COVID-19 Member Initiatives by OH region

May 12, 2020

AFHTO recognizes that our members are doing fantastic work on the frontlines attending to patients and adjusting to the COVID-19 pandemic. To connect our teams and showcase the initiatives made by our them, we've created an interactive platform for our members to browse the initiatives made by their fellow members.

Please feel free to scroll through all the initiatives by OH region.

Toronto Central West North East

Have an initiative that hasn't been featured? Contact us with your initiative to be featured! 


    Toronto

    Initiative

    Description

    Team Name

    OH Region

    Lactation Support

    Village FHT is fortunate to have lactation support available to our patients. The certified Lactation Consultant offers assessments and ongoing lactation support at the clinic. With the closure of Toronto Public Health Breastfeeding Clinics, they recognized a need in our community. With the support of the lead physician and executive director, the Lactation Consultant has been able to extend her services to non-patients who are unable to access lactation resources during this time via telephone, virtual or in-person appointments. 
    They have received thanks from Toronto Public Health and the non-patients who have utilized this service. It is important to recognize the importance of community and how teams can help during these challenging times.

    Village FHT Toronto

    Virtual Well Baby Groups

    Village FHT provides care to many infants and families. Prior to COVID-19, Well Baby Groups were offered in clinic to new parents with the purpose of providing comprehensive education based on infant’s age (starting at 2 months through to 9 months old). Topics such as developmental milestones, nutrition and sleep are discussed in a group of parents and infants of similar ages & stages. Due to COVID-19, all in clinic groups had to be abruptly cancelled. Our team recognized an ongoing need for education and support for new parents and decided to trial Virtual Well Baby Groups as an alternative. Guided by the clinic RN / Lactation Consultant to families continue to receive education, support and connection with other first-time parents in a virtual setting. The regular PowerPoint presentation is shared, and discussion is had between the nurse and participants. Resources are sent via Avocare. The team has received great feedback and appreciation that these services continue despite the current circumstances.

    Village FHT Toronto

    Caring for Seniors and Vulnerable Populations during the COVID Pandemic

    To reduce the spread of COVID-19 in buildings in East Toronto and improve access to the frail, elderly and the vulnerable, SEFHT is collaborating with the East End Community Health Centre and their community partners to create a Primary Care and Community Care Virtual Response Team.

    South East Toronto FHT

    Toronto

    Mobile Unit Medics

    Mobile primary care units (Mobile Unit Medics) are being set-up in East Toronto to address the indirect impact on non-COVID conditions due to resource restrictions. As a result of COVID (2nd wave) and the effect of interrupted care on chronic diseases (3rd wave).

    South East Toronto FHT

    Toronto

    COVID-19 Virtual Monitoring

    SETFHT partnered with MGH to virtually monitor patients discharged from in-patient units, assessment centres and the ER. More details can be found in the Hospital News article - (see p. 28)

    South East Toronto FHT

    Toronto

    Community Pediatric Care During COVID-19

    If patients do not have access to a pediatrician or family doctor, and they are not providing virtual or in-person visits, SETFHT will be providing access to a family-friendly primary care environment for the safe assessment of children during the COVID pandemic. This is to help the patients of the community and their families get through this challenging time.

    South East Toronto FHT

    Toronto

    Social Media Q&As

    SETFHT has found this to be a great tool in helping patients deal with social isolation. They have had a great response from their Instagram LIVE sessions on a variety of topics.

    South East Toronto FHT

    Toronto

    Primary Care Virtual FHT

    NYFHT has supported a new primary care virtual FHT for patients unable to access their primary care provider during this time, including those in congregate settings and those recently discharged from hospital for COVID-related illness. The NYFHT facilitated this by providing increased IHP support and supporting physician/patient EMR accessibility.            

    North York FHT

    Toronto

    Sharing Best Practices and Information/Resources with the Community

    Best practises and information/resource sharing within the community, such as pharmacist-led medication updates, webinars and communiques, were led and distributed by the NYFHT in collaboration with the North York Toronto Health Partners (NYTHP) and Department of Family and Community Medicine (DFCM).

    North York FHT

    Toronto

    Patients Continue to Come First

    NYFHT IHPs conducted outreach and wellness calls to patients identified as vulnerable and high risk. They provided support, resources and connected them with services to keep them safe and at home. Counselling for chronic disease management, health promotion and prevention, and mental health continued to take priority. Urgent in-person care continued where necessary to ensure timely access to care, and to keep patients out of the emergency department.

    North York FHT

    Toronto

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    Central

    Initiative

    Description

    Team Name

    OH Region

    COVID-19 testing complete at three local nursing homes

    The Georgian Bay FHT confirmed testing is complete at Bay Haven Care Community, Collingwood Nursing Home, and Creedan Valley (Creemore) and will continue testing for local long term care homes. The Georgian Bay Family Health Team is running the Collingwood COVID-19 assessment centre, a drive-thru tent in front of the medical clinic building. They have set up a website where patients can sign up to be on the waiting list.

    Georgian Bay FHT Central

    In Office Medical Monitoring

    There are a number of stable (Child, Adolescence and Young Adult Eating Disorders Program) patients who were being followed by their family physician for medical monitoring. However, due to COVID-19 some practices have switched to virtual care with no in-person visits. This has increased the potential for these patients to become de-stabilized. As such, Aurora-Newmarket FHT has stepped up and will complete in the in office medical monitoring of these patients.

    Aurora-Newmarket FHT Central

    Virtual Check Ins and Groups 

    At Aurora-Newmarket FHT, the occupational therapist has introduced a new feature, Wellness Wednesdays, where the team shares helpful information on our Facebook page each week to support patients health and well-being while staying home.The team of IHPs are working on a new process to start Virtual Groups to continue providing care for our patients and staying on track with our Schedule A programs. For example, Caring for the Caregiver, What the Tech, and even some groups for patients living with Type 2 Diabetes (carb counting or What the Tech) will be important to run. "What the Tech" will focus on mental health apps and online resources and/or nutritional resources. The team will utilize our social media and website to gather interest.

    Aurora-Newmarket FHT Central

    Providing Care to Unattached Newborns and Moms

    Aurora-Newmarket FHT is providing care to unattached newborns and moms who no longer have ready access to their family physician after discharge from Southlake Regional Health Centre. NP and RNs are administering immunizations for our rostered patients, as well as unattached babies and pregnant women.

    Aurora-Newmarket FHT Central

    Patient Check Ins

    BCFHT has created a template for IHPs to check in on high-risk patients for social supports, health care needs and COVID-19 questions.

    Barrie and Community FHT

    Central

    System Navigation

    RNs at Crosstown FHT are focusing on system navigation and reaching out to isolated patients with resources during this situation

    Crosstown FHT

    Central

    Drive-through Covid-19 Pop Up Testing Centre 

    The Georgina Nurse Practitioner-Led Clinic is proud to be leading the setup of a drive-through Covid-19 pop up testing center on July 29th at the local arena. We have worked with several organizations and they include, but are not limited to, the Town of Georgina, Central LHIN, York Region Public Health, York Region Community Paramedics, Sutton firehall, Health Georgina, Knights of Columbus, Kinsmen and others.  

     

    This testing day will be for asymptomatic people who may be concerned about contact, want to visit family in Long Term Care, or are concerned about exposure such as with health care workers or customer service workers.   As Georgina covers a large geographical area, this will be of great value for those living in remote areas of Georgina or for those who do not want to travel 30-45 minutes to the closest testing centre.

    Georgina NP-Led Clinic

    Central

    Donated funds to purchasing Ventilators

     

    Donated PPE

    Donated money to Southlake Hospital for purchasing ventilator machines ($150k). Donated PPE to a local nursing home and continue to work with them around patient and staff supports

    Georgina NP-Led Clinic

     

     

    Central

    Collaborating with a Group Home for COVID-19 Screening

    Participated in COVID-19 screening at one group home and ran a screening day at a second local group home

    Georgina NP-Led Clinic

     

    Central

    Elderly Patient Check

    RD, HP and RPN called 220 seniors to screen for food security, medication updates, safety, and mental health supports. Patients were able to email images through a general mailbox.

    Georgina NP-Led Clinic

     

    Central

    Clinic Operation and Virtual care

    The GNPLC has continued to provide access  to primary care for patients, including access two evenings a week. The majority of the staff are working remotely and providing care through e-visits. However, there are a minimum of two NPs, RPN or Lab Tech for in-person visits as needed, as well as two medical secretaries, the lead administrator and clinic director.

    Georgina NP-Led Clinic

     

    Central

    Wait While

    The GBFHT utilized the application “Wait While” to provide patients with a virtual wait list for care at the GBFHT after-hours clinic. Utilizing this virtual list ensures that patients are able to socially distance themselves from other patients while waiting for their appointment. Patients are able to log in through the virtual portal link on the GBFHT website and add themselves to the wait list. They are notified when it is their appointment, and they can then enter the clinic after the prior patient has left. If a patient does not have access to the internet on their phone and would like to add themselves to the wait list, they can either text in their information to be added or speak with a greeter at GBFHT, who will then add them to the list on a tablet. This enables patients to access needed care in the safest way possible for both patients and staff.

    Georgian Bay FHT

    Central

    Team-Based Virtual Care for Education Groups

    GBFHT is promoting use of Primary Care Virtual Care (PCVC) in the team. PCVC is being used for patient counselling and education, and for staff and managers to connect in a more “face to face” manner beyond phone and teleconference. The diabetes team is also encouraging patients to access education videos online demonstrating blood glucose meters, sensors, and injectable medications (mainly those provided by pharma and manufacturers). The team also plans to bring together all the FHT team members (RN, Health Promoter, MH counsellor and RD) who would normally present in the T2 diabetes education groups, to create a video presentation that they can link on their website. GBFHT is committed to make the most of this crisis and to get creative about how they can continue to deliver service while protecting staff and patients!

    Georgian Bay FHT

    Central

    Follow Up of COVID-19 Assessment Centre Patients

    NSFHT is providing nursing support via telephone to patients who attend the local COVID-19 assessment clinics. Patients who are screened/assessed can consent to a follow up call from a nurse within the NSFHT. The nursing staff will share the caseload and reach out to individuals who may be having challenges with self-isolation. The nurses can refer to mental health counselling or counselling from a registered dietitian to increase access to information they may need while at home. This is a service they offer in the community to those individuals who may not already be connected with the family health team.

    North Simcoe FHT

    Central

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    West

    Initiative

    Description

    Team Name

    OH Region

    Provide virtual support to Mennonite and Amish residents The Mount Forest Family Health Team (MFFHT) has received a grant to help it provide virtual support to area Mennonite and Amish residents. The grant enables the township to provide support to help the health team obtain appropriate technology and support services to assist Old Order Mennonite, Old Order Amish, and Dave Martin Group Mennonites with access to health services that must be delivered virtually due to the COVID-19 pandemic. Mount Forest FHT West
    Chronic Pain Self-Management Program (CPSMP)

    The Minto-Mapleton FHT has been engaging with patients via OTN since the beginning of this pandemic. Chronic Pain Self-Management Program (CPSMP), a 6-week education session, is geared at teaching new ways to deal with chronic pain and requires participants to take an active role in learning and practicing these tools. Some topics include fitness/exercise, pacing, medications, emotions, fatigue/sleep, and communication. The support from the group members is an added benefit to the program. The feedback from participants has been excellent. If you are interested in learning more about how you can implement this program, more information can be found here.

    Minto-Mapleton FHT West

    GLA:D (Good Life with Osteoarthritis in Denmark)

    GLA:D (Good Life with Osteoarthritis in Denmark) is an 8-week education and exercise program for those with stiff/painful knees or those with OA of the hip/knee, and it consists of two 90-minute education sessions and 12 neuromuscular exercise classes. The program teaches how to control movement and achieve proper posture; builds strength through functional exercises; and teaches how to apply these principles to everyday activities. This group runs twice a week as an interactive virtual exercise session. 

     

    If you are interested in learning more about how you can implement this program, GLA:D Canada provides training and support to run the hip and knee OA program. More information is on their website

    Minto-Mapleton FHT West

    Schedule changes to optimize care during a pandemic

    To improve efficiency, reduce PPE use, and decrease the risk of cross contamination between sites, the HFHT has modified the schedules of its RNs and NPs. Current schedules reflect the pairing and 2-week rotation of the IHPs at various sites. This modified schedule has also helped increase consistency of care in each office and has allowed RNs to continue to work in an expanded role (using medical directives) and to consult with the NPs.

    Haldimand FHT West

    Lung Health – reducing gaps in care during COVID-19

    To reduce the risk of respiratory complications in addicted patients, the HFHT CRE provides continued smoking cessation & relapse prevention services to patients through virtual visits and NRT drop-off/curbside pickup. This effort not only initiated appreciative feedback from patients through social media and radio, but the CRE was also client nominated and selected as the local “Haldimand Hero” for her work in supporting continued patient care.


    To support continued care of patients with COPD & asthma, the HFHT CRE provides wellness calls to patients in isolation. Once assessed, the CRE collaborates with the HFHT team to ensure that patients have updated action plans that help prevent/reduce the risk of exacerbation and that may be self managed during isolation. Coordinated care plans and referrals to other services are initiated where necessary.

    Haldimand FHT West

    Virtual Visits and support for HFHT and non-FHT clinicians

    To reduce the risk of potential exposure to COVID-19, all clinicians of the HFHT initiated virtual visits (phone and/or video) with all patients. Patients requiring in-clinic visits were scheduled appropriately.
    The provision of virtual visits decreased the risk of virus transmission through unnecessary exposure while still providing access to care. An added bonus was the conservation of PPE.
    While some virtual visits were challenged by poor internet coverage in rural areas, the majority of patients were appreciative of the virtual care.


    To facilitate virtual visits throughout the county, the HFHT registered nurse provided support for access to virtual services to all HFHT clinicians as well as clinicians at other non-FHT clinics.

    Haldimand FHT West

    Improved PPE access to Family Practice clinics in Haldimand county

    To simplify distribution of PPE to primary care clinics in Haldimand County, the HFHT became the hub for obtaining and delivering urgent PPE supplies and donated PPE. Spearheaded by the HFHT Clinical Lead, PPE is redistributed and delivered to FHT and non-FHT clinics to ensure an adequate supply for all clinics.
    This effort is ongoing and has:
    • improved relations and collaboration with primary care in the county
    • streamlined access to PPE for clinics while minimizing confusion about how/where to obtain PPE
    • enabled providers to safely continue to care for patients where in-clinic visits are necessary

    Haldimand FHT West

    Mental Health Check-Ins and Counselling

    The HFHT mental health staff recognise a need for support for any isolated patient and provide check-in phone calls to counsel and monitor patients in isolation. This support is provided not only to patients in active counseling (during the period right before the pandemic), but also to patients who may have received mental health support in the past. Through collaboration with other non-FHT clinics regarding PPE distribution, counselling services have been extended to non-HFHT patients.

    Haldimand FHT

    West

    Wellness Calls to Vulnerable Populations

    To improve community support during COVID-19 and reduce the risks associated with isolation, the Haldimand FHT provides wellness calls to all elderly patients and families with children younger than 15. The team recognised that isolation may:
    • prevent elderly patients from receiving needed assistance and may put them at a higher risk for mental health issues
    • put families with young children at a higher risk for anxiety, stress, and potential domestic violence


    The RNs and mental health staff used data extracted from the EMR to identify appropriate patients and used standardised screening forms (developed to support the initiative) to maintain consistency and to help identify gaps in care. Coordinated care plans and referrals to other services are initiated where necessary.
    While vulnerable patients feel especially supported, all patients are appreciative of the service, and the HFHT has identified that the wellness calls may have prevented the need for a hospital visit for some patients.

    Haldimand FHT West

    Local health care organizations work to address long term care COVID-19 crisis

    The Grey Bruce Health Unit, SBGHC staff, and  Brockton and Kincardine Area Family Health Team, have assisted four long-term care homes with swabbing residents and staff. The partnership among public health, hospitals, and primary care to provide the enhanced surveillance testing of all residents and staff in long-term care homes has been a great success.

    Brockton and Kincardine Area FHT West

    Educational Videos for Patients

    The Niagara North FHT has created a series of YouTube educational videos for patients on topics such as hand hygiene, healthy foods, meal planning, and COVID-19 that can be found in this playlist.

    Niagara North FHT West
    Virtual Substance Abuse Program

    The Windsor Team Care Centre’s substance abuse services has moved online due to COVID-19. A new virtual substance abuse program, part of the One Team Recovery (OTR) initiative, will host sessions through the online video call platform GoToMeeting. The service will allow up to 25 people to join the group session. To reach the masses and to provide a group setting, this program could offer those extra services and extra supports virtually and connect other people. 

    Windsor FHT West

    Virtual Nutrition Groups

    Hamilton FHT offers a variety of nutrition programming from educational groups such as Healthy You, Cooking Demonstrations, Diabetes groups and grocery store tours to treatment-based groups such as Mindful Eating and Binge Eating Disorder Treatment Program.

     

    To help stay connected to patients during this challenging time, they have switched to nutrition counseling over the phone and have modified Diabetes Groups, Cooking Demonstrations, Healthy You Lifestyle Groups for a virtual platform. Participants now join their much-loved groups through Zoom meetings. They have even created a HFHT Zoom Etiquette to help facilitators and participants get used to this new platform.

     

    The dietitian/mental health counsellor-led treatment groups (Mindful Eating Groups and Binge Eating Disorder Groups) have also gone virtual. To meet the needs of the community, during the months of May and June, they are offering Zoom webinars for the public on topics of interest including diabetes, heart health, depression, and emotional eating. They are excited at the prospect of continuing to run virtual groups such as these to support patients now and in the future.

    Hamilton FHT

    West

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    North

    Initiative

    Description

    Team Name

    OH Region

    COVID-19 outreach team finishes Long Term Health Care Home testing

    Powassan & Area FHT worked closely with the Health Centre’s COVID-19 Assessment Centre Outreach Team and the North Bay Parry Sound District Health Unit to collect a total of 1,239 swabs. The outreach team conducted testing at Cassellholme, Nipissing Manor, Water’s Edge and Eastholme and tested both residents and staff.

    Powassan & Area FHT North

    Exploring primary care information as an indicator of impacts of changes in restrictions related to COVID‐19

    Public Health Sudbury & Districts has started an initiative to collect primary care data from FHTs and NPLCs that are currently screening COVID-19 patients. They anticipate the data may provide an early signal of those impacts in the community and support decision makers in their efforts to mitigate the outbreak.

    Public Health Sudbury & Districts – FHTs & NPLCs

    North

    INR Testing in the Parking Lot

    As teams move to providing care to patients within their cars in parking lots for immunizations, COVID testing etc., Atikokan FHT is providing INR testing for patients within their cars. 

    Atikokan FHT

    North

    ED Diversion Strategy

    Sunset County FHT has partnered with their local hospital to create a communication strategy in which they are offering unrostered patients’ same day/next day appointments to ensure patients continue to have access to primary care.

    Sunset County FHT

    North

    Diabetic Patient Check Ins

    Northeastern Manitoulin FHT has created a script that their dietitians are using to check in on diabetic patients to ensure continuity of care.

    Northeastern Manitoulin FHT

    North

    COVID-19 mobile assessment service

    Elliot Lake FHT has developed a COVID-19 mobile assessment service. They screen people over the phone and if a person qualifies, they send a nurse to the home to do a swab.

    Elliot Lake FHT

    North

    Primary Care Support for Supported Isolation Centre and Temporary Emergency Centre

    The emergency shelter in the City of Greater Sudbury has been temporarily relocated to a hotel. Sudbury District Nurse Practitioner Clinics is working with Canadian Mental Health Association Sudbury/Manitoulin and the City of Greater Sudbury to provide primary care for individuals who are using the temporary emergency shelter. Through a Supported Isolation Centre, homeless individuals that have to be in quarantine due to COVID-19 (e.g. symptomatic individuals, those awaiting results) will be monitored by a team of health care providers. In addition, primary care providers review all intake assessments and participate in care plan development, renew and/or adjust chronic disease medications, and consult with addiction and mental health specialists as required.

     

    Sudbury District Nurse Practitioner Clinics

    North

    Virtual Programming for Community

    Through Zoom and promotion on Facebook, the website, and emails to community stakeholders, they are holding free virtual programming for patients and broader community. The Social Worker and Dietitian are holding ‘Am I doing this right? Caring for ourselves in unprecedented times.' This provides practical strategies for managing mental and emotional health during a pandemic. The Social Worker and Registered Nurse are holding Mindfulness Awareness Stabilization Training to help participants learn how the body processes stress and emotions, and to develop resources for self-care.

    Sudbury District Nurse Practitioner Clinics

    North

    Connecting with Patients via Multiple Platforms

    Marathon FHT has shared any clinic changes in various ways with communities they serve. Some examples include: clinic Facebook page, sent to First Nations clinics, local paper, and email.

    Marathon FHT

    North

    Collaborating with Local Pharmacists for Prescription Extensions

    Marathon FHT contacted the local pharmacist to arrange for extension of prescriptions for chronic medications rather than sending renewal requests for those medications to the physicians/NP at this time, plus a letter to employers (there are only a couple of major employers) and Chamber of Commerce indicating that they will not be providing off work notes for workers.

    Marathon FHT

    North


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    East

    Initiative

    Description

    Team Name

    OH Region

    Outdoor RN Injection Clinic

    West Carleton FHT is running an injection clinic under a tent in the staff parking lot for injections. Patients are instructed to arrive in short sleeves and pre-screened over the phone. Patients appreciate this effort as injections for allergies, chemo etc. continue.

    West Carleton FHT

    East

    Renfrew County Virtual Triage and Assessment Centre (RC VTAC)

    The RC VTAC is a collaboration between Renfrew County Primary Care teams, the County of Renfrew Paramedic Service, Renfrew County Hospitals, and the Renfrew County and District Health Unit, with the support of Ontario Health East.

     

    The RC VTAC is a primary care solution to reduce the demand on Emergency Departments and provide Renfrew County residents, who do not have a family physician or cannot access their family physician, with the appropriate level of care when they have any health concerns (including concerns related to COVID-19).

    Primary Care in Renfrew County

    East

    Elderly Patient Check Ins & Community Collaboration Website

    Bancroft Community FHT is calling all elderly patients to encourage self-isolation, checking to ensure that they have enough medication and groceries, and assisting with making arrangements. They have set up a community website for individuals to offer or ask for help.

    Bancroft Community FHT

    East

    Transitioning Care Virtually in response to a Positive COVID-19 Patient

    In late March, Lakelands FHT discovered a positive case at the Northbrook site, which resulted in the immediate closure of the building. They all had to go home for a 14-day self-isolation. In response, they decided to build a clinic without walls! They created an email account for patients to contact them and posted this on their website and Facebook page. Physicians and NPs were able to remotely access the PSS EMR and fax prescriptions from their homes. Their super RN/IT expert also had remote access and provided critical support. They were able to create schedules for themselves and call patients from their homes by turning off the Caller IDs on their phones. The mental health social worker was able to call the patients in her schedule as well.

    Lakelands FHT

    East

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