Conference

Poster Displays

Information & Resources for Posters:

Here is the poster information kit for poster presenters.

To view posters at a glance by conference theme, please click here.
To view poster descriptions, please see the end of this page.

If you are unsure of the status of your poster presentation, please contact conference@afhto.ca.

2018 Key Dates:

  • October 9, 2018: Extended early-bird registration deadline – payments must be received by this date
  • October 10, 2018: Deadline to submit poster PDF
  • October 24 & 25, 2018: AFHTO 2018 Conference
    • Install poster: 7:30 to 8:30 AM, October 24, 2018
    • Remove poster: 2:00 to 4:00 PM, October 25, 2018

Poster Display Guidelines:

  • The maximum size for posters is 46” (vertical) x 70” (horizontal)
  • Posters are to be put into place before 8:30 AM on Wednesday, October 24, 2018, and removed at 4:00 PM on Thursday, October 25, 2018.

Online Poster Gallery

In order to share your initiative with as many of your peers as possible, an online gallery of posters will be made available here after the conference. To participate, please email a PDF of your poster to conference@afhto.ca by October 10, 2018.

Poster Board # TitleThemeSummary / Results
#1Person-Centred Risk Assessment Framework: Assessing and Managing Risk in Older Adults Living with Dementia1. Mental health and addictionsPersons living with dementia are at increased risk for motor vehicle accidents, getting lost, medical errors, and other adverse events that contribute to high healthcare utilization; caregiver stress related to managing safety risks is a key factor contributing to institutionalization. There is a critical need for feasible, effective ways of pro-actively assessing and managing risks associated with dementia with the aim of averting these crises events, resulting in avoidance of unnecessary suffering and costly acute care hospital utilization and institutionalization. Importantly, there is need for a person-centred positive risk management framework which focuses not only on the physical risks, but also recognizes the unintended emotional, psychological, and spiritual harm of taking away activities that are meaningful and contribute to quality of life. This presentation describes the Primary Care Risk Assessment Framework (PCRAF) developed by the Centre for Family Medicine (CFFM) Primary Care Collaborative Memory Clinic (PCCMC) that can help PCCMCs, of which there over 100 in the province and 76 located in Family Health Teams, to better assess and manage risk. The PCRAF was tested by 7 HCPs over 6 months, representing 13 PCCMCs-. Evaluation of the tool included questionnaires and interviews administered to patients/ clients and care partners (N=17), and health care practitioners (HCPs; N=6). The PCRAF allows persons with dementia to contribute as much as possible to decisions about high risk activities and alternate solutions to meeting underlying psychosocial needs, aiming to reduce safety risks and adverse events among persons with dementia while maintaining person-centred care.
#2Evolution of a Primary Care-Based Psychiatry Program1. Mental health and addictionsThe Guelph FHT Psychiatry clinic was established as a trial in 2011??. The clinic was created from an expressed need for more support for patients with mild to moderate mental health challenges. The clinic has evolved from borrowing a meeting room in our main administrative office to embarking on a renovation to build a separate and private clinic with a waiting area and office space. The clinic started with one adult psychiatrist and has grown to include child and adolescent, and geriatric psychiatry. Psychiatrists have direct access to patient EMR and can connect directly with primary care providers. We have integrated an evaluation process for the clinic to ensure that patient’s satisfaction and feedback is heard and incorporated in ongoing programming. There has been an increasing demand on our psychiatry service due to decreasing resources in our community. This has resulted in increasingly complex patients and longer waiting times.
#3Paying for Engagement: An Incentive-Based Program for Women Who Use Substances During Pregnancy1. Mental health and addictionsThe passport program is an incentive based program though the St. Michael’s Hospital available to marginalized women in Toronto. Researched by the Wellesley institute in 2009 this program has strong evidence base for its effectiveness in addressing social concerns that impact women’s ability to attend prenatal appointments. The social determinants of health often impact the overall health of mom and baby. Focusing on a portable health record for mom and baby as well as incentives to engage women in care this project assists women in not only accessing care but providing a portable health record that can increase collaborative care across service agencies. Based on this strong research the St. Michael’s Academic Family Health Team has adapted this program for use in the Substance Use in Pregnancy Program. A pilot project was undertaken to measure the effectiveness of this program in a Family Health Team setting.
#4Improving Access to Social Worker Services by Reducing Wait Times1. Mental health and addictionsWomen’s College Hospital Family Practice is a large FHT with over 20,000 patients. With only two Social Workers (SW) to support a high volume of patients, timely access to mental health services is a constant challenge. Wait times for SW in our clinic are 3 months on average (ranging from 2-6 months). Our aim was to reduce wait times for patients to see a Social Worker by more than 50% by October of 2017. In order to achieve this aim, we implemented change ideas that would a) increase capacity (e.g., clear our wait list, improve communication about our short term counselling model, ensure short term counselling time-frames [4-6 visits max] are adhered to, increase evening appointment slots), b) Improve service coordination (e.g., re-direct patients to EAP where applicable, improve community partnerships) and c) improve our booking processes (e.g., create a comprehensive referral form in our EMR that links to patient handout outlining how to access SW services, provide patients with appointment time immediately upon referral activation). Within 10 months of starting to implement our change ideas, we were successfully able to reach our goal of reducing Social Worker wait times by 50%. Through this process, we developed an even greater appreciation of the importance of using data to drive decision-making. In order to sustain our positive outcomes, our team continues to meet regularly to ensure patients are continuing to access SW services in a timely way and to identify additional opportunities for improvement and problem solving.
#5A Research Study of an Emotion Focused Mindfulness Group in Primary Care (Work in Progress)1. Mental health and addictionsThis poster presents our research project: A Feasibility Study of an Emotion Focused Mindfulness Group to Enhance Coping and Resilience in Family Medicine Patients Living with Common Mental Illnesses. Existing treatments for mental illnesses do not always deal with emotions, such as shame and self-criticism. Emotion Focused Mindfulness (EFM) addresses this by developing compassion and empathy towards oneself and others through mindfulness of embodied experiencing. This practice helps us navigate emotions, decrease suffering and empowers us to live deeply valued lives. EFM differs from traditional mindfulness groups such as Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Based Stress Reduction (MBSR). This research and our findings will potentially have the impact of offering an alternative and innovative way of managing common mental illnesses within Family Health Teams. EFM is a brief, group intervention that combines Emotion Focused Therapy with unguided meditation and journaling. It encourages curiosity, tolerance and self-compassion towards whatever arises during meditation. We have conducted 4 out of 6 research cohorts and will present the present the preliminary data. Objectives for our Research: -to examine whether participation in the EFM Group increases self-compassion and lowers symptoms of depression, anxiety and shame, as well as increases level of functioning.
#6Utilizing the Knowledge and Skills of a FHT Pharmacist and Social Worker for Opioid Weaning and Pain Management 1. Mental health and addictionsIn May 2017 new Canadian opioid guidelines called for a restriction in prescribing doses and the Ontario Drug Benefit Program notified prescribers that narcotics with more than the daily maximum would be delisted as a benefit. Data from Health Quality Ontario showed that 1.3% of patients at the London FHT have been prescribed a high dose opioid as of March 31 2017. That percent equates to 264 patients of which 191 had prescriptions by their own physician within our FHT and 73 were by other providers. When the guidelines were released, it was expected that up to one third of patients would not be able to tolerate weaning of their doses. In order to best support its patients, the London FHT generated an EMR list of all patients prescribed the delisted products and sent the corresponding list to each physician. Each physician met with the patient discuss the need to wean from the opioid prescription with the support of the FHT pharmacist and social worker. Discussions included risks, weaning process details and what the patient could expect. No targets were set rather a discussion of pain levels and daily functions were the basis for weaning end points. Each patient was seen every 2 weeks by the pharmacist for assessment of pain, activities of daily living and withdrawal symptoms. If no issues were identified then a further weaning was initiated. Several patients were also referred to a social worker at the same time as overlapping issues would affect their daily living activities. Social workers also helped patient’s pain management by teaching Cognitive Behavioural Therapy (CBT) and meditation. Several patients had joint sessions with both the social worker and the pharmacist which was felt beneficial by patient and provider.
#7Behaviours that Challenge in Adults with Intellectual and Developmental Disability: Is it Mental Health? 1. Mental health and addictionsIn adults with intellectual and developmental disabilities (IDD), behaviours that challenge (BTC) are frequent diagnostic dilemmas for primary care providers. In a UK study, 36% of patients with IDD were assessed for BTC over a 15 year period. There is evidence in Ontario that emergency room visits are twice as common in this population compared to general-population counterparts and that 40% of these visits were for aggressive behaviour. In addition, the most commonly prescribed medications in adults with IDD are psychotropic agents. Most significantly, antipsychotics continue to be frequently prescribed in treating aggression without a diagnosis of psychotic disorder in spite of lack of evidence of efficacy and ongoing concern about harm. In the context of the 2018 Canadian Consensus Guidelines on the Primary Care of Adults with Intellectual and Developmental Disabilities, this presentation will give primary care providers an organized approach and tools to systematically assess adults with IDD with BTC in an inter-professional setting. The session will include: 1. A presentation by patients and caregivers to help providers understand the concept of unmet needs and the communicative nature of BTC. Patients and caregivers will provide focus-group information on how providers can improve communication and work with patients and caregivers as partners to evaluate BTC. 2. Inter-professional team members will review a systematic approach to sequentially evaluate Health, Environment, Life events and the Psychiatric causes of BTC (HELP model). 3. A review of tools to evaluate mental health in the context of BTC and information regarding the dangers of antipsychotic use will be presented.
#8Inter-Professional Team Care Intervention in High Needs Area1. Mental health and addictionsThe West Reach IP Team was established under the TC LHIN’s Primary Care Strategy’s Access to Inter-Professional (IP) Teams priority for system improvement. This IP Team provides access to patients enrolled in Fee for Service (FFS) solo practicing Primary Care Physicians (PCPs). The IP services are provided to PCPs located within two high needs areas, Mount Dennis and Rockcliffe Smythe. The project objectives were twofold: • to establish an IP team that may be accessed by local FFS practices currently without access to such resources, and; • to evaluate the impact – including the impact on patient outcomes - of integrating an inter-professional team through an existing CHC that is made available to other primary care practices. We conducted an evaluation to analyze the use of IP Team service referrals by primary care providers (PCPs) who do not have access to such services. The IP Team will consist of a Registered Nurse, a Social Worker, a Community Addictions Worker and an Outreach Coordinator. The objectives of the evaluation were to understand the feasibility and impact of making IP care services to solo PCPs based on patient satisfaction with their experience, PCP perceptions of the value, and IP Team perceptions of their experience, and iv) indicators related to healthcare. A mixed methods design was used, and instruments to measure outcomes of interest will include surveys and one-on-one interviews. We will make an in-depth presentation of the results of the evaluation and discuss recommendations for improvements to optimize team service adoption.
#9OPIOIDS in CNCP-Identifying Your “At Risk” Patients at a FHT1. Mental health and addictionsIn response to the Opioid crisis in Ontario and in our own FHT an Opioid Task Force was formed which involved a lead physician, an NP, a Pharmacist and three 1st year U of T Residents as a part of their QI Project. A search was performed to identify all patients with an Opioid on their EMR. The list was then split between the residents and the Family MD’s. The 3 1st year Medical Residents were assigned the Resident list. A 4rth year U of T Pharm D student working on a 5 week Project rotation was assigned the MD list. Each group was to screen each patient chart to determine if they were indeed still taking an Opioid. This was confirmed by contacting the community pharmacy as well as the patient. The list was further pared down by determining which patients had been on the Opioid >3 months. This final list was studied closely to determine which patients had- received physiotherapy for their pain, also had concomitant benzodiazepine therapy, had a current narcotic contract in their EMR, had had a urine drug screen, had been assessed with the Opioid Risk Tool, had a personal or family history of substance abuse or were deemed “High Risk” due to equivalent morphine dose. We also developed a CNCP Banner and attached this to the patients’ history of problems section with details on the type of pain, and if they were high risk due to dosage.
#10From 'First Contact': Engaging Patients, Assessing Needs, and Reducing Wait Times for Mental Health Counselling1. Mental health and addictionsIn September 2016, the Dufferin Area Family Health Team implemented an internal centralized intake process for our Mental Health program and specifically dedicated staff resources to this change, with the introduction of a Mental Health Intake therapist role. The rationale behind enhancing intake was to increase patient engagement, reduce wait times, streamline services, and provide better assessment/triage support for patients and providers. This presentation will highlight the positive impact of 'investing in intake' as experienced by the Dufferin FHT. Implementation, promotion, referral tools (including the counselling prescription), data collection/results, and observations by patients and providers will be discussed.
#11Readiness for Patient Engagement in Primary Care Teams1. Mental health and addictionsThe importance of including patients in research and quality improvement is increasingly recognized, but little is known about how ready primary care teams are to do this. The results of this study will shed light on the current readiness in Ontario’s Family Health Teams and Community Health Centres (arguably the most well-resourced primary care settings in Canada), and can help to guide further efforts to promote meaningful patient engagement. We conducted an online survey of Executive Directors or their delegates at all 283 Family Health Teams, Community Health Centers, Nurse Practitioner-Led Clinics, and Aboriginal Health Access Centers in Ontario, Canada. The survey instrument was a 49-item online survey including items from the Measuring Organizational Readiness for Engagement (MORE) and Public and Patient Engagement Evaluation Tool (PPEET) questionnaires and demographic questions. We used descriptive statistics of perceived organizational willingness and ability to implement patient engagement, as defined by the necessary tasks and resources, organizational culture, and other contextual factors. We will be sharing our results to a national/international stakeholder dialogue group to start developing priorities and strategies for future patient engagement in collaborative mental health care. This survey of teams’ perceived readiness will provide vital insights into what supports they might need to advance patient inclusion and participation in healthcare design, evaluation and improvement.
#12Reducing Harm from Opioids: A Multi-Pronged Team-Based Approach1. Mental health and addictionsCanada is in the midst of an opioid crisis, with escalating overdose deaths in multiple provinces and the second highest rate of per capita opioid consumption in the world. Prescription opioids are an important therapeutic tool, however they carry risks, even when prescribed and used appropriately. Recent guidelines have provided some clinical guidance around safer opioid prescribing for chronic non-cancer pain. Guidelines, however, can be challenging to implement in practice. Creating systems to support prescribers in implementing guidelines in a complex clinical environment can be an enabling force. This session will demonstrate an approach to reducing harm from opioids in a large inner city academic family health team using a Quality Improvement framework, which entails: - Understanding the problem through reviewing prescribing and dispensing data and qualitative interviews with prescribers and patients - Identifying measures to allow us to quantify improvement - Implementing a multi-faceted approach to address the problem from a variety of angles including targeted pharmacy involvement in opioid and opioid-benzodiazepine de-prescribing, educational activities to increase naloxone/buprenorphine prescribing capacity in the FHT, increasing the prescription of naloxone kits for high risk patients.
#13Expanding HAES® to Our Community by Delivering an Interdisciplinary Intuitive Eating Program at SETFHT2. Healthy relationships, healthy teamsIntuitive Eating (IE) takes the focus off of weight and places it on behaviour. It the opposite of how weight is viewed in most healthcare settings. Research shows that intuitive eaters have higher self esteem and significantly improved health. People that eat with the intention of weight loss tend to gain weight over time, show health improvements initially (but not long term) and have an increased risk of binge eating disorder. This poster will outline our success with developing and implementing an IE group program for our patients and the surrounding community.
#14Understanding the Incentives and Disincentives that Influence Team Collaboration to Improve the Quality of Care for Depression and Anxiety in Ontario’s Family Health Teams 2. Healthy relationships, healthy teamsOver the past two decades, significant efforts have been made to improve the quality of care for patients with depression and anxiety in primary care contexts. Barriers to optimal prevention and management of depression and anxiety in Canadian primary care services may lie in the misaligned incentive systems currently in place. There has been insufficient attention directed towards the incentives and disincentives that influence care for anxiety and depression, especially for interprofessional team-based settings. The aim of our study is to develop an incentives model to help guide providers and policymakers in their efforts to improve prevention and management of patients with depression and anxiety in FHTs. This is especially important in Ontario, where a regional strategy for primary health care resources, including the availability and role of mental health workers, is being planned. We are currently in year three of our study. Individual interviews are being conducted with a diverse group of FHTs across Ontario and with healthcare professionals working in these settings, which can help us understand how various financial and non-financial incentives and disincentives influence their ability to provide evidence-based collaborative care for patients with depression and anxiety. We have completed and analyzed 82 interviews with healthcare professionals from FHTs (n=59 physicians, psychiatrists, executive directors, nurses, social workers, counsellors, occupational therapists, systems navigator, psychologist); community informants (n=6); and policy informants (n=4). Participants represent 17 FHTs and span 9 Local Health Integration Networks. At time of poster presentation, we aim to have 100 interviews completed.
#15Aiming Our Sights High: Bringing Together Primary Care Practitioners of the Couchiching FHT for a Yearly QI Summit2. Healthy relationships, healthy teamsProviding excellent health care for our patients is a priority for all of us. While we all work on ensuring we are addressing the large priority areas in healthcare, there are many smaller, innovative initiatives underway each day that can have far-reaching benefits for those we serve. In an effort to bring these projects and initiatives to the forefront of what we do, the Couchiching Family Health Team holds a yearly QI Summit. This event brings together physicians and allied health practitioners across the CFHT to share creative ways that they are maximizing resources and directly improving patient care. The Summit is offered on a yearly basis, for one afternoon. Family Doctors, Specialists, Nurse Practitioners, and Allied Health Practitioners speak for 15-60 minutes on a variety of topics. Past presentations have include: Medical Assistance in Dying, use of an opioid toolbar, review of online booking systems for patients, use of an osteoporosis screening toolbar, and an EMR reminders project for really impaired patients.
#16Nurse Led Well Baby and Child Visit Program2. Healthy relationships, healthy teamsThe purpose of this poster is to demonstrate how Nurse-provided well child care (WCC) in primary care can be implemented successfully. The primary and secondary goals of this program within the Trent Hills FHT should be easily transferrable to other FHT’s across the province. The poster demonstrates how family-centered care by Registered Nurses working to full scope of practice can enhance long-term outcomes for patients and can improve overall rates of vaccination. At the Trent Hills FHT there was a need for more appointments with Doctors and Nurse Practitioners; Registered Nurses generally have more flexible schedules. The WCC program would allow for more efficient use of doctors’ and NP’s time to focus on acute care patients and same day bookings to decrease wait times. Another benefit of nurse led WCC is improved continuity and rapport between the care provider and family. This leads to fewer missed appointments, earlier detection of developmental concerns, earlier referral to external resources, and improved support or intervention for school age children. Moving forward the team is also looking at Nurse led Prenatal care and currently Registered nurses complete most of the cervical cancer screening within the Trent Hills FHT. The goal is to eventually have a fully comprehensive Nurse led well Women and Child program that includes all of the aforementioned services as well as breastfeeding support. This poster clearly and concisely outlines all of this.
#17An Interprofessional Approach to Developing a Homebound Patient Medication Safety Tool2. Healthy relationships, healthy teamsBackground/rationale: The medication regimens of homebound patients tend to be complex due to multiple comorbidities, and in many cases, multiple caregivers. Currently, there are no tools designed to help monitor and assess medication safety in patients who require home visits. Methods/methodology: This quality improvement project was undertaken by an interprofessional team consisting of 3 family physicians, a pharmacist, a nurse, an occupational therapist, an administration staff, and an IT specialist, to develop a tool to assess and improve the safety of homebound patients' medication use. Results/outcomes: The team met twice a month for 8 months to develop and trial a ‘medication safety in homebound patients’ tool. The team initially came up with many measures, which then had to be whittled down in order to make the tool feasible to complete during a busy home visit. The team also grappled with challenges around creating a tool that is both print friendly and can be used seamlessly with the electronic medical record. Conclusions: The team developed a standardized tool to assess how patients are taking their medications and the barriers they face, as well as tracking and resolving discrepancies between what clinicians think their patients are taking and what they are actually taking. The tool gives the care team important information to consider when making treatment recommendations. The tool continues to be fine tuned and the team believes it will enhance patient care. Plans for the future include patient/caregiver and provider satisfaction surveys as well as spread to non-homebound patients.
#18An Application of Social Constructivism Theory to Improve the Utilization of a Community of Practice for Occupational Therapists Working in Primary Care2. Healthy relationships, healthy teamsOTs have been working on primary care teamsin Ontario for several years and often work as the solo OT on the team and have a very large scope of practice (paediatrics to palliative care). There is a strong need for the OTs to connect and share resources, expertise and reduce isolation. The benefits of OT CoPs have been documented and include knowledge sharing, knowledge translation, reflection in action and boundary crossing (Barry, M. et al, 2017). Utilization of an online community of practice for OTs working in primary care has been poor and strategies to improve this utilization by applying the principles from Vygotsky’s Social Constructivism Theory to the OT CoP will be presented and discussed in this poster.
#19INSPIRED – Scaling Up INSPIRED Approaches to COPD Care3. Expanding your reachJoseph Brant Hospital has partnered with one local Family Health Team (FHT) to introduce the INSPIRED approach to COPD within their practice and utilize results to spread and scale the approach to primary care within the Burlington, Oakville and Hamilton (North) communities. JBH and the Caroline Family Health Team (FHT) will develop and execute an outreach program to engage other FHTs in Primary Care with the goal of initiating three additional primary care organizations to adopt the INSPIRED program at the end of 18 months.
#20Here We Grow – The Evolution of an In-Home Interprofessional Primary Care Team to Include a Clinic Model 3. Expanding your reachKW4 Health Links Community Ward (CWT) – a partnership between the WW LHIN and Centre for Family Medicine FHT - is an interprofessional team that delivers and coordinates in-home care for medically and socially complex patients. CWT works with the WW LHIN, health and community partners, patients and families to tailor care to patients, over 65% of whom have mental health or addictions issues in addition to other co-morbidities. Faced with an increasing wait list due to rising referrals, and challenges in attaching highly complex patients to primary care and additional mental health services, the CWT is piloting an associated clinic with dedicated nurse practitioner and social work resources to expand CWT’s capacity, by: • enabling CWT to refer current patients who no longer require intensive in-home care, but require ongoing access to primary care and/or counseling; • facilitating continuity of care for complex patients for whom traditional primary care visits are not enough, particularly Health Links patients with ongoing coordinated care plans; • allowing the CWT to expand its approach and offerings, e.g., by offering patients individual counseling, group counseling and drop-in appointments; and • enabling CWT – by distributing patients between its in-home team and clinic - to expand its reach and accept new referrals from across KW4 sub-region. As a new initiative, program development is focusing on enablers and barriers to design and implementation through the lens of relationships within CWT, between CWT and its patients and between CWT, partner organizations and other sub-regional initiatives and opportunities within the KW-4 sub-region.
#21Hearing Screening: Expanding Access with Mobile Technology and Giving Kids the Edge in School 3. Expanding your reachCost, wait times, and travel distance to subsidized testing locations, are barriers to audiology assessments for Ontario children. The early years are critical in a child’s development. If children have hearing deficits that are not identified, they risk falling behind their peers in school. Starting hearing screening when children are 5 and 6 years old, helps to ensure that hearing problems are identified and addressed early on, before children fall behind in school. Our goal is to implement a hearing screening program for children aged 5 and 6, in a primary care practice through the use of mobile technology, while improving access for our rural patients. In addition, we are striving to develop a system, a "how to" so that other Family Health Team’s can reproduce our model and implement it in their practice. The mobile technology that we are using for our hearing screening program is an iPad audiometer. Potential patient's are identified and scheduled for screening tests assisted by the nurse. We have been integrating community partners as part of our team including the company that provides the mobile technology and community audiologists. Data is compiled to assess the percentage of patients who were successfully screened. A hearing screening program using mobile technology has the potential to expand access while helping children reach their potential in terms of language development and listening skills, as well as to positively impact their social skills. The program is simple, cost-effective, and could benefit patients and families across the province.
#22Infant Nutrition & Sleep – Creating and Implementing a Program for Sleepy New Parents3. Expanding your reachGetting an infant to sleep is a very hot topic for parents and is regularly brought up by parents at Well Baby Visits to the South East Toronto Family Health Team. In addition, for years, the need for more information on how to support baby to sleep has been requested in evaluations of the pre-existing Infant Nutrition program, run by the Registered Dietitians and Nurse Practitioners. To meet this need, an infant sleep workshop was created and offered with the nutrition workshop to capture the interested audience. It is also being offered beyond our rostered patients, to the community at large. This workshop was created from community based programs and evidence based resources. The group setting promotes access for patients to the interprofessional team, and offers an opportunity for social interaction and facilitated discussion.
#23Transgender Care Clinic3. Expanding your reachWhen a gap in care was identified for transgender individuals, the Peterborough Family Health Team (PFHT) stepped up to the plate by creating the Trans Care Clinic. This service was generously funded through the Canada 150th grant and a kind donation from the Greater Peterborough Health Services Foundation, and provides patients with the services and support they require. The Trans Care Clinic is led by nurse practitioners and operates once a week at the PFHT office. Additionally the clinic is supported by mental health clinicians, pharmacists and collaborating physicians. The services provided by the clinic are individualized for every patient based on both their needs and wants. Some services include: Counseling support, medical treatment initiation, hormone monitoring, and additional individualized services and supports (i.e. surgery consultations, gender marker changes for legal documents). This poster will highlight the response we have received since staring this clinic in February 2017, and examine areas for improvement and expansion in the future. Our goal is to build confidence and capacity within primary care providers in Peterborough. This poster will illustrate how collaboration within primary care enhances access and patient care for this marginalized population.
#24Chronic Pain: A Registered Nurse Led Self-Management Program3. Expanding your reachCurrently, majority of chronic pain in Canada is managed by physicians in the primary care setting. Self-management is considered an effective chronic pain treatment modality. However, the provision of self-management support for chronic pain patients faces challenges within primary care facilities likely related to the lack of time, knowledge and expertise. A nurse led chronic non-cancer pain program has been effective in working with a multidisciplinary approach within the Bruyere Academic FHT. The goal of this project is to improve how chronic pain is currently managed and review the outcome measures to assess any need for change within the program. An initiative is now underway to offer the chronic non-cancer pain self-management program to another FHT in the Ottawa area.
#25Palliative Care in Multi-Cultural Rural Communities: Interweaving Practice and Learning3. Expanding your reachHealthcare providers in rural communities have dual personal-professional relationships, multiple professional roles, a high burden of care, and broad scopes of practice. Rural health care can be characterised as generalist, often limited in resources, spread across large and challenging geographies and practiced within systems that are relationship based. Many rural communities in Canada are multi-cultural with a strong Indigenous presence. Family Health Teams on Manitoulin Island in rural northeastern Ontario are active partners in the ‘Manitoulin Hospice Palliative Care Resource Group”: a multi-disciplinary and multi-cultural group that has, as its explicit goal, supporting seamless access to high quality and culturally safe and respectful palliative care. The concept of a good death underlies the practice of hospice palliative care. When considering rural dwellers, both Indigenous and non-Indigenous, a common unique descriptor for a good rural death is the dying person is not removed from their home community and culture. Through collaborative efforts multiple healthcare providers as well as administrative and support staff across Manitoulin Island have had opportunities to participate in nationally recognized palliative care courses and to bring this learning to their clinical workplaces. Through the development of a common language, vision, and strong practice networks, we work to support and care for patients and families in preparing for end of life in their home communities.
#26Advances Evaluation Methods: An Examination of the Barrie and Community Family Health Team Diabetes Management Program3. Expanding your reachThe presentation will walk those in attendance through the following: • The academic and practical tools and processes used for this evaluation; • The evaluation process and stakeholder engagement; • The performance and outcome measures used; and • The results and recommendations from the evaluation. The Barrie and Community Family Health Team (BCFTH) has been working towards the implementation of an ongoing 3-year evaluation cycle that looks at the performance and focus of each of its programs. The BCFHT started its evaluation process by evaluating its Diabetes Management Program. This program is one of the longest running programs and most sophisticated, making it an ideal candidate to test the evaluation process. The evaluation itself was designed and conducted by the Quality Improvement and Decision Support (QIDS) team of the BCFHT. The QIDS team worked very closely with the Diabetes Management Program and its stakeholders to develop the overall evaluation process and performance measurements for the program. The evaluation looked extensively at the following areas: • Patient demographic and clinical descriptions • Patient Feedback and Satisfaction • Stakeholder Feedback and Satisfaction (employees, physicians, partner community programs etc.) • Process Mapping and Performance • Employee Workload Performance • Clinical Outcomes and Performance Financial and economic indicators were proposed, but data was not available to complete while the evaluation was being conducted.
#27Optimization of Patient Visits to Improve Access and Quality of Care3. Expanding your reachCare teams are strapped for time and patients experience that as poor accessibility. What if we could identify patients that don’t really need to be seen before an appointment is booked? By providing low-risk patients with services over the phone, it may be possible to free up appointment slots for higher risk patients. We have done this by extracting data from electronic medical record systems, cleaning up the data and calculating a variety of risk scores for all patients. We then identify a cohort of patients that need prescription renewals or lab tests before a visit with a health care provider and triage them appropriately. Prescriptions for low-risk patients seen in the last 6 months get an automatic renewal while patients requiring lab tests are told to get them done before requesting a visit. We also identify a second cohort of high-risk patients who have not had diabetes related visits or smoking cessation counselling within the appropriate time periods. These patients are called-in proactively to fill in appointments that were freed up by previously wasted visits. Preventing even one wasted visit per clinic per day can provide greater convenience to approximately 200 patients per year (the approximate number of working days per year). Avoiding unnecessary visits provides greater access to 200 patients who need that appointment the most.
#28Chomp and Stomp – Keeping Infants on Track3. Expanding your reachPreventive primary care guidelines encourage providers to cover a large volume of issues in each well baby visit. Many teams struggle to accomplish this despite their best efforts. Parents and caregivers come with many questions and there is often not enough time to address all of them on top of doing immunizations and routine assessments. The Sunnybrook Academic Family Health Team is a Wave 5 FHT with limited resources. In order to maximize the skills and scope of our team, we developed an innovative alternative to group well baby visits. Our team identified the most common questions parents were bringing to well baby visits and to individual appointments to our IHPs. The most common questions were about physical development and nutrition. We piloted our initial education session and the evaluations demonstrated that parents appreciate time to discuss their questions with our IHPs and also enjoyed being together with other families. To date we have held 18 sessions with 176 participants and continue to have interest in this program. By having our IHPs doing education/support sessions together, they have been able to learn from each other and widen their scope of practice which makes their individual visits with families more valuable.
#29Breathing Easier: Using the Health Equity Impact Assessment to Ensure Equitable Delivery of a Primary Care Respiratory Program 4. The “How to” streamTen Primary Care Asthma Program (PCAP) coordinators in Ontario completed the Ministry of Health and Long-term Care (MOHLTC) Health Equity Impact Assessment (HEIA) Tool and results were compiled by the PCAP Provincial Coordinator. A focus group was held, facilitated by the MOHLTC and the Centre for Addiction and Mental Health (CAMH), to review the results and discuss how this information can be used to make the delivery of our program more equitable across the province. During the focus group, each coordinator reviewed their own assessments and gathered information from other sites. Some sites were already mitigating the impacts of the identified gaps (e.g., PCAP was only offered in one city, but accepting patients from another neighbouring town making it difficult for patients to access the clinic. The PCAP educator arranged for a policy change to travel to the neighbouring clinic to see those patients).
#30ROAR: Addressing Literacy in Primary Care with Our Youngest Population 4. The “How to” streamChildren who have poor literacy skills have been shown to have worse social and health outcomes later in life. There is a growing body of literature that suggests that assessing and counselling parents regarding literacy at primary care visits can improve rates of childhood literacy. However, in our current paediatric primary care model, physicians are not always able to address literacy at preventative care visits due to limited time and knowledge about counselling. Furthermore, parents may not have access to resources that can improve the literacy of their child. Reach Out And Read (ROAR) is an evidence-based literacy program to enhance pediatric preventative care visits. It is endorsed by the Canadian Pediatric Society. In June 2017, an interprofessional collaborative team at St. Joseph’s Health Centre Urban Family Health Team took the lead to become an official ROAR clinic. In accordance with the ROAR model, our clinicians underwent a training module to improve skills in literacy counselling. Our waiting room was made “literacy rich” with books and resources for children to use before appointments. At well child visits, children are given an age-appropriate book to take home, and parents are counselled on literacy. To date, we have had over 300 ROAR visits of the ROAR model at our Family Health Team. This also has allowed us to showcase the benefits of collaborative work by mobilizing our clinical, administrative and decision support resources, has generated participation of parents in improving care for their children and has created opportunity to collaborate with community partners and the Foundation to make ROAR happen.
#31Providing Evidenced-Based Care as a Best Practice Spotlight Organization Pre-Designate4. The “How to” streamEvidenced-based practice in Healthcare often leads to both enhanced quality improvement measures and improved patient safety. It incorporates a combination of three main knowledge sources: management information systems, personal knowledge of decision makers, and research findings. With the evolution of technology and resources in research and policy development, information is more readily available; however the quantity of information is also constantly increasing. The Guelph Family Health Team (FHT) has engaged in a formal partnership to provide both resources and support at an Organizational level to enhance evidenced-based practice through best practice guideline (BPG) implementation. The Guelph FHT has been accepted as a Best Practice Spotlight Organization (BSPO) pre-designate, recognized as the second Family Health Team in Ontario to apply for this designation. This is a 3 year partnership with the Registered Nurses Association of Ontario (RNAO) to effectively plan, implement and evaluate a minimum of 5 RNAO best practice guidelines in Primary Care. The commitment allows for shared resources and support through implementation frameworks, formal training, and mentorship strategies. We have developed an organizational structure that encompasses project sponsors, steering committee, BPG working groups and implementation teams. Combining both available resources and organizational structure for guideline implementation, The Guelph FHT aims to continue to provide a culture where patients feel good about the care we provide because we are able to maintain quality care through evidenced-based practice.
#32Power Over Pain: An Interdisciplinary Approach to the Treatment of Chronic Pain4. The “How to” streamThe presentation will focus on the development and delivery of “Power Over Pain” chronic pain management program at Dufferin Area Family Health Team, as delivered by the Clinical Pharmacist and an Occupational Therapist. The audience will be provided with an overview of materials included in a 90 minute Pain Education workshop, and the evidence for this approach; will be introduced to a Management framework using the 3 M’s (Movement, Mindfulness and Medication). We will look at the actual and potential impacts this type of intervention has had on primary care, as it relates to outcomes in improved function, patient satisfaction and self management skills after participation in a multidisciplinary program, in addition to the effectiveness in reducing wait times for multidisciplinary care for patients experiencing chronic pain.
#33Mediterranean Style Eating: Guide to Why and How4. The “How to” streamDiabetes Canada CPG 2018 suggests a variety of dietary patterns are beneficial for people at risk and with diabetes. The Mediterranean dietary pattern has the following benefits: improved glycemic control, blood pressure, cholesterol and triglycerides, reducing cardiovascular events and preventing or delaying the onset of type 2 diabetes. Sunnybrook Academic Family Health Team (SAFHT) diabetes class evaluations (2017), indicated that clients are interested in learning more about Mediterranean dietary patterns, recipes and practical meal planning tips. Currently there is a gap in group educational options for individuals at risk in our setting. A pilot Mediterranean style eating program was developed by the SAFHT RDs to meet the needs of this growing population of at risk clients. The main goal is to provide clients with a more detailed dietary approach encouraging behaviour change using meal planning skills. This interactive program consists of a series of 4 classes. Each class starts with an explanation of the Mediterranean diet, the health benefits, and then focuses on 2 key food groups within the Mediterranean style eating plan. Incorporated into each class are tips on how to purchase, store and prepare each of the featured food groups. The potential impact is for clients to learn and apply their knowledge on Mediterranean style eating patterns in a practical way. The long term benefits are to prevent or delay the onset of type 2 diabetes and promote cardiovascular health creating a culture of health and wellness.
#34NutriSTEP: Is Your Child at Risk? Tips to Healthy Screening 4. The “How to” streamOur poster will provide an overview of the NutriSTEP tool for primary care professionals. We will discuss our methods along with where we are with our findings and implications for future practice. In the near future we plan to hold focus groups with health care providers and parents of those screened to determine the benefit of the nutriSTEP program and whether or not the questionnaire screens our population appropriately for those who are at moderate to high risk. We will assess the barriers health care providers came across when completing the nutriSTEP in order to continually improve the delivery of the screen. Based on current literature, NutriSTEP improves quality of care and nutritional management of children. NutriSTEP helps to raise awareness of children’s eating habits, create an opportunity for early intervention, and streamline the process of nutrition assessment referrals. We hope to share our findings and review of the literature on the impact of primary care to prevent future complications.
#35Successfully Engaging Team Members in a FHT-Wide Implementation of the Telus PS Smoking Status Toolbar4. The “How to” streamIn 2017-2018 BQWFHT was redesigning its Respiratory Management program because its rate of COPD admissions (2.6 patients/1,000) was 1.7 times the provincial average. As well, 7.7.% of BQWFHT’s patients had a documented COPD diagnosis. It was recognized that there were probably many undiagnosed cases of COPD, but inconsistent and incomplete smoking status documentation meant that smokers and ex-smokers who should be assessed with the Canadian Lung Health Test for potential referral to spirometry could not be identified easily. In fact, only 15.4% of patients had their smoking status documented in the EMR’s Risk Factor field. To address this barrier to implementing Respiratory Management program components, the Program Data Administrator installed the Telus PS Smoking Status Toolbar developed by the East Wellington FHT. “Rate of smoking status documentation in the Risk Factor field” was also adopted as 2017-2018 QIP measure with a target of 50%. A launch event was held at the AGM where the rationale for adopting the toolbar was explained. This was followed up by training team members to use the toolbar and providing them with an illustrated guide. The rate of smoking status documentation was tracked quarterly, both by provider and by site, and the tracking data were circulated to all team members. Staff and providers who had more effective processes were encouraged to share them with the rest of the team. Those who had less effective processes were offered one-on-one training. BQWFHT’s overall smoking status documentation rate was also graphed monthly on posters installed at each site.
#36Optimize Vascular Protection with ACE Inhibitors or ARBs in a Diabetic Population in a Community Based FHT – A Health Improvement Initiative and Validating the My Practice Report by Health Quality Ontario4. The “How to” streamThe validation of the Mypractice report and medication review provides understanding and supports the combination of the best practice and patient goal driven personalized pharmacotherapeutic and pharmacoeconmic decisions to optimize the use of ACE or ARB in patients participating in the diabetes program at FFHC.
#37The Journey to Cultural Competency – Learning Lessons Along the Way4. The “How to” streamInitiative: Changing a culture, and in effect, gaining cultural competency is a process that requires time, commitment and champions. By identifying cultural competency as a priority for our organization we have been able to participate in exercises to identify our own knowledge, attitudes and skills. This initiative has provided us the opportunity to reflect on our biases and assumptions, as well as, identify learning needs and areas for organizational improvement. Our increased awareness has also resulted in an interest in improving our understanding of populations within our practice that may experience stigma or marginalization. We have specifically identified both the LGBQT community and adults with Intellectual and Developmental Disabilities as areas for additional mentorship. Impact: By identifying cultural competency within our quality improvement plan our organization has had a formal mechanism to work on this process at an organizational level. By establishing where our team is on the journey to cultural competency we have been able to identify needs and target key professional development events. We have sought out local expertise and community partnerships to improve our overall organizational cultural competency beyond the level of patient-provider interactions. Relevance: Although still in the early stages, we hope to share our experiences, lessons learned, timelines and events with other teams interested in improving the accessibility and effectiveness of care provision for all patients through a lens of cultural competency. Specific recommendations on improving care for the LGBQT community and adults with Intellectual and Developmental Disabilities will be provided.
#38Using EMR Reminders to Make a Difference to Renally Impaired Patients4. The “How to” streamAs part of the Couchiching Family Health Team’s (CFHT) Quality Improvement plan, Dr. Murphy spearheaded a project to use the EMR reminders in Telus Practice Solutions to directly benefit patients. Recognizing that this could be a large project, the team agreed to start with medications in one area only. The goals for the project were as follows:  To create a set of reminders for renally sensitive medications used in primary care office practice using the Telus EMR  To improve patient safety  To provide a clinical decision support tool Dr. Murphy worked with the CFHT pharmacists, IT Manager, and QIDSS to create this reminder set. Alpha testing of the program was done with Dr. Murphy and 2 other family doctors in the CFHT. Physicians in the CFHT were then invited to the Annual CFHT Quality Improvement Summit to learn about the project, see it in action, and discover how they could use this in their own practice to benefit patient care. Dr. Murphy plans to demonstrate to conference participants how this program works, along with its implications for improved patient care.
#39Guelph FHT’s Evaluation Mindset: A Ten Year Evolution4. The “How to” streamThe use of evaluation & quality improvement to strengthen patient-centred care is core to the Guelph FHT’s work. Over the past ten years, the Guelph FHT has evolved its evaluation & quality improvement approaches to embrace a comprehensive, integrated, and team based evaluation & quality improvement strategy. This has given rise to a number of experiential lessons and a shifting of mindset from simply asking “How are we doing?” to one in which we ask “How are we doing, what are we doing, how can we do it better?” The Guelph FHT has come to leverage several strategies as core components of our evaluation & quality improvement approach: • We are actively changing how we engage patients and how we receive and use their feedback. Through online surveys, focus groups and creating a platform for patients to share their experiences with us, we are able to collect data on patients’ journeys within the healthcare system. • The decision support capacity of our organization has grown, and with it, the capacity for sophistication in our EMR searches, chart audits, and extraction of meaningful data. The Guelph FHT relies on one EMR, with 23 servers across our clinics, making this work challenging but critical in collecting influential data to shape the future of our FHT’s services and programs. • Through strong community partnerships and commitment to shared care, we are also able to leverage data from healthcare partners. This helps to inform our work and its relevance in providing care for all Guelph residents.
#40Moving with the Times – Improving the Patient Experience with Communication and Technology4. The “How to” streamTo improve access for booking appointments, SETFHT set up a central four-person phone line system, with dedicated staff answering the phones. This has been in place for several years and has improved access for patients. However, we still received complaints about getting through on the phone lines, so SETFHT recently introduced on-line booking to allow staff to make their own appointments. We will share the details of how this initiative is going and how it is positively impacting patients. We also recently launched self check-in terminals, allowing patients to bypass the line at reception and get checked in faster. The terminal also allows patients to update demographic info, giving patients more ownership of their personal data. Regarding communication, over 9000 patients have signed up for secure email. This allows us to confirm appointments with them and directly communicate with them, on a privacy-ensured system. Using these emails we communicate with patients every quarter with a newsletter tailored to their needs and concerns, as well as reminding them of policies and services the FHT provides. We have a robust website with easy to access information for all patients. We are very clear on how patients can provide feedback in many ways, both good and bad, via the website, on a paper comment form, by telephone or in person. We have also had a Patient Advisory Council for the past several years, giving patients a direct voice in how the FHT is run, allowing them to make suggestions and give us feedback.
#41Agile Approach to FHT Emergency Preparedness4. The “How to” streamSETFHT has dealt with emergencies in the past year due to gas leaks, power outages, elevator not working and lack of internet, resulting in the need to close one of our two clinic sites. Although SETFHT has a robust emergency preparedness binder on hand, these kind of “in the moment” emergencies are not dealt with by reading a binder that is sitting on a shelf, but by using common sense, good communication and working together with staff and physicians to assess the situation and make a quick and sensible decision as quickly as possible. SETFHT will share the following: • How to coordinate decision making between FHT staff and physicians as to when/if a closure should happen • Designating a lead contact at the FHT to take ownership of the process • How the administration/management team can assist • How to divide up staff to deal with the closure • How to divide up staff to contact patients • What’s the best communication method between staff and providers • How to sort out where all the providers will work when sharing a space that usually accommodates half the staff/physicians • How the FHT can work with the building owner to deal with the issue at hand SETFHT will also share our learnings on what could be done better, the gaps we identified and what we have done to update policies and processes.
#42How to Reduce Cardio-Metabolic Risk in Your Patients through Diet and Exercise? Creating Community Collaborations and Optimizing Resources for the CHANGE Program4. The “How to” streamThe CHANGE program, Canadian Health Advanced by Nutrition and Graded Exercise, is an evidence based diet and exercise program aimed at reversing metabolic syndrome and reducing cardio-metabolic risk in primary care settings. Unlike other lifestyle programs, the CHANGE program involves regular follow up by a Family MD/Nurse Practitioner, dietitian, exercise specialist and includes an evaluation of outcomes relevant to cardio-metabolic risk over 12 months. Given the lack of exercise specialists in FHTs and the need for weekly/monthly diet and supervised exercise visits, innovative ways to maximize existing resources and to create collaborations with community partners is needed. In this session, you will learn how participating FHTs have been able to develop such partnerships and the strategies they have used to deliver the CHANGE Program within the complex environment of primary care. Program evaluation metrics and experiences from patients that have participated in the program will also be shared.
#43Upstream Healthcare: A Postpartum Gestational Diabetes Group4. The “How to” streamWomen with gestational diabetes mellitus (GDM) are recommended to have an oral glucose tolerance test (OGTT) six weeks to six months postpartum. Across Ontario completion rates are as low as 15%. At the Sunnybrook Women’s and Babies program their baseline completion rates were 30%. With the addition of a QI project that focused on email reminders, the completion rate increased to 44%, but did not reach the target of 60%. Clients were booked to return to Women’s and Babies postpartum to receive their OGTT results. Attendance rates were low, wait times were long and clients reported it difficult and inconvenient to attend. The Sunnybrook Academic FHT’s Diabetes Education team was approached to develop and enhance the quality of client postpartum visits by offering a group program geared towards discussion of their health beyond GDM. This program is an opportunity to collaborate with a hospital clinic, FHT and DEP, provided in a primary care setting. The goal is to educate these women on prevention strategies such as healthy eating, exercise, OGTT results, future pregnancy planning, and an opportunity to meet with other new moms. At regional meetings in the TC LHIN, other hospitals were noting similar issues. Sunnybrook developed a train the trainer workshop on the postpartum GDM class for the community DEPs. Next steps will be to encourage all women to attend, regardless of OGTT completion. With the risk of 50% going onto develop pre-or diabetes, offering this group within the FHT seems to be an effective solution.
#44To Be or Not to Be… Assessing Hallux Abductovalgus Deformity as Part of the 60-Second Diabetic Foot Screen4. The “How to” streamIntroduction
 Increased plantar pressures have been associated with foot ulceration in diabetics and are measured briefly in foot screening tools. The aim of this study was to positively correlate increasing plantar pressures with increasing stages Hallux abducto-valgus boney deformity. This is a common boney foot deformity that can be measured with visual tools. However, health care providers vaguely recognize it. Methods
 333 rostered patients from the foot clinic underwent a neurovascular and biomechanical assessment and measurement of the stage of HAV deformity using the Manchester scale visual tool. The Manchester scale categorized patients according to the visually assessed degree of deformity from stages 1 to 4. The cross-sectional study aimed to isolate patients randomly from each of the 4 stages for further plantar pressure studies. Patients walked over a 3D scanning map barefoot after normalizing barefoot gait. Once this occurred, correlation models of stage of HAV deformity and plantar pressures markers were created. Plantar pressure markers included plantar digital apices, metatarsal heads, and medial and plantar heel. These markers assessed peak pressures during different stages of gait.
#45Innovation Explosion: Developing and Using Strategies and Resources to Build the Capacity or Family Health Teams to Implement Baby-Friendly Best Practices4. The “How to” streamSince 2013, the Baby-Friendly Initiative (BFI) Strategy for Ontario has been supporting organizations, such as birthing hospitals, community health centres and Family Health Teams, to implement BFI best practices. During the time the BFI Strategy has developed a number of innovative strategies and resources which support organizations across Ontario who are moving towards or maintaining BFI designation. These supports include tools to implement BFI best practices, individual coaching, education strategies to meet the needs of staff, and resources to provide consistent client education. This session will provide information and practical examples about the supports and tools available, or planned, and how they can reduce duplication of efforts and save valuable resources, as they support organization in the BFI designation process and/or the application of Baby-Friendly best practices. Specific examples from working with Family Health Teams will be highlighted.
#46PPI DE-PRESCRIBING PROJECT - Where We Came From - Where We Are At Now - Where We Are Going 4. The “How to” streamThe project started with an audit to identify all patients with a PPI still on their active EMR which was run by 2 U of T Pharm D students in December 2016. The students were able to pare down a smaller list which was more reflective of the possible numbers through thorough EMR clean up. This list started to identify which patients had been on a PPI>1 year and also a “Gastrointestinal Agent” banner was added to the “History of Problems” section of the Accuro EMR. In May 2017, a third U of T Pharm D student, on a specific 5 week project rotation, moved closer to actual number by verifying with the community pharmacy and also with the patient to further clarify the patients’ use of PPI. Final evaluation for this first step was presented to all staff via a weekly Information email entitled “InfoBlast” as well as at the by-yearly mandatory organizational meeting, “The Enterprise Meeting”. Results of this first phase will be presented as well as results following up 1 year later May 2108. These include # of patients on a PPI, # on a PPI>1 year, % of PPI patients with a banner in the EMR, % de-prescribed and details on stopped, decreased dose or substituted agents, % failed, % successful. Future next steps will be discussed.
#47Learning How to Get Lucky: Enablers of High Performing Primary Care Teams 4. The “How to” streamThe session has 4 parts and will involve didactic presentation as well as small group discussion on each of the topics to allow participants to reflect on the extent to which the topics presented are working (or not) in their teams and what they and their small-group members might consider doing next to learn to be luckier in measurement and improvement. The four sections of the session are: Evidence of measurement culture: Summarize and reflect on participation in D2D and changes such as improving access to and quality or EMR data quality and use of data by teams (thru convening QI committees and increasing conversations about performance with physicians and leaders etc) Factors contributing to culture change: Describe and reflect on factors such as focus on “getting started” and “do what you can” approach, building relationships and keeping the conversations going. Highlight the LACK of importance of specific indicators in building measurement culture. Team characteristics contributing to better performance: Describe characteristics and activities of teams related to better performance on D2D indicators (eg co-location, physician champions, other dimensions of team work) Specific approaches to reach new heights of performance even with no new resources: Showcase teams (specific teams to be determined) with history of improving performance over several iterations of D2D in indicators like reasonableness of wait for appointment, follow-up after hospitalization or diabetes management etc. Teams will share the role that data and inter-professional collaboration (and other factors) played in achieving and sustaining success, generally within existing team resources.
#48The role of Chiropody within the Family Health Team4. The “How to” streamThe goal of this poster is to create awareness about the Chiropody profession, scope of practice and its role within the FHT that leads to improved system quality, equity and efficiency. Chiropody is the health care profession that assesses and treats foot conditions. Although a referral is not required, physicians and other healthcare professionals, often refer their patients for consultations. The scope of practice varies from province to province, but in Ontario, Chiropodists have several controlled acts including soft tissues surgeries, prescription and injection of controlled substances. Treatments offered within the FHT include foot physical therapy, surgical procedures (ingrown toenail removals), cutting into subcutaneous skin (callus/corn debridement), plantar wart treatments, wound care, orthotic therapy, administering by injection into the foot designated substances/drugs and by inhalation, and prescription of designated drugs. Chiropodists also are an integral player within the team in providing diabetic foot wound care. Foot examinations are an integral component of diabetes management and are critical in preventing diabetic foot ulcers. Both prevention of diabetic foot ulcers and the treatment of active ulcers by a Chiropodist within the FHT will help to reduce visits to the ER or hospitals. This helps to improve pt. access to care as they no longer need to wait for wound care clinic appointments. It will ultimately lead to a decrease in number of amputations and decrease the total cost of care.
#49The iDynaForm: An Innovative Tool to Efficiently Manage Patients with One or Multiple Chronic Diseases to Increase Scope for Allied Health and Build Capacity within Family Health Teams5. Why hasn’t this expanded: scalable pilot programsThe Peninsula Family Health Team (FHT) spearheaded the successful approval of an Ontario Centres of Excellence Health Technology Fund grant for an early adoption pilot that targets providing better patient care closer to home. iDynaForm, the health innovation technology solution developed by Fig.P Software Incorporated, is a secure, cloud-based, EMR-embedded, EMR-agnostic, and EMR-integrated evidence-based guidelines-aligned patient care tool that supports the care of patients who have any combination of one or more of 14 common vascular conditions, or none of them plus risk factors. It is built on a scalable, standards-based architecture that will permit future inclusion of additional chronic conditions. The project team is piloting the use of this innovative health technology solution with the aim to support early adopter evaluation among primary care providers across Ontario. The FHT has partnered with Fig.P Software Incorporated, eHealth Centre for Excellence, Centre for Effective Practice, CorHealth Ontario, Women’s College Hospital Institute for Health System Solutions and Virtual Care, and the Stroke Network of Southeastern Ontario. Together, this group is pursuing a larger evaluation of the care tool in an 18-month project. The project examines whether the iDynaForm solution will provide better, faster, and “easier” patient care than is currently available, with potential to increase roster size through redistribution of work to more inter-professional healthcare providers, working to their full scope of practice.
#50Ontario’s First FHT to Achieve Baby-Friendly Designation – A Roadmap to Success5. Why hasn’t this expanded: scalable pilot programsTwo Rivers FHT is the first of its kind in all of Canada to achieve BFI designation. The journey started as a pilot project with the Breastfeeding Committee of Canada to determine how a FHT could implement Baby-Friendly best practice strategies. One step at a time, we engaged the support of management, doctors, nurses, staff, community partners and the BFI Strategy for Ontario to strategically work through implementation of the 10 Steps. We integrated many of the resources that were developed and recommended by the BFI Strategy as well as accepted individual coaching to simplify and streamline the process. Through discussion with the Ministry of Health and Long Term Care we aligned our Annual Operating Plan (AOP) with the BFI Outcome Indicators and reporting requirements. Key stake holders in our process were the local hospitals and public health unit who are BFI designated or engaged in the implementation process. This inspired and held us accountable to provide clear and consistent messaging to our patients regardless of where they receive care. Our goal for seeking designation was to implement best practices, support mothers in their decision to breastfeed, ensure informed decision-making results in responsible use of formula, and work towards a Baby-Friendly community and LHIN. Through continued education concerning the BFI 10 Steps, the Code, and the RNAO Best Practice Guidelines, we have been able to keep our staff up-to-date on current practice standards. All efforts combined to help us reach the goal of our journey: BFI Designation in February 2018.
#51Levelling the Playing Field: Helping Patients with Severe Physical Disabilities in Your FHT5. Why hasn’t this expanded: scalable pilot programsIn Canada, 11.5% of adults are affected by mobility impairments, the incidence of which increases with age. Access to appropriate and quality primary care is a significant challenge for individuals with severe physical challenges due to barriers of physical space, equipment, knowledge, and attitude. Their health outcomes are worse. Family health teams can offer equity in care for these people. This presentation will give FHT administrators, leaders, and primary care clinicians practical tips and concrete actions they may wish to consider to improve the health of persons with severe physical disabilities within their communities. Examples for FHT administrators and leaders are concrete funding opportunities leverage via CFFM FHT, the Ministry of Health, and Spinal Cord Injury Ontario agreement for equipment such as accessible exam tables, patient ceiling lifts, and wheelchair scales. Opportunities for e-referral and virtual visits will be discussed. Examples for primary care clinicians are tips for helping people with neurogenic bladder, complicated UTI, bowel routines, persistent pain, and pressure injuries. Awareness of availability of an in-depth training program to establish a primary care Mobility Clinic within a FHT will be introduced with evidence of the 3 new pilot sites in Ontario where we are starting this process.
WithdrawnMotivate, Engage and Activate! How Occupational Therapists Empower Patients with Mental Health and Addiction Issues to Live Their Best Lives 1. Mental health and addictionsThe role of occupational therapy can often be difficult to explain especially in community mental health. When patients and other health care professionals are asked about what OTs do, they often describe OTs as providing equipment suggestions and home safety assessments. While these services are within the OT scope of practice, there is so much more to our role, especially for patients with mental health issues. OTs help patients solve the problems that interfere with their ability to participate in their daily activities. OTs promote health and well-being through occupation and have an important role in supporting patients with mental health and addiction challenges. OTs investigate how patients are spending their time each day and teach practical ways for patients to cope with the effects of mental illness. They help replace unhealthy coping strategies with meaningful activities. OTs support patients in developing structure in their daily routines so that they can achieve more balance in their life. Return to work planning or independent living goals are also part of the OT role in many OT programs in primary care. This presentation will provide participants with practical clinical examples of how to integrate the OT role into current as well as emerging mental health programs in primary care.
WithdrawnAdvance Care Planning: Building Capacity and Successful Implementation in Interdisciplinary Teams 5. Why hasn’t this expanded: scalable pilot programsMcMaster Family Health Team is an academic family health team consisting of two clinics and approximately 40,000 patients. ACP is a discussion of care options; patient beliefs, values and preferences; mental and physical prognoses; and care decisions not restricted to goals-of-care [GoC] and resuscitation directives. Patients increasingly want to have ACP discussions with their health care providers. A national public survey determined that 60% of individuals want their health care provider to provide them with information on ACP. Currently, ACP discussions rarely occur in primary care settings. In a Canadian national survey of the public, only 9% of respondents indicated that they discussed end-of-life care with their primary care physicians. Despite this trend, primary care clinicians and trainees want to increase comfort in having ACP discussions with patients. Patients have longitudinal relationships with their primary care clinicians, which ensures better patient-centred care during ACP discussions. Therefore, there is a strong rationale to have more ACP discussions in primary care. The SICG Training in ACP project is a quality improvement project designed on the principles of Normalization Process Theory. This project investigates whether ACP can become embedded as the routine practice by the clinicians and learners in the McMaster Family Health Team. A training program, adapted from the SICG, was to increase skill and confidence in having ACP conversations. We will describe the SICG training program, demonstrate the use of the method, provide opportunity for participants to practice the method, and discuss results of our research on impact and implementability.