LEADING and IMPLEMENTING CHANGE Abstract Book
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An Urgent Statement from Hospitals in the City of Toronto and the Regions of Durham, Halton, Peel and York GTA Hospitals Support Further Lockdown Measures
An Urgent Statement from Hospitals in the City of Toronto and the Regions of Durham, Halton, Peel and York GTA Hospitals Support Further Lockdown Measures December 20, 2020 - Today, on behalf of our patients, health care workers and staff, we are supporting the Ontario Hospital Association’s call for stronger lockdown measures from the Government of Ontario. Across the Greater Toronto Area, COVID-19 infections are continuing to rise, as are hospitalizations and intensive care cases. These trends show no sign of slowing – in fact, a surge in cases following the holiday season is expected to make the situation even worse. Our staff are caring for increasing numbers of COVID-19 patients in hospitals and assisting in other settings such as long-term care homes. They are also keeping up with the care needs of patients without COVID-19 and trying to make progress in the significant backlog of scheduled surgeries and procedures cancelled during the first wave. For many months now, these frontline health care workers have been devoting enormous energy and skill to caring for their patients, at the very epicenter of the pandemic. They are stressed and overstretched. This level of strain is simply not sustainable for much longer. We are seeing increasing numbers of staff becoming ill and not able to work – both with COVID-19 and other illnesses. While we are coping and planning for redeployment, we are seeing more illness and stress and hearing about the toll this is taking on people’s families. We recognize that lockdown measures are challenging for many members of our communities, but we cannot afford to put patients and health care workers at further risk. -
Opioid Prescribing and Pain Management
Opioid Prescribing and Pain Management: Prescription Monitoring Program Overview and the Management of Acute Low Back Pain Conflict of Interest Disclosure and Funding Support Content Creation: CADTH Disclosures CADTH is an independent, not-for-profit organization funded by Canada’s federal, provincial, and territorial governments, with the exception of Quebec CADTH receives application fees for three programs: • CADTH Common Drug Review (CDR) • CADTH pan-Canadian Oncology Drug Review (pCODR) • CADTH Scientific Advice Relationships with commercial interests: None CADTH Opioid Prescribing and Acute Low Back Pain Module Collaborators Special acknowledgement and appreciation to the following organizations who supported the development of this slide deck: • New Brunswick Department of Health • New Brunswick Medical Society o Choosing Wisely New Brunswick CADTH Opioid Prescribing and Acute Low Back Pain Module Learning Objectives • Describe the risks associated with opioid use (including overdose, duration of therapy, and drug combinations). • Review the objectives of the prescription monitoring program (PMP) and how it can support decision-making at the point of care. • Examine the appropriate management of acute low back pain in the primary care setting. • Identify strategies for communicating the risks versus benefits of opioid therapy with patients. CADTH Opioid Prescribing and Acute Low Back Pain Module “The roots of what we now call the opioid crisis can be traced back many years to the promotion of opioid prescribing as low-risk, non-addictive, -
Ontario Health Remote Care Monitoring for COVID-19
Ontario Health Remote Care Monitoring for COVID-19 Regional Digital Health Lead Digital Health Team Region OHT Lead Organization RPM Technology Contact 1 Contact 2 Hills of Healthwaters CollaborativeHeadwaters Health Care Centre LIVE Community Paramedicine RPM- Ideal Life Donald Stokes Rod Black Central Western York Region Mackenzie Health-LIVE EPIC-Healthy Planet-One Care plan [email protected] [email protected] MYCare COVID-outpt Scarborough, Durham, Vivify Go+ Paul Boissonneault Michael Spinks Peterborough, Northhumberland, Kawartha Lakes Central East LHIN Home and Community Care-LIVE Ottawa and Ottawa East OHTs Champlain LHIN Home and Commuinity Care Vivify Go+ [email protected] [email protected] East Lanark Leeds Grenville OHT Brockville General Hospital aTouchAway-(Aetonix) Rural Hasting, Quinte OHTs Belleville Quinte West Community Health Centre Raziel (Ideal Life), aTouchAway Frontenac, Lennox, Addington Lennox and Addington County General Hospital aTouchAway-(Aetonix) OHT North West LHIN Home and Community Care LIVE Vivify Go David Newman Mark Stevens Thunder Bay Regional Health Sciences Centre LIVE Vivify Go [email protected] [email protected] Sudbury EMS -LIVE Raziel (Ideal Life) Cochrane EMS Raziel (Ideal Life) North Parry Sound EMS and West Parry Sound Health Centre Raziel (Ideal Life) LIVE Superior North EMS (Thunder Bay) Raziel (Ideal Life) Maamwesying North Shore Community Health Vivify Go Services East Toronto OHT Michael Garron Hospital- LIVE Vivify Go Wilfred -
STARTER KIT for Your Choosing Wisely Campaign INTRODUCTION
ChoosingChoosing WiselyWisely InternationalInternational LearningLearning NetworkNetwork STARTER KIT for your choosing wisely campaign INTRODUCTION Thank you for your interest in joining the Choosing Wisely International Learning Network. Become a part of the growing international movement of physician leaders combatting medical overuse and ensuring high quality care. What is Choosing Wisely®? Choosing Wisely®, first launched in the United States in 2012 by the ABIM Foundation and Consumer Reports, has been adopted by countries across the world. Campaigns encourage clinicians and patients to engage in evidence- based conversations about what tests and treatments may not benefit them and could cause ?harm. This guide is intended to provide basic information and tools to help you start your Choosing Wisely campaign. You can then ABOUT tailor your campaign to your local circumstances this starter kit and creative vision. Included in the Starter Kit are: Core principles of a Choosing Wisely 1 campaign Links to current Choosing Wisely 2 campaigns across the world Key publications to guide the 3 implementation of your campaign 4 Contacts to connect to for support LET’S GET STARTED. CORE PRINCIPLES of a Choosing Wisely campaign COREphysician-led PRINCIPLES patient-centered multiprofessional evidence-based transparent PHYSICIANPHYSICIAN- 1 LEDLED The campaign must be physician- led (as opposed to payer/ government led). This is important to building and sustaining the trust of clinicians and patients. It emphasizes that campaigns are focused on quality of care and harm reduction, rather than cost reduction. PATIENTPATIENT- 2 FOCUSEDFOCUSED The campaign must be patient- focused and involve efforts to engage patients in the development and implementation process. -
Ten Things Physicians and Patients Should Question 3 1 2
The American College of Obstetricians and Gynecologists Ten Things Physicians and Patients Should Question Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age. 1 Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery. Due to recently-published evidence related to induction of labor between 39 and 41 weeks gestation, the ACOG has withdrawn this 2 recommendation. Don’t perform routine annual cervical cytology screening (Pap tests) in women 30–65 years of age. 3 In average risk women, annual cervical cytology screening has been shown to offer no advantage over screening performed at 3-year intervals. However, a well-woman visit should occur annually for patients with their health care practitioner to discuss concerns and problems, and have appropriate screening with consideration of a pelvic examination. Don’t treat patients who have mild dysplasia of less than two years in duration. 4 Mild dysplasia (Cervical Intraepithelial Neoplasia [CIN 1]) is associated with the presence of the human papillomavirus (HPV), which does not require treatment in average risk women. Most women with CIN 1 on biopsy have a transient HPV infection that will usually clear in less than 12 months and, therefore, does not require treatment. -
Why Clinicians Overtest: Development of a Thematic Framework
Why clinicians overtest: development of a thematic framework Justin H Lam ( [email protected] ) The University of Sydney https://orcid.org/0000-0001-6076-3999 Kristen Pickles The University of Sydney Fiona Stanaway The University of Sydney Katy JL Bell The University of Sydney Research article Keywords: medical overuse, health service misuse, overtest, overtesting, clinician Posted Date: October 12th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-43690/v2 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on November 4th, 2020. See the published version at https://doi.org/10.1186/s12913-020-05844-9. Page 1/36 Abstract Background: Medical tests provide important information to guide clinical management. Overtesting, however, may cause harm to patients and the healthcare system, including through misdiagnosis, false positives, false negatives and overdiagnosis. Clinicians are ultimately responsible for test requests, and are therefore ideally positioned to prevent overtesting and its unintended consequences. Through this narrative literature review and workshop discussion with experts at the Preventing Overdiagnosis Conference (Sydney, 2019), we aimed to identify and establish a thematic framework of factors that inuence clinicians to request non-recommended and unnecessary tests. Methods: Articles exploring factors affecting clinician test ordering behaviour were identied through a systematic search of MedLine in April 2019, forward and backward citation searches and content experts. Two authors screened abstract titles and abstracts, and two authors screened full text for inclusion. Identied factors were categorised into a preliminary framework which was subsequently presented at the PODC for iterative development. -
Choosing Wisely: an International Campaign to Decrease Unnecessary Medical Care
Choosing Wisely: An international campaign to decrease unnecessary medical care Webinar Objectives 1. To review the international evidence of the magnitude of overuse of technology 2. To describe the Choosing Wisely campaign in Canada and internationally 3. To share the emerging evidence of impact of the campaign on overuse About Choosing Wisely ™ Optimizing value and eliminating waste in medical care is a worldwide concern. In some countries, evidence shows that a significant amount of medical spending is Presenter unnecessary and does not add value in care.[i] Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and Dr. Wendy Levinson, treatments and make smart and effective choices to ensure high quality care. Chair of Choosing Wisely Choosing Wisely Canada leads an international community, made up of countries from Canada & Professor of around the world who are implementing similar programs in their respective Medicine at the countries. At present, this community includes representation from Australia, Austria, University of Toronto. Brazil, Denmark, England, France, Germany, India, Israel, Italy, Japan, Netherlands, India, New Zealand, South Korea, Switzerland, United States and Wales. Dr. Levinson is a national and international expert Choosing Wisely Canada is organized by a team of leading Canadian physicians, in partnership with the Canadian Medical Association. More than 45 Canadian medical in the field of physician- specialty societies are at various stages of engagement in the campaign. To date, over patient communication 170 clinician recommendations of “Things Clinicians and Patients Should Question” and, in particular, on the have been released across participating specialties. -
Patient & Public Engagement in Choosing Wisely
PATIENT & PUBLIC ENGAGEMENT IN CHOOSING WISELY TOOLKIT | VERSION 1.0 Editors Anna Kurdina Karen Born Wendy Levinson Contributors Marco Bobbio Stephanie Callan Angela Coulter Moriah Ellen Amy Ma Robyn Lindner Paul Myres Ramai Santhirapala Todd Sikorski Choosing Wisely Canada receives support from The Commonwealth Fund, Bertelsmann Stiftung and Korea University to coordinate Choosing Wisely International. For more information, please contact [email protected] 2 CONTENTS BACKGROUND 4 Executive Summary 4 About Choosing Wisely International 7 Patient and Public Engagement 7 Framework 7 PARTNER 8 Case 1.1 - US: Partnership with Consumer Reports and 70 Other Organizations 9 Case 1.2 - Norway: Partnership with the Norwegian Patient Association 10 Case 1.3 - Canada: Patient Advisor Roles 11 Case 1.4 - Japan: Engagement Strategies with the Public nd Media 12 Case 1.5 - Italy: Partnerships with Altroconsumo and Partecipasalute 13 Case 1.6 - Australia: Consumer Stakeholder Roundtables 14 ENGAGE 15 Case 2.1 - New Zealand: Consumer Commentary Sessions 15 Case 2.2 - Canada: Canadian Rheumatology Association List 18 Case 2.3 - Israel: Recommendations from the Association of Family Physicians 19 Case 2.4 - UK: Specialty Societies Involving Patients 20 Case 2.5 - US: Tools to Engage Patients in QI Initiatives 21 Case 2.6 - Wales: “What matters to you/me” Day 22 Case 2.7 - Australia: Consumer Working Group 23 Case 2.8 - US: Community Conversations About Overuse 25 INFORM 26 Case 3.1 - Canada and New Zealand: Survey Data on Patient Attitudes -
Fracture Clinic Access at Toronto Hospitals Not All Hospitals Offer Fracture Clinic Telephone Call Or Referral Required - No Walk-Ins Accepted
Fracture Clinic Access at Toronto Hospitals Not all hospitals offer fracture clinic Telephone call or referral required - no walk-ins accepted Note: Fracture clinics are not for initial evaluation and stabilization of acute fractures. This must be done at primary care or emergency department level as appropriate Humber River Hospital 416-242-1000 Monday to Friday 7:30 am – 4:30 pm 1235 Wilson Ave x 23000 2.5 hrs for each AM, PM clinic Toronto, M3M 0B2 Call to speak to ortho-on-call, will accept if space avail Michael Garron Hospital 416-469-6384 Monday, Tuesday, Friday 8 – 4 pm 825 Coxwell Avenue Fx: 416-469-6424 Wednesday, Thurs 8:30 – 4 pm Toronto, M4C 3E7 Referral triaged according to urgency North York General Hospital 416-756-6970 Use referral form, only for minor fracture, 1st flr, West Lobby Fx: 416-756-6502 splinting/casting 4001 Leslie St., 1st flr Located near the Information Desk Toronto, M2K 1E1 Scarborough Health Network 416-495-2557 Referrals/consultation not accepted from Birchmount Hospital community physicians/NPs. 2 ways to access clinic: 3030 Birchmount Rd., 1) Through ER d/t injury Scarborough, M1W 3W3 2) Apt scheduled by Ortho Scarborough Health Network 416-431-8212 Monday to Thursday 7:00-3:00 pm General Hospital Refer to individual Ortho to obtain appointment 3050 Lawrence Ave. E., Scarborough, M1P 2V5 Scarborough Health Network 416-281-7269 Monday to Friday 7:30-3:30 pm Centenary Hospital Fx: 416-281-7204 2867 Ellesmere Road, M1E 4B9 Mount Sinai Hospital 416-596-4200 Clinic hours vary. -
Psychiatry.Pdf
Psychiatry Thirteen Things Physicians and Patients Should Question by Canadian Academy of Child and Adolescent Psychiatry Canadian Academy of Geriatric Psychiatry Canadian Psychiatric Association Last updated: June 2017 Don’t use atypical antipsychotics as a first-line intervention for insomnia in children and 1 youth. Recent research confirms a dramatic increase in the use of atypical antipsychotics with subsequent side-effects including obesity, which is already a major health issue. It is prudent to pursue nonpharmacological measures first, such as behavioural modifications and ensuring good sleep hygiene (such as eliminating daytime napping and shutting off electronics an hour before bedtime). If these interventions are not successful, then consider short-term use of melatonin. 2 Don’t use SSRIs as the first-line intervention for mild to moderately depressed teens. Evidence clearly indicates that antidepressant medication is less effective in children and adolescents up to the age of 17 years and first-line treatment for this group should include cognitive behavioural therapy or interpersonal psychotherapy. Attention should always be focused on children’s and teens’ environmental safety and adequate parental support to avoid missing cases of neglect or abuse. Following this, a first-line intervention should be psychoeducation on the importance of regular sleep, diet and exercise to ensure healthy, age-appropriate developmental support. 3 Don’t use atypical antipsychotics as a first-line intervention for Attention Deficit Hyperactivity Disorder (ADHD) with disruptive behaviour disorders. Treatment of ADHD should include adequate education of patients and their families, behavioural interventions, psychological treatments and educational accommodations first. If this approach is not sufficient, stimulant medication and a behavioural analysis to ensure appropriate support from the parent and classroom is indicated. -
Implementing Choosing Wisely Principles in a Service This Guide Covers
IMPLEMENTING CHOOSING WISELY PRINCIPLES IN A SERVICE THIS GUIDE COVERS This guide is intended to provide basic information and tools to help you start your Choosing Wisely campaign. You can then tailor your campaign to your local circumstances and creative vision while following the core principles of a Choosing Wisely campaign. 1. What is Choosing Wisely? 2. The rationale behind the campaign 3. Core Principles of a Choosing Wisely Campaign 4. Choosing Wisely Internationally 5. Choosing Wisely in New Zealand 6. Getting started 7. Measuring your performance 8. Changing the culture 9. Factors for success 10. Involving patients and consumers 11. Contacts and resources 2 WHAT IS CHOOSING WISELY? Choosing Wisely is a campaign targeting the reduction of low-value health care by encouraging conversations between health professionals1 and consumers2 / patients, so they: • Are fully informed by the evidence about their treatment options. • Are able to make the right choices for themselves. • Do not undergo tests, treatments or procedures which are unnecessary. The focus is on the health professional and consumer working together to improve the quality of care that is delivered. The Council of Medical Colleges (CMC) is facilitating the Choosing Wisely campaign as part of its commitment to improving the quality of healthcare in New Zealand of care for consumers/patients. The programme encourages health professionals to hold conversations with consumers/patients to ensure they understand the evidence relating to the care being proposed, so they can make wise choices. Overseas research has shown that effective Choosing Wisely programmes are clinician-led and that effective consumer/patient engagement is necessary if the programme is to be successful. -
Benzodiazepine Use Among Older Adults
Commentary For reprint orders, please contact: [email protected] Benzodiazepine use among older adults Aarti Gupta1 , Gargi Bhattacharya2 , Kripa Balaram3 , Deena Tampi4 & Rajesh R Tampi*,5,6 1Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA 2Department of Electrical and Computer Engineering, Purdue University, Indiana 47906, USA 3Department of Psychiatry, MetroHealth, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA 4Co-Founder and Managing Principal, Behavioral Health Advisory Group, Princeton, NJ 08542, USA 5Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, USA 6Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA *Author for correspondence: Tel.: +1 203 809 5223; [email protected] “the use of benzodiazepines is increasing among older adults and they form the largest group of users for these drugs. These agents are effective in treating some clinical symptoms, but their use is fraught with serious side effects and addiction potential among older adults.” First draft submitted: 26 October 2020; Accepted for publication: 29 October 2020; Published online: 11 November 2020 Keywords: adverse effects • benzodiazepines • cognitive decline • elderly • falls • older adults Benzodiazepines are one of the most commonly prescribed psychotropic drugs in the developed world. Recent data from the 2015 to 2016 National Survey on Drug Use and Health show 30.6 million adults reported benzodiazepine use in the past year. The highest use of benzodiazepines of all age groups was reported by respondents aged 50–65 years at 14.3%, followed closely by the ≥65 years age group at 12.9% [1].