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The Home First philosophy

The Home First philosophy has been adopted by hospitals across Ontario and the Champlain region over the past several years. At The Ottawa Hospital, we have recently undergone a refresh to ensure that staff and physicians are aware of the benefit this philosophy provides to patients.

Home First is about providing the right care, at the right time, in the right place, for the right cost. The focus is to keep patients (particularly high-risk seniors) safe in the community for as long as possible, with community resources and supports. This means that through providing enhanced personal support upon discharge, seniors can remain at home and make decisions about their future in a more comfortable and familiar environment.

In addition to providing better care, closer to home, the Home First approach is a significant strategy that can help to reduce hospital occupancy, minimize the volume of Alternate Level of Care (ALC) patients and support access to acute care. As a collaborative effort between The Ottawa Hospital and the Champlain LHIN, work is being done to ensure early engagement of the discharge team, which will allow for discussions regarding Long Term Care to occur in the community.

For primary care physicians, an understanding of this approach, as well as the messaging that your patients will experience while in hospital, is key to success and will assist in reassuring them. While patients are in hospital, the discharge planning team, comprised of a Social Worker and LHIN Care Coordinator, will be engaged early on to discuss plans for returning to the community. All efforts are placed by interdisciplinary team members to create safe and timely plans for discharge to a community setting. For patients who require Long Term Care, plans for this transition will be made from home through follow-up from a LHIN Care Coordinator.

A Home First approach avoids patients being identified too early for Long-Term Care and through timely discharge, the risk of deconditioning and exposure to hospital-acquired infections is reduced. Minimizing the need to make decisions in a time of crisis during a hospital admission offers the opportunity for patients to wait in a home environment for a preferred Long Term Care Home choice.

 

__________________________________________________________________________________

Contact:

Carol Murphy, Manager, Subacute Transitions & Post Acute Flow, The Ottawa Hospital

613-798-5555 ext 17502

cmurphy@toh.ca

Breast Imaging Update 2019

The Champlain Regional Cancer Program invites you to attend its’ annual Breast Imaging Update 2019, part of the Continuing Professional Development Series. Please find details below. You can attend in person or by OTN. Please feel free to forward to your colleagues. 

 

Effectiveness of Shockwave Treatment Combined with Eccentric Training for Patellar Tendinopathy

Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study

Karin M. Thijs, Johannes Zwerver, Frank J. G. Backx, Victor Steeneken, Stephan Rayer, Petra Groenenboom, Maarten H. Moen.

Clinical Journal of Sport Medicine, Volume 27, No. 2, May 2017

Patellar tendinopathy is a common overuse injury that affects the origin of the patellar tendon at the inferior pole of the patella. Overload of the mechanism leads to pain and dysfunction, and this condition can become chronic and difficult to treat. While eccentric training has developed a standard role in the rehabilitation for patellar tendinopathy, the role of extracorporeal shockwave therapy (ESWT) is less understood. The goal of this study was to determine the effectiveness of a combined treatment of eccentric training and ESWT compared with eccentric training and sham shockwave (placebo) in participants with patellar tendinopathy over a 24-week follow-up period.

This multicenter randomized and placebo-controlled trial was conducted at sports medicine departments in a university hospital and general hospital in the Netherlands. Fifty-two physically active male and female participants (mean age 28.6 years, range 18-45) with a clinical diagnosis of patellar tendinopathy were randomly allocated to either eccentric exercises with ESWT (ESWT group), or eccentric exercises in combination with sham-shockwave therapy (placebo group). Extracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants in the study were instructed to perform eccentric exercises on a decline board at home (3 sets of 15 repetitions, twice per day). To assess outcomes, the Victorian Insitute of Sport Assessment-Patella (VISA-P) scores, pain scores during functional knee loading tests, and Likert scores were registered at baseline, 6, 12, and 24 weeks after initiating the ESWT or sham-shockwave treatment.

 

The results of the study revealed that when comparing the ESWT group to the placebo group, there ware no significant differences found. While VISA-P and pain scores significantly improved over the study period, there was no treatment effect between the groups over time.

Despite being a double-blinded, randomized control trial study, the authors note several limitations in their work. The power analysis prior to the start of the study revealed that 56 patients were needed to detect a clinically significant difference in the VISA-P score of 15 points. Unfortunately, there was a large loss to follow-up (31.8% in the ESWT and 13.3% in the placebo groups respectively). Furthermore, the physical therapists that performed the treatments were unblinded (as they needed to adjust the shockwave device to “true” or “sham” treatment), and this could have influenced the results. With these limitations in mind, this study showed no additional benefit of 3 sessions of ESWT in patients with patellar tendinopathy.

Sean Mindra, MD, CCFP

PGY3 – Sport and Exercise Medicine, University of Ottawa

 

Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine

Champlain Lung Health Intake and Referral

The Champlain Lung Health – Intake and Referral program is your access point to community lung health education and support in Champlain if you are living with COPD.

For healthcare providers, this program offers one referral form that allows your adult clients living with COPD access to effective community lung health services in Champlain.

The lung health programs provide an evidence-based approach that improves the health and quality of life of people living with COPD.

http://champlainlunghealth.ca/

“Since joining your program my breathing and general overall health has been greatly improved …Your program is a hidden gem and should have more exposure so others may experience what I have been given”

– Lung Health Program Participant

“When I started 4 years ago, I was barely able to walk due to my shortness of breath; today I am able to walk for over a half an hour. I love this program for what is has helped me accomplish.”

– Lung Health Program Participant

Cancer Update 2018

The Champlain Regional Primary Care Cancer Program presents: CANCER UPDATE 2018

Friday, December 7, 2018, from 08:00-16:30
Ottawa Conference and Event Centre
200 Coventry Road, Ottawa, ON K1K 4S3 Cost: $125.00 (Until December 6, 2018)
$150.00 (After December 6, 2018)

Register online NOW!
www.cancerprimarycare.eventbrite.ca
For more information contact cancerprimarycare@toh.ca or 613-798-5555 x 15811

View details and agenda – print and share! Cancer Update 2018 – details and agenda

Meet regional experts & learn more about :

  • Cardiovascular Health and Cardiotoxicity
  • Pancreatic Cancer
  • Preserving Fertility After Cancer
  • Indigenous Health and Cancer  Genetics and Cancer
  • New Prostate Guidelines and Treatment
  • Advanced Care Planning
  • Pain Management
  • Population Health
  • Cancer Related Risk Factors
  • and more!

Mental Health Resources for Primary Care Practitioners

A new resource to help family physicians support individuals with mental health and substance use problems

From the Mental Health Commission of Canada and the College of Family Physicians of Canada 

MONTREAL, Oct. 23, 2018 /CNW/ – Today, the Mental Health Commission of Canada (MHCC) and the College of Family Physicians of Canada (CFPC) launched the Best Advice guide: Recovery-Oriented Mental Health and Addiction Care in the Patient’s Medical Home at the Canadian Mental Health Association’s 3rd annual Mental Health for All (MH4A) Conference.

Family physicians deliver almost two-thirds of mental health services in Canada, yet some describe mental health and addiction as an area in which they would like further development. At the same time, people living with mental health or substance use problems often report that their needs are not being met. The new Best Advice guide represents a small step toward bridging that gap.

Developed in consultation with family physicians, mental health experts and people with lived experience, the guide offers a compendium of practical and easy-to-implement strategies and recommendations. It includes simple yet powerful tips for health care providers on how to open the door to important conversations on mental health and addiction issues — from using non-stigmatizing language and displaying signage in support of mental wellness to incorporating at least one question per visit that elicits a response about emotional health.

Family physicians are invited to learn more about the recovery-oriented approach — a concept in which the caregiver supports and engages the individual as an active participant in their own treatment and recovery. All primary care providers should find this guide useful in their daily practice. Similarly, people with lived experience are encouraged to share the guide with their physician to promote dialogue on how to break down barriers to receiving quality mental health care.

For more details please refer to the Best Advice guide: Quick Reference fact sheet.

Quick Facts

  • In 2012, 1.6 million people reported an unmet need for mental health care, and 7.5 million people in Canada were living with a mental health issue.
  • It is estimated that about one in five Canadian youths are affected by a mental illness at any given time and, by age 40, half of all Canadians will have experienced a mental health issue.
  • Almost 40 per cent of parents say they wouldn’t tell anyone, including their family doctor if their child was experiencing a mental health problem.
  • Patients who receive recovery-oriented, comprehensive mental health and addiction care in primary care settings experience greater satisfaction and better health outcomes.
  • The Patient’s Medical Home is the CFPC’s vision for the future of family practice in Canada. In this vision, every family practice offers care that is centred on individual patients’ needs, within their community, throughout every stage of life, and integrated with other health services.

About the College of Family Physicians of Canada 

The College of Family Physicians of Canada (CFPC) is the professional organization that represents more than 37,000 members across the country. The College establishes the standards for and accredits postgraduate family medicine training in Canada’s 17 medical schools. It reviews and certifies continuing professional development programs and materials that enable family physicians to meet certification and licensing requirements. The CFPC provides high-quality services, supports family medicine teaching and research, and advocates on behalf of family physicians and the specialty of family medicine.

About the Mental Health Commission of Canada 

The Mental Health Commission of Canada (MHCC) is a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues. Through its unique mandate from Health Canada, the MHCC brings together leaders and organizations from across the country to accelerate these changes. Each of its initiatives and projects is led by experts who bring a variety of perspectives and experience to the table. The MHCC’s staff, Board, Advisory Council and Network of Ambassadors all share the same goal — creating a better system for all Canadians.

Stay Connected

Follow MHCC on Facebook

Follow MHCC on Twitter

Follow MHCC on LinkedIn

Follow MHCC on Instagram

Subscribe to MHCC on YouTube

www.mentalhealthcommission.ca

www.cfpc.ca

For further information: Samuel Breau, Manager, Communications & Stakeholder Relations, Public Affairs,

BounceBack Endorsement from Dr. Max Buxton

My name is Max Buxton, and I am a family physician in the Ottawa Valley. Like many other primary care providers, I have at times felt overwhelmed by patients seeking help for depression and anxiety. The problem is not uniquely rural, but the lack of services available to rural patients provides an additional barrier to addressing the problem.

A relatively new service that I have found very helpful, and that my patients have come to appreciate is BounceBack.

BounceBack provides cognitive behaviour therapy through an online program, with the help of a coach who contacts your patient directly via phone or email, and guides them through a series of CBT exercises.

The program is funded by the Ontario Ministry of Health and requires a referral from a registered nurse practitioner or family physician.

Feedback from my patients to date has been universally positive, and it has given me something to offer people who may have no access to a psychiatrist, no coverage for psychologic services, and limited ability to travel.

The referral process is simple. Forms can be downloaded from bouncebackontario.ca, along with a brief screening questionnaire for the patient to complete. The referral can be faxed, emailed or submitted directly through some EMR’s. BounceBack has helped my patients with anxiety and mild to moderate depression. Maybe it can help your patients too.

See related article: https://primarycaredigest.org/2018/09/18/new-mental-health-resources-available-to-everyone-who-needs-them/

Interprofessional Spinal Assessment & Education Clinic (ISAEC) rolling out across Champlain

By  Dr. Aly Abdulla,

BSC, MD, LMCC, CCFPC, DipSportMed CASEM, FCFCP, CTH (ISTM), CCPE, Masters Cert Phys Leader

Medical Director The Kingsway Health Centre

FHO Lead Manotick Rideau River South BAPH

Assistant Professor The University of Ottawa Faculty of Medicine

Clinical Instructor The University of Ottawa Faculty of Nursing

Ottawa West LHIN Subregional Clinical Lead

I am a family doctor in Manotick in a 20 doctor Family Health Organization (FHO). I am also a sports medicine doctor so I receive many referrals for various musculoskeletal issues. The most common referral is for chronic low back pain (LBP). These patients don’t seem to get better with conventional therapy or after so many weeks. There is a consideration for an MRI and a neurosurgeon consult but the wait list is too long so they decide to send the patient to me. Many doctors (and patients) find this challenging.

But there is another option:

The ISAECS Interprofessional Spine Assessment and Education Program is a great resource in our community to manage these cases. In addition, they provide a robust educational program online (for patients and doctors) at your convenience to improve outcomes. Here are some highlights:

  • Is your pain back or leg dominant?
  • Is the pain constant or intermittent?
  • What position makes it worse/better (flexion or extension)?
  • What have you tried and failed?
  • How disabled are you?
  • The use of red flags (NIFTI guide for critical pathology),
  • yellow flags or STarT Back (for risk of chronicity) and
  • the Opioid Risk Tool (to prevent addiction).

The biggest benefit is the patient self-management and the CORE back tool home exercises.

The ISAEC program provides optimisation of conservative management including exercise prescription, education and advice, support and appropriate referral if needed.

SEE: 1. http://www.isaec.org/educational-resources.html

SEE: 2. https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf

SEE: 3. https://www.thewellhealth.ca/wp-content/uploads/2016/04/CEP_CoreBackTool_2016-1.pdf

New mental health resources available to everyone who needs them

The Province has rolled out new mental health resources that are proving to be very valuable in the Primary Care Sector. Many mental health problems present first in the primary care setting and Big White Wall and Bounce Back are evidence-based resources that will help support primary care patients on their path to recovery.

Big White Wall is a guided self-help peer community that supports the recovery of individuals with moderate depression and/or anxiety. The resource utilizes highly trained “Wall Guides” to moderate your patient’s experience and has demonstrated significant improvements for patients who have used the resource. While many publically funded resources have significant wait lists, this resource is immediately available to anyone with an Ontario postal code simply by signing up for the resource.  Big White Wall is accessed directly by patients at https://www.bigwhitewall.com/v2/Home.aspx

Bounce Back is a coaching Intervention that is available through a Primary Care Practitioner’s referral. Developed in the U.K. and established in York Region two years ago, the program has been used by more than 80% of the physicians in the York region. Bounce Back will contact your patient within five days of referral and will deliver an intervention of telephone coaching sessions supported by workbooks developed for the patient’s specific goals. Your patient’s Telephone Coach will set up a schedule of sessions and will assess your patient’s risk and improvement at each session. Bounce Back will also link back to you to ensure the intervention is complementary to other treatment you may be providing.

You may access Bounce Back by visiting the website at http://ontario.cmha.ca/bounce-back-ontario/

 

 

Pain Management Resources for Ontario Providers

Helping patients manage their pain is complex. To support primary care providers as they navigate this challenging landscape, partners across Ontario have come together to provide a one-stop spot for family physicians, nurse practitioners and other primary care clinicians to find resources to help manage their patients’ pain.

A range of supports – from guidelines on appropriate opioid use to CME-accredited webinars on topics like chronic pain – are included. Plus, access direct links to medical mentors who can provide timely advice and guidance on challenging care issues.

Resources are updated regularly and can be found at: http://www.hqontario.ca/Quality-Improvement/Guides-Tools-and-Practice-Reports/Primary-Care/Partnered-Supports-for-Helping-Patients-Manage-Pain

For more information about this coordinated approach to provide clinicians in Ontario with pain management resources contact:  http://www.hqontario.ca/