C3 Creating and Sustaining a Primary Care - Public Health Partnership_Frank Martino

Creating & Sustaining a Primary Care – Public Health Partnership The Peel Region Experience Frank Martino, MD, CCFP (EM), FCFP

“Relationships are Core to Family Medicine” June 2014

CFPC Conflict of Interest Disclosure of Commercial Support Presenter Disclosure

Presenter:

Frank Martino

Relationships with commercial interests: •

Grants/Research Support:

None

•

Speakers Bureau/Honoraria:

None

•

Consulting Fees:

None

•

Other:

None

Our Focus Today  Communication  Co-planning  System

Integration

Communication

The Evolution of Primary Care

A Historic Departure 

The late 80s and 90s saw a move to community practice for primary care



The evolution had begun in tertiary centres



Larger community hospitals followed suit



This concept led to the urbanization of family medicine

Primary Care Transformation

Patient’s Medical Home A VISION FOR CANADA

THE COLLEGE OF FAMILY PHYSICIANS OF CANADA

LE COLLÈGE DES MÉDECINS DE FAMILLE DU CANADA

Partnerships

The Bright Idea!

SARS

Central West, Mississauga Halton LHIN, Primary Care, Public Health Network Sponsor:

Ontario College of Family Physicians

Membership: Peel Public Health, Chiefs of Family Medicine, Regional Family Medicine Leadership, LHIN Administration Terms of Reference Monthly Meetings Opportunities  

REACH Portal

Communication Sharing 

EMR Adoption

Peel Public Health– “more than vaccinations”

Realizing the value of the team‌

Collaborations  Services

and Programs  Continuing professional development  Health Promotion  Prevention  Health Systems Design



Defining Our Different Roles



Unified Goals

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Relationship Building

6 Steps to Meaningful Primary Care Engagement 1.

Develop Primary Care engagement champion(s)

2.

Go to primary care

3.

Act on what you hear

4.

Build a network of primary care leaders

5.

Nurture relationships with the Early Adopters

6.

Foster ownership (not buy-in)

Outcomes 

Family Medicine Rounds



CMEs  Smoking  The

Cessations

Returning Traveller

 Healthy

Sexuality

 Antibiotic

Stewardship

 Childhood

Obesity

 Breastfeeding  Seniors

Health

Effective Use of Resources and Services

“EFFICIENCY”

Relationships Pandemic Planning

Creating and Sustaining a Primary Care — Public Health Partnership: Lessons from Peel Region Megan Ward, MD, MHSC, CCFP, FRCPC PREVENT MORE TO TREAT LESS. Public Health and Primary Health Care TOGETHER June 2014

CFPC Conflict of Interest Disclosure of Commercial Support Presenter Disclosure Presenter: Megan Ward Relationship with commercial interest: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: None

Co-planning: pandemic influenza

Public Health • Directed by Regional Council to create a Regional plan • Became a link between municipal and health sectors

Planning Process Health sector • Public health • Primary care • 3 hospitals • 2 LHINs • Paramedics • CCAC • Long term care • MOHLTC • 350 Pharmacies

Municipal sector • Public health • Region of Peel • Brampton, Caledon, Mississauga • Emergency planners • Police • 4 school boards • NGOs

Primary Care • 860 primary care physicians • 10% of 1.3 million Peel residents covered by FHT • History of good primary care-public health connections

Pandemic Planning • 2 year process 2007-08 • Chiefs of Family Medicine at the planning table • Ongoing updates to all physicians through well established communication mechanisms • Special sessions with MOHLTC for physicians

Successes • • • •

Agreement on a primary care model Agreement on immunization plan Broad agreement across health and municipal sectors Open communication

Challenges • Lack of infrastructure • Lack of local media • Negotiating with so many partners

Results • Execution of plan almost immediately • Effective public health and primary care dialogue throughout H1N1 • Successful response: morbidity, mortality, system pressures

Comments • Dr Frank Martino • Dr Paul Philbrook

Creating and Sustaining a Primary Care-Public Health Relationship: System Integration Prevent More to Treat Less, June 5, 2014 Paul Philbrook MD, CCFP 35

CFPC Conflict of Interest Disclosure of Commercial Support Presenter Disclosure Presenter: Paul Philbrook Relationship with commercial interest: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None None Other: 36

System Integration Do we really have a system?

• • • • • • • •

Hospitals Public Health CCAC LHIN Primary Care Providers Specialists Labs, DI Oh, and PATIENTS!

Are these groups connected?

• • • • • • •

Chiropractor Complementary Medicine Pharmacy Dietician Physiotherapy Hospice Long Term Care

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

37

What should an integrated system look like?

38

Doctor in the middle!

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

39

HOSPITAL is the focus!

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

40

Build a system Around the patient

What about the patient?

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglington Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

41

Patient in the Middle?

Everybody thinks the patient is in the middle

Does everybody really think together?

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

42

Patient in the middle: what does that look like?

• • • • •

Rapid Response Nursing Virtual Ward Health Links Primary Care Network Quality Improvement: Research and Innovation

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

43

Rapid Response Nursing

• • • • • • •

CCAC program Focused on patients being discharged from hospital Patients are identified by LACE score Follow up by nurse within 24 hours, by FD in 7 days For 30 days Prevention of Readmission ++ Collaboration with hospital Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

44

Virtual Ward • • • • • • •

Focused on patients being discharged from hospital Patients identified by high LACE score Follow up by family doctor within 1 week For 6 weeks Own FD is engaged through this time Prevention of Readmission ++Collaboration with hospital Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

45

Health Links

• Linking hospital inpatient care givers with community caregivers.

• Wrapping care around the patient • Team members: hospital FHT, CCAC • Focuses on high risk patients

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

46

Primary Care Network

• Sponsored and supported by MH LHIN • Led by Grass Roots primary care providers • Focuses on care issues and concerns from the community caregiver’s perspective

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

47

Quality and Innovation

• • • • •

A University of Toronto initiative based in Mississauga Focus on embedding Quality in all initiatives Developing “microsystems” of care Uses “teaming” strategies Deliver scaleable new care models

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

48

Collaboration with Public Health • Public health has the Big Picture •Data, perspective •Help design new programs and initiatives: e.g. cancer prevention, obesity, smoking cessation.

•Advocacy: design of cities, tax incentives for wellness screening etc

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglington Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

49

Where do we want to go? Let’s create a well designed, integrated system.

Credit Valley Hospital

Mississauga Hospital

Queensway Health Centre

2200 Eglinton Avenue West, Mississauga

100 Queensway West, Mississauga

150 Sherway Drive, Toronto

50