Vascular Health in Southeastern Ontario 2012
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Vascular Health in Southeastern Ontario 2012 Vascular Health in Southeastern Ontario A Focus on Primary Care September 24, 2012 A report prepared for the Southeastern Ontario Health Collaborative Vascular Health in Southeastern Ontario 2012 Special thanks to: All the members from primary care organizations in Southeastern Ontario who participated in the Environmental Scan and the Primary Care Think Tanks The Southeastern Ontario Health Collaborative including Dr. Adam Steacie, Dr. Hugh Langley, Maureen McIntyre and Julie Gordon for their assistance with this review and active participation in the Primary Care Think Tanks The planning committee for the Primary Care Think Tanks: Dr. Jonathan Kerr, Marg Alden, Stafford Murphy, Lynne Poff, Mary Woodman, Colleen McMahon, Sherri Fournier-Hudson, Dr. Adam Steacie, Dr. Hugh Langley, Mike Bell and Ron Shore This report was prepared by: The Stroke Network of Southeastern Ontario For further information, please contact: Colleen Murphy, Regional Stroke Best Practice Coordinator ([email protected]) Vascular Health in Southeastern Ontario 2012 Table of Contents Executive Summary…………………………………................................................................................. 1 Introduction……………………………………………………………………………………………………..... 5 Environmental Scan……………………………………………………………………………………………. 9 Literature Review…………………………………………………………………………………..... 10 Internal Survey………………………………………………………………………………………... 15 External Questionnaire………………………………………………………………................... 15 Face-to-Face Visits………………………………………………………………………………….... 15 Opportunities Identified During Environmental Scan……………………………………………. 22 Think Tanks………………………………………………………………………………………………………… 26 Think Tank Plan……………………………………………………………………………………….. 27 Vision for a Robust Vascular Service……………………………………………………..…… 29 Tools, Resources or Programs that are Working Well…………………………………. 30 What Tools, Resources or Programs are Needed?.……………………………………… 31 Common Elements Related to Top Three Needs…………………………………………. 37 Action Planning………………………………………………………………………………………………....... 38 Conclusion…………………………………………………………………………………………………………… 44 Recommended Next Steps……………………………………………………………………………………. 46 References…………………………………………………………………………………………………………… 47 Appendix A FHTs, CHCs, NP-Led Clinics in Southeastern Ontario………………………….. 52 Appendix B Primary Care Questionnaire……………………………………………………………... 53 Appendix C Environmental Scan of FHTs, CHCs, NP-Led Clinics………………………........ 54 Appendix D Planning Committee for Primary Care Think Tanks…………………………… 58 Appendix E Invitation & Agenda Templates for Think Tanks………………………………... 59 Appendix F Needed Tools, Resources or Programs…………………………………………....... 61 Appendix G 3 Action Plans for 3 Local Areas……………………………………………………….. 69 Vascular Health in Southeastern Ontario 2012 separate Think Tanks involving many Executive Summary different primary care health A recent health profile of Southeastern professionals, administrators and support Ontario continues to report higher than staff from different urban and rural provincial rates for vascular diseases such locations. The main objectives for the ES as diabetes and stroke. The report also and Think Tanks were to discover the reveals higher rates of vascular disease tools, resources, or programs currently in risk factors such as hypertension, obesity place and to help identify primary care and smoking (Statistics Canada, 2012). The needs in relation to vascular health. vascular health profile of the south east Despite the variation in services, region provides the rationale for further programs or systems because of the exploration and review that is detailed in diversity of the community primary care this subsequent report. The solution to serves, there were some commonalities improving vascular health largely lies identified including issues and needs. with primary care and in collaboration with others such as the Southeastern Findings Ontario Health Collaborative (SEO Health Most primary care organizations have at Collaborative), speciality clinics and least one to two vascular disease public health. prevention services on-site. The The SEO Health Collaborative recently consistent services offered include formed in January 2011 as different smoking cessation and diabetes health organizations decided to come education. Many during the ES and the together and determine how best to work Think Tanks indicated their wish to in collaboration with primary care. The expand the services or programs they first priority of the newly formed SEO provide and apply relevant components Health Collaborative was to determine of smoking cessation and/or diabetes how best to further support primary care services to preventing other vascular to improve vascular health. disease risk factors such as hypertension. First Steps Simplicity and user-friendliness were mentioned over again during the visits Primary care is perceived by many to be and Think Tanks in reference to having fairly complex and is changing at a one integrated electronic medical record remarkable rate. The many new and (EMR) and one evidence-based different functions and services within harmonized vascular disease prevention primary care related to vascular health guideline (i.e., C-CHANGE: Canadian may not be fully understood. In order to Cardiovascular Harmonization of National better understand the nuances within Guidelines Endeavour). primary care it was decided to perform an environmental scan (ES) and host three 1 Vascular Health in Southeastern Ontario 2012 The common vision for a robust vascular Integration: health service program identified would 6. Develop a user-friendly integrated be one that is patient-centred, equitable, system that incorporates improved accessible, team and community-based access (e.g., EMR) and has one valid with emphasis on self-management. vascular health-related guideline; one Common Needs & Opportunities vascular disease risk assessment tool Identified in the ES and Think Tanks that everyone can agree to use; one clinical flow sheet that captures all Communication & Collaboration: relevant health indicators. 1. Increase sharing of information Determine what vascular health between primary care organizations indicators should be tracked such as lessons learned and tips for consistently. Regular training for all success to initiate, sustain and expand staff to increase comfort with the vascular disease prevention services functions within the EMR system. or programs; and how others Increase access to other clinical tools effectively utilize their EMR (e.g., such as point-of-care blood testing. generate reports and referrals). 7. Develop a person or patient-centred 2. Facilitate consistency such as integrated vascular health service or documentation practices within the program within each primary care EMR. organization encouraging self- 3. Examine innovative ways for sharing management, physical activity, a up-to-date vascular health-related healthy diet and smoking cessation. information, tools, and resources A vascular health program, service or such as a common web site. system should be flexible in order to 4. Continue to improve connections be applicable to a local setting. with groups interested in vascular Components of a vascular health health such as the SEO Health program, service or system could be Collaborative, Public Health Units and modelled after established programs specialty clinics. such as the Global Risk Reduction 5. Increase awareness and promotion of program in the Upper Canada Family established vascular disease Health Team. prevention community services or Given the interest to improve vascular programs to reduce duplication of health, the time seems right to work efforts. Further development of collaboratively and start addressing some partnerships and plans to increase of the prioritized needs identified during physical activity and safe exercise the ES and Think Tanks. Acknowledged programs. advice by some primary care providers was to start with smaller and potentially more doable action plans. Some feasible 2 Vascular Health in Southeastern Ontario 2012 plans to begin with in relation to the 2. Local Action Plans will be followed up needs identified could include: 1) by those engaged and self-identified in collaborative education sessions in developing the preliminary action relation to common interests such as plans made at the Primary Care Think blood pressure management and Tanks. motivational interviewing; 2) support for shared work experience opportunities to 3. The SEO Health Collaborative will enhance information sharing about review this report to guide the focus vascular health programs or services that for a collaborative and supportive are working well; and 3) consideration for partnership with primary care in developing or enhancing local vascular addressing regional concerns and health community resource directories. proposed actions. The SEO Health Collaborative will lead a process to Ultimately, primary care plays a critical identify a consolidated regional action role in ensuring the success of an plan that will guide its ongoing activity integrated and collaborative vascular for the coming year. The intent would health strategy. be to carry on the momentum for Recommended Next Steps improving vascular health by translating the identified prioritized 1. This report will be shared with: needs into actionable plans. This will a. Primary care providers across the be initiated in partnership with the region – including all who Primary Care Lead for the SE