce planning in the City of Toronto: Co-development and operationalization of a fit-for-purpose planning toolkit

     
    Introduction  Regional planning capability is increasingly necessary to ensure that the primary care healthcare needs of defined communities can be met.  Ontario Health Toronto and the Canadian Health Workforce Network partnered to co-develop a comprehensive regional-level primary care workforce planning toolkit to address disparities in access to integrated primary care across the City of Toronto, support equitable distribution of resources, and facilitate system efficiency.     Methods  The approach was based on a health workforce systems framework that acknowledges the unique social, political, geographic, economic and technological contexts of the City of Toronto. A toolkit that includes qualitative tools and a quantitative workforce planning model was co-developed in Phase 1 and operationalized in Phase 2. Data from multiple sources were brought together to populate the model and various open-access outputs have been produced to help decision-makers. The process included broad consultation and engagement with frontline primary care providers and experts to ensure outputs were relevant and useful, and to build workforce planning capacity and partnerships.     Impact on Primary Care  This toolkit will help primary care providers, planners, Ontario Health Teams and other stakeholders to understand their patients’ current and emerging needs, care seeking patterns and the resources required to meet these needs. It will inform the development of sustainable solutions to address primary care problems, and build capacity for ongoing primary care planning at the regional level. This toolkit was designed to meet the needs of Ontario Health Toronto, but the processes and principles can be leveraged and adapted for other jurisdictions.  
     
    38 3. Sustainable solutions to primary care problems Technology enabled collaborative care (TECC) for adults with diabetes: Results from a feasibility study

     

    The Technology Equitable Collaborative Care (TECC) model aims to engage patients and leverage technology to provide equitable access to holistic care. The use of the digital care pathway enables accessibility and bridges systemic gaps in healthcare providing clients with evidence-based treatments to support physical and mental health. By employing technological tools (e.g., REDCap and Cisco Webex), current challenges in primary care, including geographical barriers, time pressure, disjointed care, and a lack of local expertise can be addressed to improve client wellbeing.    The TECC model has two main components. The care coordinator functions as the cornerstone of this model and connects clients and their associated care providers (family, primary care, community services, etc.) with expert guidance to streamline the treatment process. The care coordinator works closely with clients to co-create goals, enhance motivation, and create and implement treatment plans. The virtual care team (VCT)  which may include physicians, mental health professionals, registered nurses, dietitians and peer mentors, works collaboratively to provide ongoing treatment recommendations.     The TECC model creates a feasible and scalable care solution that empowers clients to take an active role in improving their physical and mental health. For clients with limited digital literacy or limited internet access, the TECC model can be adapted to provide care over the phone. For clinicians, this model facilitates access to an interdisciplinary team of experts and provides an opportunity to learn evidence-based approaches to physical and mental health care.  

    39 3. Sustainable solutions to primary care problems Developing a Practice Guidance Tool for Prescribing Cascades in Primary Care Teams Background: Prescribing cascades occur when a medication is used to treat the side effect(s) of another medication. This often arises when signs or symptoms are attributed to a new medical condition rather than a medication side effect. Following interviews with people who may have experienced prescribing cascades, their caregivers, physicians and pharmacists, a behavioural science approach was used to develop potential interventions for recognizing, investigating and managing prescribing cascades. The analysis demonstrated that a practice guidance tool(s) is the foundation for potential interventions.   Objective: To gather clinician perspectives that will inform the design of a practice guidance tool as a component of an intervention for addressing cascades.   Methods: Twenty clinicians (physicians, nurse practitioners, and pharmacists) working in Ontario's primary care teams will participate in a series of intra- and inter-professional focus groups. The focus groups will explore clinicians’ perspectives on addressing prescribing cascades in their teams and about a potential practice guidance tool(s). The discussion will be guided by the Theoretical Domains Framework and GUIDE-IT tool. Data will be analyzed using reflexive thematic analysis.  Results: in progress: Recruitment and data collection are underway.  Conclusions: Understanding clinicians’ perspectives about what facilitates and impedes addressing cascades in practice will inform a future intervention design. Understanding their perspectives about useful features of a practice guidance tool(s) to assist with recognizing, investigating and managing cascades is needed. This study lays the foundation for future work that develops and evaluates interventions to address prescribing cascades in primary care practice.
     
    40 3. Sustainable solutions to primary care problems Leading Change From the Ground Up: An Approach for Sustainable Change in Primary Care 
     
    Change management efforts in digital health, led over recent years by the eHealth Centre of Excellence (eCE) have proven a widespread understanding that primary care professionals do not have equal access to the required supports to ensure sustainable success in the adoption of digital health. The eCE approach to change management includes elements of practice facilitation to address variations in clinic infrastructure and contextual factors that can create barriers to change. The approach supports more opportunities for digital health tool implementation, the build of effective workflows in primary care, and delivers on the goals of the IHI quintuple aim.      Our successful combined approach focuses on the following key elements:      - Build and maintain strong clinical partnerships and relationships to support collaboration and active involvement      - Collaborate with primary care to assess and address clinical infrastructure gaps and areas for improvement     - A systematic process to identify needs and derive sustainable solutions     - Focus on assessing, evaluating, and leading change for the entire clinical experience and primary care service(s)     - Implement customized approaches to change that are informed by a thorough understanding of the environmental, cultural, and social factors influencing the readiness and desire for change      - Pace change efforts to align with needs and resources available at the clinic level      - Build internal capacity for change at the primary care organization and Ontario Health Team levels  
     
    41 3. Sustainable solutions to primary care problems Exploring the impact of ECHO Ontario Integrated Mental and Physical Health on participants’ approach and attitude towards the care of complex patients
     
    A complex patient typically presents with co-occurring physical and mental health concerns compounded with psychosocial issues. Research demonstrates that complex patients tend to have poorer clinical outcomes and higher mortality rates. In Ontario, a high proportion of complex patient care is addressed within the primary care setting due to the province’s geographically dispersed population and distribution of specialized care. However, the majority of primary care providers (PCPs) managing these cases have limited training in these specialized areas and have poor access to specialist support, particularly in remote and under-serviced areas. As a response to these challenges, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health launched the Integrated Mental and Physical Health (ECHO-IMPH) program.   Project ECHO is a “hub and spoke” tele-education model that has been shown to build capacity for management of complex conditions by connecting PCPs throughout Ontario to specialist and multidisciplinary teams at academic health centres (the Hub). This research study took on an exploratory qualitative approach to understand how ECHO-IMPH affects participants’ clinical approach and attitudes toward complex patients.   Twenty two (n=22) individual post-cycle semi-structured interviews were conducted following the fourth and fifth cycles of ECHO-IMPH. We utilized a systematic thematic analysis following the Braun and Clarke six phase approach. An initial coding dictionary was created based on four randomly selected transcripts and used to code the transcripts in NVivo. Following the coding, a summary of the coding was analyzed in order to develop a thematic map that outlined the final themes.
     
    42 3. Sustainable solutions to primary care problems Using “bots” to support more efficient workflows and reduce the risk of clinician burnout Clinician burnout is an issue that many primary care clinicians face, and the stresses associated with COVID-19 have only exacerbated this crisis. In a survey published by the Ontario Medical Association in March 2021, more than 72% of respondents reported at least some level of burnout (n: 2,649).    A major contributing factor to clinician burnout is the amount of mundane clerical work they are expected to complete, such as duplicate documentation, looking through appointments for billing purposes, faxing information for sharing, etc. Clinician burnout is not just a problem for clinicians but has a massive effect on the entire healthcare system with significant costs associated with decreased clinic hours and early retirement, and the disruption of the continuity of care for patients.     Our presentation will focus on the various bots we’ve co-designed with clinician input to enhance practice efficiencies. We will also provide a demo of a bot created to support primary care with a big problem they encountered when attempting to record the status of their patients’ COVID-19 vaccines: Immunization reports could be sent through a system called OntarioMD’s Health Report Manager, but the reports just created notes in the charts rather than documenting the immunizations properly. This created an extremely time-consuming data entry task for clinicians and their staff.    In response to this issue, the eCE Automates team launched a new bot process that seamlessly automates how a patient’s COVID-19 vaccination status is updated within the EMR based on the HRM COVaxON vaccination report, replacing a manual process.
     
    43 3. Sustainable solutions to primary care problems Evaluation of real-time collection of patient-reported experience to support continuous improvement
     
    Improved patient experience is at the core of the Quadruple Aim. While many tools have been developed to measure both patient-reported experience and patient-reported outcomes, little has been done to implement these within routine care, limiting the availability of patient-reported data for health care providers and decision makers. In Ontario, health systems are being restructured into Ontario Health Teams (OHTs). The Frontenac, Lennox & Addington OHT (FLA -OHT) is implementing routine collection and reporting of patient experience data from primary care practices.     Our formative evaluation will describe the implementation of the project, including relevant context, and assess how end-users incorporate patient experience data into routine use. We will use a multiple case study design which will allow us to describe contextual factors relevant to implementation in each participating clinic. Surveys and interviews will be conducted with a wide range of stakeholders including administrative personnel, health care providers, managerial team members of each participating primary care clinic, and FLA-OHT decision-makers.    The Consolidated Framework for Implementation Research and Process Redesign (CFIR-PR) will guide data collection and evaluation across five major domains: intervention characteristics; outer setting (e.g., political, economic, and social context); inner setting (e.g., culture and leadership); characteristics of the individuals involved (e.g., knowledge and beliefs); and implementation process.
     
    44 3. Sustainable solutions to primary care problems POPLAR, the Primary care Ontario Practice-based Learning and Research Network The future of primary care can be shaped through collaborations between clinicians, communities and academics.  The term “Practice Based Learning and Research Networks” (PBLRNs) has been proposed for these key partnerships; PBLRNs use electronic medical record (EMR) data and evidence-based strategies to improve care as part of Learning Health Systems. Ontario currently has seven PBLRNs, six affiliated with a University Department of Family Medicine and one in the Alliance for Healthier Communities.  Funded by the Ontario government, we formed the Primary care Ontario Practice-based Learning and Research Network, POPLAR (https://www.poplarnetwork.ca).       POPLAR is harmonizing data collection and processing into a provincial data platform for province-wide reporting of indicators. POPLAR is also coordinating efforts to enable meaningful analytics, implement clinical research and foster quality improvement initiatives. EMR data includes over 1.5 million patients receiving care from the 1,000+ family physicians and nurse practitioners participating in their PBLRN.  POPLAR data supports a QI Dashboard initiative, led by quality improvement and implementation science experts, which will provide practices, teams and OHTs ready access to several practice metrics.    POPLAR’s clinical-academic collaboration builds QI and research capacity in primary care, enhancing the generation and translation of practice-ready evidence by and for FHTs. As a member of the POPLAR Stakeholder Engagement Committee, AFHTO encourages FHT participation in POPLAR as a first step towards collecting important data in showing the value of IHPs in team-based care. POPLAR data will support participating FHTs to prepare their Quality Improvement Plan and achieve their QI goals. We welcome expanded participation.  
     
    45 3. Sustainable solutions to primary care problems Intelligent automation to improve chronic disease identification and coding in primary care Practice registries of patient populations with chronic conditions, embedded in Electronic Medical Records (EMRs), are needed to plan and measure quality improvement efforts.   Our objective is to improve the completeness, accuracy, and coding of chronic disease data in primary care EMRs to allow reliable registries to be established.  We will use the Primary care Ontario Practice-based Learning and Research Network (POPLAR) data platform, containing patient-level data with validated, algorithmically coded EMR data to identify individuals with the target conditions, and compare these findings to the diagnoses recorded in the “problem list”. This process will allow discordant findings to be flagged as “patient likely has the condition but not recorded in EMR” or “patient unlikely to have the condition recorded in EMR”. That data will be returned to EMRs through the eHealth Centre of Excellence’s automated software assistants, called “CODY bots”. These assistants connect remotely to the EMR, search for patients with health conditions, prompt the physician for validation and add an ICD-9 or SNOMED-CT code to problem list of the chart as appropriate  The initial conditions selected are diabetes, chronic renal failure and dementia.  We will use routinely collected POPLAR EMR data on over 1.5 million patients from participating Ontario practices to measure changes in the proportion of patients with coding for the chronic conditions.    If successful, coding could be scaled and spread to more chronic conditions in primary care EMRs. The method could also be extended to introduce other relevant patient information such as neighbourhood level Social Determinants of Health.     
     
    46 4. Mental health and addictions Optimizing the role of social work in primary care across Ontario: A mixed methods study Social workers are often part of interdisciplinary teams found within team-based, primary health care (PHC). Their role includes early identification, treatment, counseling, follow-up, and recovery of mental health concerns. During the COVID-19 pandemic, social workers in Ontario faced significant impacts to their practice due to increasing complexities of clients, transitioning to the virtual environment, adapting in-person services, and taking care of their own well-being. Using a mixed-method approach, our study seeks to examine the daily practice of social workers in primary care teams during the pandemic. The goal is to describe the current structure and processes of social work practice, as well as providing recommendations from the perspectives of social workers on how to structure social work practice in primary care to optimize patient care. The quantitative phase comprised of: i) Cross-sectional online survey distributed to social workers in primary care across Ontario; and, ii) Qualitative focus groups with geographically diverse social workers from different primary care teams, guided by a semi-structured interview guide. This presentation will share findings from both the survey and our focus groups to illustrate social work practice in its present form and the recommendations social workers have for strengthening their contributions to patient care.
     
    47 4. Mental health and addictions Empowering our Patients Receiving Mental Health and Addictions Treatment using Measurement Based Care Measurement-based care (MBC) is the practice of basing clinical care on patient data collected throughout treatment. MBC has also been called progress monitoring, outcome monitoring or use of feedback systems. MBC has four major components: routine use of symptom, outcome or process measures, clinician and patient review of data and collaborative re-evaluation of the treatment based on the data. MBC has been shown to improve treatment outcomes and to facilitate care among providers.    MBC has been implemented for all patients seen in consultation by the collaborative care psychiatry team serving the Hamilton Family Health Team Hamilton Mountain primary care practices (N=34). Prior to the consultation, patients complete the following measures on-line: GAD-7 and PHQ-9; Alcohol use disorder – AUDIT-PC; PTSD - PTSD Checklist for DSM-5 (PCL-5); Adult ADHD - Adult ADHD Self-Report Screening Scale – DSM 5– ASRS-5 and the measure of function – Sheehan Disability Scale. The psychiatric consultation then includes clear instructions to the clinician and patient to monitor progress in treatment using one or more of the above measures. If the patient is showing less than a 50% improvement from baseline on the measure then an indirect or direct psychiatric re-assessment is recommended.    A survey of patients and providers has been completed with Hamilton Mountain practices and a patient education video has been developed to assist patients to be full partners in the MBC initiative. The video informs patients that MBC will help them learn more about the symptoms of their disorder and warning signs about possible relapse.  
     
    48 4. Mental health and addictions Implementation and Impact of an Interprofessional Postpartum Support Group
     
    This presentation will highlight Queen Square Family Health Team’s novel Postpartum Peer Support Group program from its initial development to pilot implementation. We will share the rationale behind the program, its objectives and procedures, as well as the impact the pilot iteration has had on our patient community. The program was developed to fulfill a gap in postpartum mental healthcare in primary care settings and was structured around principles of interpersonal psychotherapy. An initial workshop was developed to increase parents’ coping skills and understanding of postpartum mental health. Feedback from this session revealed the desire to use this program as an avenue to foster postpartum support networks and prevent mental health from declining. As a result, a 4-week program was designed to allow continuous opportunity for patients to connect. The program maintained focus on postpartum mental health while integrating interdisciplinary approaches, which addressed key challenges that were considered mental health stressors for parents, such as breastfeeding. Upon submission of this abstract, the program is set to be piloted in July 2022 and this poster will present the journey as well as insights from clinicians and patient feedback once the program has been completed. Such an initiative will be helpful to other primary care locations across the province by providing an example of how to implement a postpartum support program in their practices, as well as the importance of addressing postpartum mental health in various areas of care. 
     
    49 4. Mental health and addictions Party n Play/ Chemsex: Mental Health, Resilience and Culturally and Clinically Competencies for GBMSM  
     
    Party n Play (PnP), also known as Chemsex, is the sexualized use of recreational substances, injecting drug use, and other drugs by gay, bisexual, and men who have sex with men (GBMSM). PnP is associated with increased condomless sex, group sex, transactional sex, STBBIs, and stigma, and discrimination. PnP involves using various depressants and stimulants such as alcohol, cocaine, MDMA, crystal meth, ketamine, poppers, and Viagra. PnP is used by GBMSM to increase acceptance by peers, reduce inhibition, promote closeness, sustain sex, pleasure, and intimacies, and manage trauma.     The persistence of health inequities persists for GBMSM who experience intersecting forms of oppression, stigma,  discrimination, and trauma. Healthcare providers and health care services are not equipped or knowledgeable of practices of PnP/Chemsex “because of a lack of knowledge of practices, associated vocabulary, and a failure to integrate sexual health with drug services” (Florian et al., 2021).  PnP is not taught in medical education and medical education “about 2SLBTQIA+ health is currently limited and inconsistent in Canada” (Schrieber et al., 2021).  The workshop explores diversity, equity, and inclusion of the GBMSM communities in sexual health promotion and mental and emotional health needs. The contents examine a framework for effective responses for cis and transgender GBMSM who PnP. The workshop will provide information on PnP and how to provide cultural safety, cultural competence, and practice clinical competencies when working with cis and trans GBMSM who PnP. 

     

    Virtual Posters

    a 2. Health equity at the centre Access Impacts to Primary Care Rehabilitation Practice During the COVID-19 Pandemic Introduction: The COVID-19 pandemic introduced significant changes in delivery of primary care rehabilitation services. This upheaval impacted both how patients accessed care, and who could access care. Some of these changes, including virtual care, may continue. An evaluation on how the practice changes impacted access, under a lens of equitable access, is important as we reflect on which changes should be continued into the future.    Purpose:  To explore changes in access to primary care rehabilitation practice during the COVID-19 pandemic from the perspective of healthcare providers, applying a lens of equitable access.    Methods: In this qualitative descriptive study, thirteen rehabilitation professionals (RPs) working in primary care in Manitoba and Ontario participated in semi-structured interviews, timed 9-10 months into the pandemic. The interview questions explored the practice changes and access impacts. Qualitative analysis steps included data immersion, coding to identify the practice changes and the access impacts associated with each practice change, then the application of Levesque et al.’s Patient-Centred Access to Healthcare framework as a lens of equitable access to inform the findings.
     
    b 2. Health equity at the centre Amplifying the voices of Black communities: A participatory approach to designing smoking cessation programming for Black Torontonians
     
    In Canada, Black adults have a smoking prevalence that is half that of white adults, and smoke fewer cigarettes, yet are more likely to die from smoking related diseases than white individuals. Anti-Black racism and discrimination are key determinants in the negative health outcomes for Black individuals in Canada. The exposure to smoking, low physical activity and chronic diseases are driven by stress that is exacerbated due to inequitable access to quality health care. Due to lack of race-based data, the direct effects of anti-Black racism on smoking and quit rates in Canada is unknown. In addition, historically, health interventions for marginalized populations, including Black populations often fail to include the voices of diverse Black community members.      This presentation will describe a project using a community-based participatory research approach to directly examine the needs of Black individuals who smoke tobacco cigarettes, to inform the design of a tailored smoking cessation program, and to ultimately reduce the harms associated with tobacco use and increased risk of chronic disease. We will describe results from a literature review and environmental scan examining existing evidence to support smoking cessation for Black communities in Canada and describe the initial stages of a qualitative study that considers how members of diverse Black communities in the Greater Toronto Area envision a culturally relevant smoking cessation program that considers lived experiences of anti-Black racism, culture, language and intersecting identities. 
     
           

     

    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.