2019|20+ Yearbook

Proven partners Proven people Proven practice 1.3 Board of directors Table of contents Bernita Drenth BA 1 Introduction 4 Bart Harvey 1.1 Helping Ontario thrive 4 MD, MSc, PhD, MEd, FACPM, FRCPC 1.2 Elevating care 6 Dan Gordon PhD 1.3 Impact at scale 8

David Price 1.4 Driving better provider solutions 10 BSc, MD, CCFP, FCFP 2 Proven partners 12 Helen Stevenson BCOM, MSM, ICD.D 3 Proven people 14

Hugh MacLeod 4 Proven practice 16 MA 4.1 Supporting better patient outcomes 16 John Yip 4.2 Enhancing the provider experience 18 MBA, ICD.D 4.3 Creating solutions during COVID-19 20 4.4 Moving at the pace of the pandemic 22 4.5 Modernizing delivery 24 4.6 Improving pain and MSK management to 26 safely reduce opioid prescriptions 4.7 Addressing the realities of mental health 28 4.8 Improving cancer care through guideline reviews 30 4.9 Tailoring care for our aging population 31 4.10 Promoting compassionate care in women’s health 32 4.11 Bridging gaps in early Lyme disease treatment 33 4.12 Collaborating to connect care 34

This yearbook focuses on work completed between April 2019 to September 2020. 5 Proven practice, people and partners 35

2 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 3 1.1 Helping Ontario thrive

Tupper Bean, Executive Director Bernita Drenth, Board Chair

The provision of care in Ontario has shifted. Year over year, the Centre for Effective Practice uniquely positions It’s a simple statement that speaks to a new opportunity that the CEP can itself to drive practice change based on policy and system-level needs. best deliver based on our proven partners, people and practice. Through various partnerships and projects, it has proven to successfully help providers incorporate the latest recommendations and guidelines As an agile organization, we moved quickly through the onset of the into their practices. COVID-19 pandemic to advance the province’s patient-centered mandate. The entire CEP team strategically rallied to support providers by Especially in today’s unprecedented environment due to COVID-19, the developing an accessible and comprehensive COVID-19 Resource Centre, CEP’s reputation for swiftly providing trusted, evidence-based clinical including timely one-on-one clinical education (academic detailing). information is highly recognized. The CEP’s clinical resources and supports are examples of its nimble work impacting the provision of Recognizing that effective health care stems from patients and not one care. From targeted, ongoing partnerships with other system leaders pandemic, we maintained our lens on providers and the Ontarians like the Ontario College of Family Physicians and the Nurse Practitioners’ accessing care, and evolved critical resources. Mental health, high Association of Ontario, to 97% of surveyed providers reporting an unemployment rates, medication adherence, poverty and social increase in their clinical confidence because of them, the CEP's impact is determinants of health were all addressed through our online and prominent across every corner of the province. up-to-date resources. Another CEP project proven to drive change is its one-on-one clinical Since 2019, we developed 28+ clinical tools, resources and programs, led education (academic detailing) for family physicians. Family physicians 915+ one-on-one education visits, supported the processing of 117,000+ who participated in one-on-one education about opioids had a 37% e-referrals, and completed 623+ cancer guideline reviews. In our role improvement (compared to a group that didn't participate) in reducing as the trusted source for clinical and practical primary care, we also the opioid doses for their patients over an 18-month period. This type of conducted guideline reviews and eHealth initiatives to support frontline personalized educational outreach by pharmacists for family physicians workers in their targeted patient focus, especially during times of crisis. has not only informed providers but also impacted behavior change. This CEP yearbook catalogues the initiatives that help those who access From opioids to COVID-19, the CEP adapts and innovates to drive and provide our services, the breadth of clinical tools we develop through change, ensuring primary care is at the forefront. On behalf of the CEP’s our rigorous processes, and the partners who bring practice to people. Board of Directors, I continually stand by the CEP’s work and cannot As Ontario’s health care continues to evolve - be it in a pandemic or wait to see what’s beyond the horizon as we reimagine primary care for otherwise - proven, effective resources, delivered by expert people the future. working in partnership, are key to successful patient outcomes. We’re humbled to implement the standards of care that advance Ontario’s health care and are focused on expanding its proactive future-forward approach.

4 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 5 1.2 Elevating care We're helping Ontario enhance health care through four key concepts.

10 million+ patients benefit 98% of providers give us a

each year UNPA thumbs up T RA Across our clinical tools, one-on-one clinical education EN L We offer real-time provider support through digital tools, I S LE and guideline reviews, we help providers help Ontarians T AT L or one-on-one education by other trained and experienced A ES I E P S D be healthy. For example, over 18-months, our one-on-one R M F providers. When surveyed, 98% of providers reported that O A education reduced opioid doses by 37% compared to a E C C P our tools and resources increased their knowledge of the T T T R matched control group. T I O evidence. Similarly, 98% of providers who participated in U O E V O N B one-on-one education were satisfied with their visit. I D

E

R

PATIENT

D

B E E 80% return on investment M Patients provide feedback T R T We’re driving a sustainable health system by optimizing E O By proactively engaging dozens of patients with lived R F resources. As a result, the CEP’s programs and services N experience, our team and leading clinicians develop tools V I have generated at least an 80% return on investment. For A T that are informed by patients themselves. Alcohol use L N example, with even a modest adoption rate, our CORE Back U E disorder, Lyme disease, women-centred HIV and manual E TI Tool can save the province over $950,000 per year. PA therapy for MSK pain are just some of our patient-centered tools that have promoted a proactive, comprehensive patient care plan.

6 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 7 northern ontario north bay 1.3

peterborough orillia Impact at scale Our impact across the province is proven. Through a variety of Sudbury primary care supports, we have a strong presence throughout Ontario Health Team regions. Here is a sample of the work we provide to support different regions in Ontario. muskoka algoma Ottawa-Champlain

Western York Region barrie south lake

dufferin-caledon Ottawa; Ottawa East North toronto North Etobicoke, Brampton and area Eastern York and North Durham halton

huron perth Northumberland CEP'S PRESENCE County One-on-one clinical education (academic detailing) guelph Clinical lead(s) for tool(s) Scarborough Clinical working group member(s) for tool(s) cambridge north dumfries Digital integration western ontario (EMR testing, eReferrals, etc.) Mississauga; Provider(s) who contribute Niagara Toronto East; to tool development North york chatham-kent Clinical tool implementation burlington

hamilton

8 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 9 1.4

Driving better provider “I find your tools invaluable and share them with my colleagues” DR. SALLY SHARPE solutions YORK, ON The CEP is the leading primary care tool producer and reviewer of clinical guidelines in the province. Leading primary Throughout our development process, we have more direct provider involvement, unmatched rigour and care clinical tool higher quality, which allow us to develop the province's most trusted clinical tools, resources and services. producer 28+ Direct provider involvement tools developed 68% FAMILY PHYSICIANS PARTICIPATING NGAGEMENT TY BY E PE IN ONE-ON-ONE CLINICAL EDUCATION

VIDER PRO TYP BY E AMILY PHYSI % F CIA 59 NS

17% 10 million+ patients reached FOCUS GROUP AND PROTOTYPING PARTICIPANTS

836+ providers directly engaged on topics

S

R E 11% N CLINICAL WORKING GROUP MEMBERS O I T I T C A Providers love and R P E S share our tools S R UR E N ID 38% V RO R P THE 2/3 3% O of primary care providers 2% access our site each month ACADEMIC DETAILERS

2% CLINICAL LEADS

10 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 11 2 PROVEN PARTNERS

COVID-19 MENTAL HEALTH

Provincial Primary Care Mental Health and Addictions Across healthcare partners Advisory Table — Department Leadership Advisory Panel (MHLAC) of Family Medicine, McMaster — Ontario's Mental Health and Addictions Every year, we do more by working with dozens of stakeholder organizations from across the system University — Department of Family Leadership Advisory Council — Ontario Family to provide value that impacts providers and their patients daily. The diagram below illustrates who and Community Medicine, Caregivers' Advisory Network — Addictions and Mental we've worked with on recent initiatives. University of Toronto — The Health Ontario — Family Physician in the Department Upstream Lab —The Health of Family and Community Medicine at the University Line of Toronto — Hawkesbury & District General Hospital — National Native Addictions Partnership Foundation — DIABETES Project ECHO – Mental Health — Canadian Mental Health Association: Ontario — College of Family Physicians Diabetes Canada — of Canada Patient Education Committee — Sunnybrook Health Sciences Addictions and Mental Health Ontario — Centre — Mount Sinai Canadian Paediatric Society — CADDRA Hospital — St. Michael’s Departments of Family eREFERRALS — Springboard Clinic Medicine Hospital ThinkResearch — CognisantMD — eHealth Ontario Health Centre for Excellence — Eastern Ontario College of Family Ontario Health Teams Ontario Primary MRI Central Intake Program — Merivale Medical Physicians of Canada Local Health Health Care Nurse Imaging — Arnprior Hospital — University of Ottawa Integration Networks Practitioner Programs Ontario College of Heart Institute — Pembroke Regional Hospital — Montfort Family Physicians Ontario Medical Association Registered Nurses’ Section on General & Family Association of Ontario Hospital — The Royal — Bluewater Health — Erie Shores Nurse Practitioners’ Practice Association of Ontario Centre for Addiction Hospital — Windsor Regional Hospital — MyHealth Centre — and Mental Health Association of Family Joseph Brant Hospital — St. Joseph's Healthcare, Hamilton — PAIN, MSK AND Health Teams of Ontario OntarioMD Temiskaming Hospital — Quinte Health Care — Lennox and OPIOIDS College of Physicians Rapid-Improvement Addington County General Hospital — Kingston Health and Surgeons of Ontario Support and Exchange Sciences Centre — Perth and Smiths Falls District Hospital National Opioid Use Guideline Group — Cambridge Memorial Hospital — Guelph General — Toronto Rehab — Ontario Pharmacists CEP Hospital — St. Mary's General Hospital — Groves Association — Branford Family Health Evidence Synthesis National Resource Memorial General Hospital — Grand River Organization — Sauble Family Health Team — Centre Network Centre for Academic de Santé Univi — Petawawa Family Health Team — Detailing, Harvard Med Hospital — Louise Marshall Hospital — Canadian Partnership Association of Ontario Health Centres — Society of Against Cancer Women’s College Hospital Palmerston District Hospital Rural Physicians (Ontario) — Ontario Chiropractic Canadian Academic Ontario Ministry of Health Research Institute Detailing Collaborative Association — Grand River Family Physicians — Mental Health and Institute for Health System Addictions Branch Solutions and Virtual Thamesview Family Health Team — Ontario Healthy Living Initiatives Unit Care Neurotrauma Foundation — Ontario Strategic Policy and Pain Management Resources — Planning Division OLDER University Health Network Primary Health Care Branch ADULT CARE Partnerships and Consultation Unit Alzheimer Society of Ontario — Specialized Models Programs Alzheimer Society of Canada — Quinte Health Link — Advocacy Centre for the Elderly — Seniors Health Knowledge Network — Concerned Friends of Ontario Citizens in Care — Geriatric Education and Research in Aging Sciences — Canadian LYME DISEASE Unparalleled Society of Consultant Pharmacists — Neighbourhood HIV Public Health Agency of Canada Pharmacy Association of Canada — Institute for stakeholder — Canadian Lyme Disease Research Women's College Human Development, Life Course and Aging at the engagement Network — Society of Obstetricians Hospital, Women and HIV — University of Toronto — Accreditation Canada and Gynaecologists of Canada — Research Program — Canadian — Canadian Foundation for Healthcare Public Health Ontario — Association HIV Women’s Sexual and Improvement — Ontario Association of 100+ of Medical Microbiology and Stakeholder Reproductive Health Residents’ Councils — Baycrest organizations engaged Infectious Disease Canada Cohort Study Health Sciences Centre

12 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 13 3 PROVEN PEOPLE

EXPERT ADVISOR SPOTLIGHT Guided by leaders PAYAL AGARWAL, MD, CCFP, BASC Through experience and education in medicine, design and human factors, Payal's unique expertise Our strong reputation among family physicians and primary care nurse practitioners allows us to as a family physician and human factors engineer helps us re-imagine our tool development process attract highly-regarded experts and clinical leaders from across Canada. This lets us act quickly, while to better suit providers, while investigating innovative ways to integrate our work in the digital space. still keeping the quality providers love, to drive results and impact care. She brings a hardened, rigorous frame around design and usability to medicine. Clinical working group members Adult depression • Anne Rucchetto, MSc • Cindy Pritchard, RN(EC), BScN, Early Lyme disease • Archna Gupta, MD, CCFP, MPH, PhD(c) NP-PHC • John Jenkins, MD, CCFP • Gary Bloch, MD, CCFP Ainslie Gray Andrea Moser Cecilia Newton Deanna Telner • Colin Wilson, MD • Kieran Moore, MD, CCFP(EM), FCFP, • Jillian Macklin, MSc • John Ihnat, BA, MD, CCFP MD MD, PhD MSC, MD, CCFP MD, MED, CCFP, FCFP • Jose Silveira, BSC, MD, FRCPC, DIP, MPH, DTM&H, FRCPC ABAM • Liz Zubek, MD, CCFP, FCFP • Katherine Rouleau, MD ADHD in adults Use of antipsychotics in Early Lyme disease Urinary incontinence • Mireille St-Jean, MD, CCFP(AM), FCFP • Marg Sanborn, MD, CCFP, FCFP • Kelsey Lawson, MD, CCFP behavioural and psychological • Marnie LePage • Megan Parry, RN, MSc Nursing symptoms of dementia Alcohol use disorder • Samir Patel, PhD, FCCM • Noor Ramji, MD • Claudette Chase, MD, FCFP • Todd Hatchette, MD, FRCPC • Nothando Swan, MD, CCFP • Ken Lee, MD • Valerie Winberg, NP • Rachelle Perron, RN • Natasha St-Onge, MD • Ritika Goel, MD, MPH, CCFP Manual therapy for MSK pain • Rose Wang, MPH ADHD in adults • David Dos Santos, B.Sc., D.C., • Tara Kiran, MD, MSc, CCFP, FCFP • Christopher Bentley, MEd, MD, FRCPC FCCPOR(C), FCCO(C) • Vanessa Redditt, MD, CCFP

Derelie Mangin Felicia Presenza Janice Harvey Jose Silveira • Joan Flood, BSc, MD, CCFP, FCFP • Erica Weinberg, BSc, MSc, MPhil, MD Women-centred HIV care MBCHB (OTAGO), DPH BSC, MD, CCFP (COE) MD, CCFP(SEM), FCFP DIP. BSC, MD, FRCPC, DIP, ABAM • Leah Skory, MD, CCFP • Lindsey Rebeiro, BScH, DC • Adriana Carvalhal, MD, MSc, PhD (OTAGO), FRNZCGP (NZ) SPORT MED. • Mireille St-Jean, MD, CCFP(AM), FCFP Benzodiazepine use and Alcohol use disorder • Lynn K. Cooper, BES (patient with • Alice Welbourn, PhD, FRCOG (Hon) COVID-19 proton pump inhibitor use Manual therapy for Benzodiazepine use lived experience) • Amber Gooden, BSc MSK pain • Debora Steele, MScN, NP-PHC, • Angela Kaida, PhD • Brenda Gagnier, PRA CPMHNC(C), GNC(C) Proton pump inhibitor use • Carmen Logie, MSW, PhD • Jane Cox, MD, CCFP • Debora Steele, MScN, NP-PHC, • Denise Jaworsky, MD • Shelly Christensen, RN(EC), MN CPMHNC(C), GNC(C) • Heather Wong • Jane Cox, MD, CCFP Concussion • Jay MacGillivray, Reg. Mid. • Katherine Trip, MN, NP • Jesleen Rana, MD, MPH • David Greenberg, BA, MD • Michael Schroder, MPH, RN(EC) • Manjulaa Narasimhan, PhD Mark Silverman Mona Loutfy Risa Bordman Shannon • Dawn Tymianski, MN, MA, PhD, • Mark Yudin, MD, MSc, FRCSC MD, CCFP MD, FRCPC, MPH MD, CCFP-PC, FCFP NP-Adult Type 2 diabetes during Kenrick-Rochon • Mary Kestler, MD • Diana Velikonja, PhD, CPsych, MScCP COVID-19 Adult depression Women-centred Type 2 diabetes MN, NP-PHC • Mary Ndung'u, BA • Lisa Fischer, BScPT , MD, CCFP (SEM) • Gray Moonen, MD, MSc, HBSc HIV care Concussion • Melanie Lee, PRA , FCFP, DipSportMed • Harpreet S. Bajaj, MD, MPH • Mina Kazemi, MSc • Shawn Marshall, MSc, MD, FRCPC • James Kim, MD • Mona Loutfy, MD, FRCPC, MPH • Noah Ivers, MD, PhD COVID-19 • Muluba Habanyama, PRA • Onil Bhattacharyya, MD, PhD • Nadia O’Brien, MPH, PhD • Claudia Mariano, MSc, NP-PHC • Payal Agarwal, MD, CCFP, BASC • Neora Pick, MD, FRCPC • Darren Larsen, MD, CCFP, MPLc • Tara Kiran, MD, MSc. • Rebecca Gormley, MPH • Dominik Nowak, MD, MHSc, CCFP, CHE • Rebeccah Parry, PRA • Jennifer P. Young, MD, FCFP-EM Social care guidance in the Sid Feldman Tara Baldisera • Shaz Islam, RA • Lee Donohue, MD, CCFP, MHSc, MPLc COVID-19 context MD, CCFP, FCFP MD, CCFP • Stephanie Smith, PRA • Mira Backo-Shannon, MD, BSc, MHSc • Alicia Fung, BA Use of antipsychotics in Concussion • Valerie Nicholson, PIRA • Paul Preston, MD, CCFP, CCPE, CHE • Andrew Terence Lam, MPH behavioural and psychological • Wangari Tharao, MA • Rob Annis, MD, CCFP • Andrew Pinto, MD, CCFP, FRCPC, MSc. symptoms of dementia • Soreya Dhanji, MD, CCFP

14 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 15 4.1 PROVEN PRACTICE

Supporting better patient Exceptional provider uptake

of primary care providers of primary care providers outcomes using our tools and using our tools and Includes digitized tools and Contextualized for Available to family physicians and nurse 98% resources report an 97% resources report an resources (EMR, web-based, etc.) COVID-19 practitioners across all OHTs increase in knowledge of increase in clinical the evidence. confidence. Ontario family physicians and primary care nurse practitioners trust tools developed by the CEP to provide the information they need, when they need it, to advance patient health care and outcomes. In consultation with providers and partners, we act quickly. We learn what topics, in which context, are needed. Where we have a tool, we actively review it to ensure it responds to the current environment and profile it. Where a tool doesn’t exist, we develop knowledge products that are both accessible and timely. 96% of patients and providers Providers rely on us agreed that the CEP tool helps to promote a 67% of Ontario providers reported using CEP tools and resources during and outside of patient visits for shared understanding of Patient early Lyme disease decision-making and patient education. between resources to patients and complement healthcare provider tools providers. We impact behaviour change Our tools help reduce costs

SECTION: ReferencesA B C D E B C D E References CEP tools and resources influence and change They have proven to support the reduction of SECTION: A provider behaviour for improved patient inappropriate diagnostic imaging referrals, which SECTION B: I have been bitten by a tick - will I get Lyme disease? • There are many types of ticks found in Canada. Only blacklegged ticks (deer ticks) can spread Lyme disease. SECTION: A B C D E References care. They have led to more comprehensive helps the system save money. Data suggests we • To give you Lyme disease, a blackleggedTicks tick must and feed on youEarly for several Lyme hours (usually Disease:more than 24 hours).1 (See picture below.) • You can get Lyme disease inSECTION many parts C: of ICanada. have been The risk diagnosed is greater in Novawith Scotia, early Ontario, Lyme diseaseQuebec, Manitoba - now1 what? and British Columbia. PatientsSee Section E: Where am I at risk? Information for Patients for information about risk areas for Lyme disease. 6 assessments and fewer inappropriate reduced inappropriate imaging through the CORE • If you find a loose tick on your body, then the Lyme disease bacteria was likely not spread to you. A tick must be firmly attached to your skin to Treatment and recovery2,3 feed on you and spread the Lyme disease bacteria. Healthcare providers 1 tests. 81% of providers reported improved Back EMR Tool (no new referrals for low back pain If you are diagnosed with early Lyme disease, you willprovider be prescribed tool. an antibiotic. Rest and take them as prescribed by your healthcare provider. What does a blacklegged tick lookDo not like? stop antibiotics early, even if you feel better. 7 This resource has been developed for patients who have been bitten by a tick or diagnosed with earlyHow Lyme do Idisease. know if a tick fed on me? Blacklegged ticks (deer ticks) are much smaller than dog ticks (wood ticks). 7 prescribing, testing and screening patterns, and imaging during 3-month post-intervention period). looking for guidance on how to diagnose and treat early Lyme disease should refer to the complementary 1 To get Lyme They also do not have white markingsIn most on cases, top. The Lyme average disease size can for be an cured adult by taking antibioticsAs they feed for B.onthree burgdorferi blood, weeks. a tick’s ).Some stomach symptoms gets willbigger. go away This quickly. Others, like tiredness or aches, may take weeks or longer to go away. Your healthcare provider may book a check-up for when your antibiotics are finished to see if your What is Lyme disease?blacklegged tick is 3mm, or about the size of a sesame seed. Immature 1 Your healthcareis called ‘engorgement’. provider will ask When about fully your fed, a tick becomes symptoms are gone. 67% reported improved referral patterns as a Assuming it's adopted by 15% of family physicians in Lyme disease is causedticks by are being are even bitten smaller, by a blacklegged about the sizetick (deerof a poppy tick) that seed. is infectedImmature with ticks the Lyme diseaseegg-shaped bacteria and( much larger than an unfed tick. Ticks can 2 Lyme disease is treated successfully with antibiotics, but symptoms can disease from a blackleggedare called tick, ‘nymphs’. it must Adultsfeed on and you nymphs for many can hours both (usuallyspread Lymemore disthanease. 24 hours).For engorge to over twice their normal size when fully fed, as seen symptoms and yourmore risk information,of being infected visit whenthe Public diagnosingIf Healthyou have LymeAgency symptoms disease. of Canada’s after finishing your antibiotics,in your the imageshealthcare below. result of the CEP. Ontario and projecting a 25% reduction in imaging, 2-4 It is important to treat Lyme disease as early as possible.website on be long-lasting if untreated.Blacklegged (deer) ticks. provider might: ! it could lead to at least $950,000 in annual savings. • Give you more of the same antibiotics. See your healthcare provider if you have symptoms after • Give you different antibiotics. Engorgementfinishing your antibiotic treatment. If you do not have a in immature check-up scheduled, ask for one. Section A: How do I remove Blackleggeda tick?• Think ticks of (deer other ticks) causes of your symptoms (different from Lyme ticks (left) and disease). adult ticks American dog ticks (wood ticks) (right). Section B: I have been bitten by a tick - will I get Lyme disease? There is no test to know if you are cured of Lyme disease. Repeating a blood test after being treated will not give you new information. The available blood tests show if your immune system has seen an infection. A positive result could mean that you had an infection that is no longer there. It does Section C: I have been diagnosed with early Lyme disease - now what? not mean that you still have Lyme disease.2 What are the symptoms of Lyme disease?2-4 Section D: How do I prevent tick bites? “The CEP affirmed what I was doing and gave me access to resources that will enable me to do my job better It takes 3 to 30 days for Lyme diseaseSection symptoms D: How to develop. do I prevent The most tick bites? common sign of Lyme disease is a red circular rash that gets bigger. The rash, which is called erythema migrans (EM), looks like a bullseye on some and more safely.” Section E: Where am I at risk?You do not become immune to Lyme disease once you’ve had it, so you can still get re-infected from another tick bite. Follow these tips to people. Not everyone with Lyme disease will get a rash. Watch for Lyme help prevent another bite. disease symptoms in the weeks following a tick bite. If symptoms are present, contact your healthcare provider right away. LORNA GILLEN, MD Options for protecting you and your family from tick bites: Section A:Symptoms How do include:I remove a tick? Erythema migrans (EM)8 rash on people with early Lyme disease. 2 THUNDER BAY • Erythema migrans (EM) rash • 3,5Check If the for tick’s ticks head after breaks outdoor off activity. and remains Ticks canin the hide skin, under remove the armpits,it. You can behind visit your the knees,healthcare in the hair and in the groin. • Tiredness • Fever • Use bug spray containing DEET or icaridin (also! called picaridin) on skin and clothing (always follow the directions on the label). Follow these tips to safely remove an attached tick.• Headache Some symptoms are not seen with Lyme disease. If you • Joint pain • Wear light-coloured, long-sleeved shirts and pants to spot ticks more easily. provider to remove it. • Muscle aches have an itchy or painful rash, stomach problems, sore • Tuck your shirt into your pants, and pull your socks over your pant legs. throat, runny nose or cough, then you probably do not • Shower as soon as possible after spending time outdoors. have Lyme disease. Is there a blood test for Lyme disease?• Tumble clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, DoBlood tests cannot test if the Lyme diseasemore bacteria time may is in be your needed. body. 2 so the tests are not always accurate• in theDo earlya tick stage check of on the your disease. outdoor Blood gear tests and showyour pets.if your They immune could system carry ticks has insidestarted your to fight home. an infection, and 2,3 “One of our challenges is that 90% of [other tools and] guidelines are not written by primary care doctors. • Useexample, clean, fine-tippedif your healthcare tweezers provider to pull• determines theTreat tick petsstraight that that you out,are have commonlyslowly. the Lyme exposed Blood disease tests to rash,ticks are withnotthen always oral blood or neededteststopical are acaricidesto not diagnose needed. (as and recommended treat Lyme disease. by your veterinarian). 2 For • Wash the affected skin with soap and water or an alcohol-based sanitizer. 2 Things to know about blood tests: What’s available tends to be disease specific and doesn’t focus on complex cases—for example, somebody • Record the date that you removed 2the tick (e.g. in your phone or on a calendar). The results from testing a tick • In the first few weeks of infection, there isSection a chance B: I thathave the been test bitten will be negative (suggestingTesting thatticks? you don’t have Lyme disease) even if you do Options for keeping your yard tick-free: • Watch for symptoms of Lyme disease. Review 8 should not be used by your healthcare provider have Lyme disease. This is called a “false negative”. 5 with diabetes but also has Chronic Obstructive Pulmonary Disease (COPD), is a smoker, and is borderline poor. by a tick - will I get Lyme disease? Results will only be used • There is also a chance that the test will be positive (suggesting that you do have Lymewhen disease) diagnosing even if you you. do not have Lyme disease. This is Review Section D: How do I prevent• tickMow bites? the lawn often to keep the grass short. • called a “false positive”. to help healthcare providers better understand • Remove leaf litter, brush and weeds at the edge of the lawn and around stone walls and woodpiles. CEP helps us work in the real world.” • Only test results from Canadian laboratories are accepted by your healthcare providerwhere to aid patientsdiagnosis. are at risk of Lyme disease. • Stack firewood neatly and in a dry area. • You should not have a blood test if you do not have symptoms of Lyme disease. Contact your local public health department to • Put barriers around your home to keep out deer. x Don’t find out if ticks can be submitted for testing in • Seal walls and small openings to discourage rodent activity to keep5 out rodents. in your area. DAVID PRICE, BSC, MD, CCFP, FCFP • Crush or squeeze the tick’s body.• Place children’s playground sets, as well as patios and decks away from yard edges and trees. Place them on woodchips or mulch and in a HAMILTON • Use a twisting or jerking motion to removesunny the area, tick. if possible.

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February 2020 cep.health/early-lyme-disease 16 THE CENTRE FOR EFFECTIVE PRACTICE Page 3 of 4 17 4.2 PROVEN PRACTICE

Detailers lead a seminar about Enhancing the provider benzodiazepine use at OCFP’s Annual experience Scientific Assembly. Includes digitized tools and Contextualized for Available across all OHTs resources (EMR, web-based, etc.) COVID-19 (for certain topic areas)

Family physicians practicing in diverse clinical settings need customized solutions. We offer family physicians throughout Ontario the opportunity to have one-on-one, evidence-informed discussions with another provider (academic detailer) on key topics, based on their individual needs. With a 98% family physician satisfaction rating, these discussions have also proven to lead to postitive behaviour change. Family physicians who participated in the CEP's one-on-one discussions about pain Tupper Bean, the CEP's and opioids had a 37% improvement over matched controls in reducing opioid doses for their patients executive director, presents over an 18-month period. They also demonstrated a 58% improvement in reducing high-risk opioid a keynote speech at Harvard Medical School's NaRCAD doses for their patients (i.e. morphine-equivalent doses > 200mg/day) compared to a matched control conference, highlighting our group within the same time period. ongoing relationship with the school's clinical outreach education centre.

Topics offered include: • Opioid therapy for patients living with • Opioid use disorder Proven people chronic non-cancer pain • Benzodiazepine use in older adults Clinical service director: CEP’s academic detailers: • Non-pharmacological and non-opioid • Delivering primary care during COVID-19 Loren Regier options for chronic non-cancer pain • Type 2 diabetes: non-insulin pharmacotherapy Injeong Yang, BSC, PHARMD, RPH BSP Jana McNulty, BSCPHM, CDE Mathew DeMarco, BSCPHM, PHARMD, RPH Clinical topic leads: Nicole Seymour, BSCPHARM, PHARMD, ACPR, RPH Arun Radhakrishnan Silvana Ferrara, BSCPHM, RPH MSC, MD, CM, CCFP Sachin Duggal, HBSC, PHARMD, RPH Chronic non-cancer pain and opioids Trish Rawn, BSCPHM, PHARMD 98% Felicia Presenza physicians were BSC, MD, CCFP (COE) FHT detailing partners: satisfied with Benzodiazepine use in older adults their visit Hamilton Family Health Team 915 572 Risa Bordman Health for All Family Health Team visits (2,295 in total family physicians visited since 2018) (916 in total since 2018) MD, CCFP-PC, FCFP Prince Edward Family Health Team Type 2 diabetes Thames Valley Family Health Team

Unsurpassed reach with exponential patient impact

" As always, my discussion with the detailer was based on my personal clinical concerns…I find this to be "Academic Detailing is simply the most effective method of changing clinical practice to best practice." a very valuable return on my investment of time."

PAUL PRESTON, MD SID FELDMAN, MD, CCFP, FCFP NORTH BAY NORTH YORK

18 THE CENTRE FOR EFFECTIVE PRACTICE 192019–2020+ YEARBOOK 19 4.3 PROVEN PRACTICE 86% of visitors said “What CEP has done is facilitate a learner-to-provider use of resources that are accessing the Creating solutions during constantly being updated, that are reviewed against the evidence and are also COVID-19 Resource Centre will change relevant to current policy decisions around changes to the health care system.” the way they COVID-19 provide care NICOLE RANGER, MD to patients SUDBURY Includes digitized tools and Available to family physicians and nurse resources (web-based, etc.) practitioners across all OHTs Proven people We’ve shifted gears to meet providers’ needs from the onset of the pandemic. Since mid-March 2020, Clinical Lead: Type 2 diabetes during Archna Gupta, MD, CCFP, MPH, we have developed valuable provincial resources and tailored one-on-one education to help provide Derelie Mangin COVID-19 PhD(c) guidance and support, using the best-available evidence. While also assisting the Canadian Medical MBCHB (OTAGO), DPH (OTAGO), Tara Kiran, MD, MSc. Gary Bloch, MD, CCFP Association with content for their national resources, we actively keep our COVID-19 Resource Centre FRNZCGP (NZ) current by ensuring the information is reliable and up to the minute. Gray Moonen, MD, MSc, HBSc Jillian Macklin, MSc Onil Bhattacharyya, MD, PhD John Ihnat, BA, MD, CCFP Our team and board members also contribute solutions to Ontario's COVID-19 Evidence Synthesis Clinical working group Network, among other groups. The world changed quickly and we’ve proven that we can change with it. members: Payal Agarwal, MD, CCFP, BASC Katherine Rouleau, MD Claudia Mariano, MSc, NP-PHC Harpreet S. Bajaj Kelsey Lawson, MD, CCFP Darren Larsen, MD, CCFP, MPLc MD, MPH Megan Parry, RN, MSc Nursing 53% COVID-19 Resource Centre visits by category COVID-19 CLINICAL Dominik Nowak, MD, MHSc, James Kim, MD Noor Ramji, MD GUIDANCE AND CARE CCFP, CHE Noah Ivers, MD, PhDw Nothando Swan, MD, CCFP Jennifer P. Young, MD, FCFP-EM Rachelle Perron, RN Lee Donohue, MD, CCFP, Social care guidance in the Ritika Goel, MD, MPH, CCFP 24% MHSc, MPLc COVID-19 context ONTARIO ASSESSMENT Rose Wang, MPH CENTRES Mira Backo-Shannon, MD, Alicia Fung, BA BSc, MHSc Andrew Terence Lam, MPH Tara Kiran, MD, MSc, CCFP, FCFP 12% Paul Preston, MD, CCFP, CCPE, CHE Andrew Pinto, MD, CCFP, Vanessa Redditt, MD, CCFP PRIMARY CARE OPERATIONS Rob Annis, MD, CCFP FRCPC, MSc. Soreya Dhanji, MD, CCFP Anne Rucchetto, MSc Nearly 90% of 5% family physicians CHRONIC CONDITIONS/ in Ontario DISEASE MANAGEMENT Proven partners have accessed Association of Family Health Nurse Practitioners’ Association Provincial Primary Care our COVID-19 Teams of Ontario of Ontario Advisory Table resources 3% SPECIFIC POPULATIONS Department of Family Ontario College of Family Registered Nurses’ Association and Community Medicine, Physicians of Ontario University of Toronto Ontario Medical Association The Upstream Lab 1% LOCAL SERVICES Department of Family Medicine, Section of General and Family McMaster University Practice The HealthLine Ontario Ministry of Health 30,000 .6% web visitors to our PREVENTATIVE CARE COVID-19 resources

.4% PAIN

20 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 21 4.4 PROVEN PRACTICE Moving at the pace of the pandemic From the beginning, the CEP has responded to the needs of Ontarians. Our firstCOVID-19 clinical resource launched on Monday, March 16 - the day before a state of emergency was announced in Ontario. Since then, we've created a comprehensive suite of resources and services that align with or are ahead of what is needed in this new landscape. Putting policy into practice, we get things done. Additional measures put in Primary care providers Ontario begins collecting place as the province Windsor-Essex joins the As kids and youth return to Premier Ford declares a start running more virtual visits Ontario starts race-based data in light of continues to re-open under rest of Ontario in Stage 3 of school, Ontario prepares state of emergency using new billing codes easing some restrictions social inequities Stage 3 reopening for wave 2

MARCH 17 APRIL 3 MAY 1 JUNE 15 JULY 31 AUGUST 4 SEPTEMBER 8

KEY EVENTS IN ONTARIO

MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER

CEP RESPONDS

MARCH 16 APRIL 9 MAY 20 JUNE 2 JULY 8 AUGUST 5 SEPTEMBER 3 Launches a curated list of Launches COVID-19: Clinical Launches Maintaining Regular Launches a resource on Launches Releases COVID-19 resources Launches Navigating Patient COVID-19 resources and an and Practical Resource for Primary Care Practice in the Local Services Managing Type 2 Diabetes on chronic conditions/ Concerns and Requests in the assessment centres map Primary Care Providers COVID-19 Context During COVID-19 disease management, mental COVID-19 Context health and addictions, pain, JUNE 11 preventive care, and specific APRIL 20 MAY 27 Releases Readiness SEPTEMBER 14 populations assessment for delivering Releases Wave 2: Planning for Starts providing Launches COVID-19: Social in-person care and fall and winter one-on-one education on Care Guidance in the Operational requirements for managing primary care in COVID-19 Context in-person care the COVID-19 context to all Ontario family physicians JUNE 26 Releases Primary Care Operations in the COVID-19 Context

22 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 23 4.5 PROVEN PRACTICE

Modernizing delivery Proven partners eReferrals: Contextualized for Available across ThinkResearch CognisantMD eHealth Centre for Excellence COVID-19 all OHTs

E-health is Ontario’s most important tool in supporting physical distancing requirements while continuing to meet the province’s high healthcare standards. Employing a digital-first approach, the CEP ensures Healthcare sites supported practitioners have access to digital and EMR-enabled tools, virtual one-on-one education (academic Arnprior Hospital Guelph General Montfort Hospital St. Mary's General detailing) and eReferrals. Bluewater Health Hospital MyHealth Centre Hospital Cambridge Memorial Joseph Brant Hospital Palmerston District The Royal Ottawa All-device access Hospital Kingston Health Hospital Hospital We’ve done the legwork to ensure our tools are accessible across different devices and platforms so Eastern Ontario MRI Science Centre Pembroke Regional Temiskaming Hospital primary care providers can get right to work without worrying about compatibility. Central Intake Program Lennox and Addington Hospital University of Ottawa Erie Shores Hospital County General Hospital Perth and Smiths Falls Heart Institute EMR-integrated tools Grand River Hospital Louise Marshall District Hospital Windsor Regional We meet providers where they are: using EMRs like Telus PS Suite, Accuro and OSCAR. This is why Hospital Hospital Groves Memorial Quinte Health Care solo providers recognize the value we bring and are ten times more likely to use CEP EMR tools General Hospital Merivale Medical St. Joseph's Healthcare compared to team-based providers. Imaging Hamilton Strengthening eReferrals The CEP, along with the eHealth Centre of Excellence's Ontario eServices 65% Program, Think Research and CognisantMD have come together to WATERLOO WELLINGTON improve access to patient care across the province through the delivery of secure, EMR-integrated electronic referrals from within the Ocean 11% eReferral Network solution. This strategic partnership supports a CHAMPLAIN collaborative and standardized approach to eReferral across multiple LHINs, including Champlain, Erie St. Clair, North East, South East, 8% Waterloo Wellington, South West and Hamilton Niagara Haldimand NORTH EAST Brant.

6% Offering virtual visits 117,937 ERIE ST. CLAIR eReferrals As our world adopts virtual visits, so have our academic detailers. Trained processed to provide balanced one-on-one discussions with family physicians 5% at their convenience, our academic detailers quickly adopted the SOUTH EAST technology needed to deliver virtual visits to ensure uninterrupted access to our service. 4% HAMILTON NIAGARA “Just today after doing a baseline assessment [using a CEP EMR tool] HALDIMAND BRANT for one of my patients, he thanked me for taking the time to address his concerns regarding his pain. I think this is an invaluable tool 1% that would greatly aid our clinical care in regards to managing pain, SOUTH WEST thanks again!”

MARK SHEW, MD SCARBOROUGH

24 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 25 4.6 PROVEN PRACTICE

Improving pain and Proven people Clinical leads: Arun Radhakrishnan Janice Harvey Shannon Kenrick- Tara Baldisera MSK management to safely MSC, MD, CM, CCFP MD, CCFP(SEM), FCFP Rochon MD, CCFP Chronic non-cancer pain DIP. SPORT MED. MN, NP-PHC Concussion and opioids Manual therapy for MSK Concussion reduce opioid prescriptions pain

Includes digitized tools and Contextualized for Available across resources (EMR, web-based, etc.) COVID-19 all OHTs Clinical working group members: Manual therapy for MSK pain Concussion The CEP takes pride in two numbers, 37 and 58. Over 18 months, the CEP's academic detailers David Dos Santos, BSc, DC, FCCPOR(C), FCCO(C) Dawn Tymianski, MN, MA, PhD, NP-Adult supported family physicians to achieve a 37% improvement over matched controls in reducing the opioid doses for their patients, and a 58% improvement over matched controls in reducing the opioid Erica Weinberg, BSc, MSc,MPhil, MD David Greenberg, BA, MD Diana Velikonja, PhD, dose for their patients on high-risk doses (i.e. morphine-equivalent doses >200mg/day). With rising Lindsey Rebeiro, BScH, DC CPsych, MScCP rates of opioid deaths across Ontario, especially over the past six months, these two numbers speak Lynn K. Cooper, BES (patient with lived Lisa Fischer, BScPT , MD, CCFP (SEM) , FCFP, to the benefit that the CEP brings to families and communities across the province. experience) DipSportMed We worked with the Ontario Neurotrauma Foundation to develop a tool on concussion, and the Ontario Shawn Marshall, MSc, MD, FRCPC Chiropractic Association to create a tool on manual therapy for MSK pain. The Concussion Tool was presented at OCFP’s Annual Scientific Assembly during a session on concussion management, allowing for a broader exploration of the tool for providers who most need to be aware of its availability. Through TELUS PS Suite EMR and Ocean, the CEP adapted the CORE Back Tool and the Osteoarthritis Tool Proven partners into custom forms. In addition to TELUS PS Suite and Oscar EMR availability, our Management of Chronic Non-Cancer Pain Tool was translated into a fully web-based tool, making it more accessible to providers. Association of Ontario Health Nurse Practitioners’ Association Project ECHO – Mental Health Centres of Ontario These digital versions enable providers to access information more easily on their preferred platforms. Sauble Family Health Team Branford Family Health Ontario Chiropractic Association Society of Rural Physicians Organization Ontario College of Family (Ontario) Center de Santé Univi Physicians Thamesview Family Health Team Grand River Family Physicians Ontario Neurotrauma Toronto Rehab Foundation Local Health Integration University Health Network Networks Ontario Pharmacists Association National Opioid Use Guideline Petawawa Family Health Team Group improvement58% among improvement37% among participating family participating family physicians over matched physicians over matched controls in reducing the controls in reducing opioid opioid dose for patients on doses for patients (over 18 high-risk opioid doses (over months). 18 months).

26 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 27 4.7 PROVEN PRACTICE

Proven people Addressing the realities of Clinical or project leads: Ainslie Gray Jose Silveira Mark Silverman Peter Selby mental health MD BSC, MD, FRCPC, DIP, CCFP MBBS, CCFP, FCFP, MHSc, ADHD in adults ABAM Major depressive dipABAM, DFASAM Includes digitized tools and Contextualized for Available across Alcohol use disorder disorder Lower-risk nicotine use resources (EMR, web-based, etc.) COVID-19 all OHTs

Understandably, addictive behaviour and mental health are becoming more acute in the context of the global pandemic. Early awareness and diagnosis is key to supporting addiction prevention and mental health support for Ontarians. Clinical working group members: ADHD in adults Alcohol use disorder Adult depression Building on our suite of mental health and addictions tools, most recently, the CEP has developed tools for alcohol use, major depressive disorder for adults, and integrated a depression and anxiety Christopher Bentley, Claudette Chase, MD, FCFP Cindy Pritchard, RN(EC), BScN, tool for youth into Accuro as an EMR form. The CEP’s COVID-19 Resource Centre also includes MEd, MD, FRCPC Ken Lee, MD NP-PHC resources specific to mental health and addictions. Joan Flood, BSc, MD, CCFP, FCFP Natasha St-Onge, MD Colin Wilson, MD Coinciding with ADHD month in Ontario, the CEP released a tool that helps providers screen, diagnose and Leah Skory, MD, CCFP Jose Silveira, BSC, MD, FRCPC, implement treatment for adult patients with ADHD. DIP, ABAM Mireille St-Jean, MD, CCFP(AM), Additionally, the increased use of alternate nicotine delivery products, such as e-cigarettes and vaping FCFP Mireille St-Jean, MD, CCFP(AM), devices, is changing the landscape of nicotine use across Canada. In response to the uncertainty in this FCFP evolving field, the CEP and the Centre for Addiction and Mental Health (CAMH) partnered with a group of tobacco cessation experts from across Canada to develop Lower-Risk Nicotine Use Guidelines. These guidelines inform consumers and healthcare providers about the potential risks and harms associated with using e-cigarettes and other alternate nicotine delivery devices. Proven partners Addictions and Mental Health Department of Family and Ontario Family Caregivers' Ontario Community Medicine at the Advisory Network Canadian ADHD Resource University Health Network Ontario's Mental Health and Alliance Hawkesbury & District General Addictions Leadership Advisory

Nearly half of Canadian Mental Health Hospital Council 3,412 family physicians Association: Ontario Mental Health and Addictions Project ECHO – Mental Health TREATMENT OF ADULT and primary care 4,322 ALCOHOL USE MAJOR DEPRESSIVE nurse practitioners in Leadership Advisory Panel DISORDER TOOL Canadian Paediatric Society Springboard Clinic DISORDER (MDD) TOOL Ontario downloaded our most recent Centre for Addiction and Mental Ontario College of Family resources on mental Physicians health. Health College of Family Physicians National Native Addictions of Canada Patient Education Partnership Foundation Committee Nurse Practitioners’ Association of Ontario

“As a physician, I value that the topics we’ve worked on are for providers, by providers. Gathered directly from their needs, providers shape the resources from the beginning though to their final form. These resources are intended to be usable in community office settings addressing practice realities and considering resource and time constraints involved in clinical practice. It has been a rewarding experience.”

JOSE SILVEIRA, BSC, MD, FRCPC, DIP, ABAM TORONTO

28 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 29 4.8 PROVEN PRACTICE PROVEN PRACTICE 4.9 Improving cancer care Tailoring care for our aging through guideline reviews population Contributing to the fight against cancer, the CEP continues to work on the Canadian Partnership Against Includes digitized tools and Contextualized for Available across Cancer’s Cancer Guidelines Database. Reviewing and appraising hundreds of guidelines on cancer care, resources (EMR, web-based, etc.) COVID-19 all OHTs trained assessors identify, appraise and summarize cancer guidelines using the AGREE II Instrument, doing the heavy lifting so that providers can ensure they use the highest-quality guidelines. Our commitment to Ontario’s growing older adult population remains steadfast. Recently, the CEP developed a Managing Proton Pump Inhibitor Use in Older Adults Tool, updated a caregiver guide on antipsychotics and dementia, and collaborated to build an IOS and Android app on the topic. We Proven process also launched a tool and one-on-one education on benzodiazepine use in older adults, and held a During each database updating cycle: seminar at OCFP’s Annual Scientific Assembly to further inform providers about the topic. Proven people Clinical leads: Felicia Presenza BSC, MD, CCFP (COE) Proton pump inhibitor use in older adults Benzodiazepine use in older adults The CEP conducts a The CEP reviews all literature search for results to identify relevant guidelines Relevant English-language Andrea Moser using pre-existing guidelines are cancer guidelines MD, PhD inclusion/exclusion summarized Use of antipsychotics in behavioural and criteria and indexed Guidelines meeting psychological symptoms of dementia preliminary quality criteria are assessed Sid Feldman by a team of trained MD, CCFP, FCFP CEP guideline Use of antipsychotics in behavioural and reviewers using the psychological symptoms of dementia AGREE II (Appraisal of 623+ Guidelines Research AGREE II appraisals and Evaluation II) Guideline conducted Instrument information (e.g. Proven partners summaries and Canadian Foundation for Healthcare appraisal scores) Improvement is uploaded to Baycrest Health Sciences Centre the guideline 432+ database guidelines summarized/ reviewed

30 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 31 4.10 PROVEN PRACTICE PROVEN PRACTICE 4.11 Promoting compassionate Bridging gaps in early care in women’s health Lyme disease treatment

Available across Available across all OHTs all OHTs

he CEP continues to create tools and resources that help improve the provision of care for patients who identify as women. The Urinary Incontinence Tool helps providers introduce he CEP bridges gaps and finds common ground. To launch anearly Lyme disease clinical tool and T patient resource that would be used across practitioners, collaboration and consensus building conversations to patients who may not otherwise proactively raise the issue. The Women-Centred T HIV Toolkits supports women living with HIV and encourages clinicians to provide a participatory was required. As a controversial topic, varying perspectives exist on the identification and treatment model of decision making for their care. of Lyme disease. To ensure a successful spring 2020 launch, the CEP developed a process where everyone felt heard and understood, and the resulting protocol was implemented in the toolkit. Proven people Clinical leads: Proven people Proven partners Mona Loutfy Deanna Telner Clinical lead: Association of Medical Microbiology and MD, FRCPC, MPH MD, MED, CCFP, FCFP Cecilia Newton Infectious Disease Canada Women-Centred HIV Urinary Incontinence MSC, MD, CCFP Canadian Lyme Disease Research Network College of Family Physicians of Canada Clinical working group members: Clinical working group members: Health Quality Ontario Women-Centred HIV John Jenkins, MD, CCFP Public Health Agency of Canada Adriana Carvalhal, MD, MSc, Jay MacGillivray, Reg. Mid. Muluba Habanyama, PRA Kieran Moore, MD, CCFP(EM), FCFP, MPH, Nurse Practitioners’ Association of Ontario PhD Jesleen Rana, MD, MPH Nadia O’Brien, MPH, PhD DTM&H, FRCPC Public Health Ontario Alice Welbourn, PhD, FRCOG Manjulaa Narasimhan, PhD Neora Pick, MD, FRCPC Liz Zubek, MD, CCFP, FCFP (Hon) Society of Obstetricians and Gynaecologists Mark Yudin, MD, MSc, FRCSC Rebecca Gormley, MPH Marg Sanborn, MD, CCFP, FCFP Amber Gooden, BSc of Canada Mary Kestler, MD Rebeccah Parry, PRA Marnie LePage (patient representative) Angela Kaida, PhD Mary Ndung'u, BA Shaz Islam, RA Todd Hatchette, MD, FRCPC Brenda Gagnier, PRA Melanie Lee, PRA Stephanie Smith, PRA Samir Patel, PhD, FCCM Carmen Logie, MSW, PhD Mina Kazemi, MSc Valerie Nicholson, PIRA Valerie Winberg, NP Denise Jaworsky, MD Mona Loutfy, MD, FRCPC, MPH Wangari Tharao, MA Heather Wong

Proven partners Canadian HIV Women's Sexual & Reproductive Health Cohort Study patients in total57 were engaged to help develop the women-centred HIV and the early Lyme disease toolkits. Both tookits include patient tools aiming to empower individuals to be involved in their care.

32 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 33 4.12 PROVEN PRACTICE 5

Collaborating to Proven partners, people connect care and practice We help organizations that advance community It takes confidence to proudly recognize that it’s care and provider networks through our partners, people and practice that any part of what's been reported was possible Working alongside healthcare providers, our resources are key to increasing the implementation of accessible and affordable care in neighbourhoods and provider networks across Canada. Advancing the health of over 10 million Ontarians, we have: The College of Family Physicians of Canada (CFPC) chose the CEP to develop tailored provincial and territorial resource kits, showcasing tangible actions family physicians can take to implement the Patient’s Medical Neighborhood model, strengthening community healthcare relationships to ¤ Demonstrated a potential 80% return on investment provide better, more comprehensive patient care. Launched a comprehensive COVID-19 Resource Centre and timely The Ontario College of Family Physicians (OCFP) also reached out to the CEP to evaluate their seven ¤ Collaborative Mentoring Networks (CMNs), which aim to provide support to primary care providers one-on-one clinical education and build capacity within several clinical and practice contexts. The evaluation assessed the: ¤ Achieved a 98% satisfaction rate among primary care providers. • Level of completion of proposed educational and mentoring activities • Self-reported impact on CMN participants’ capacities to improve the quality of care ¤ Developed 28+ clinical tools resources and programs delivered to their patients Conducted 915+ one-on-one education visits (academic detailing) for • Potential return on investment (ROI) for the CMNs as they currently operate, as well as ¤ areas for improvement family physicians ¤ Helped process 117,937+ e-referrals Proven partners ¤ Completed 623+ cancer guideline reviews College of Family Physicians of Canada Developed more tools for patients, by patients Ontario College of Family Physicians ¤ ¤ Included fully digital online up-to-date resources

As Ontario’s health care continues to evolve, be it in a pandemic or otherwise; proven, effective resources and education, delivered by experts working in partnership, is key to leading successful patient outcomes. Thank you for your attention. We welcome your questions or comments to [email protected].

34 THE CENTRE FOR EFFECTIVE PRACTICE 2019–2020+ YEARBOOK 35