Post on 09-Jul-2020
Primary Health Care
Opioid Response Initiative
PCN Strategic Leads Forum February 24, 2018
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Overview ● Opioid Crisis in Alberta
● The Primary Health Care Opioid Response Initiative
● Tools and Resources to Support Capacity Building
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The Opioid Crisis in Alberta Overview of the Issue and Alberta’s Response
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Number of apparent accidental fentanyl toxicity deaths, by Zone (based on place of death) and quarter. Jan. 1, 2016 to Sept. 30, 2017
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Opioid Deaths
Of those that died of an opioid–related poisoning since 2016, within the year before their overdose: • 46% were known to have a mental health issue (including anxiety,
depression, etc.) • 16% were diagnosed with an opioid use disorder (opioid addiction) • 76% of deaths were illicit opioid poisoning from fentanyl or a non-
fentanyl opioid not dispensed from pharmacy
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Opioid Deaths
• 14% in Fort McMurray, Grande Prairie, Lethbridge, Medicine Hat, Red Deer
• 21% occurred outside an urban centre
• 70% of all opioid-related deaths within Edmonton and Calgary occurred outside of centralized urban core of the cities, whereas the highest rates of opioid-related deaths occurred within the centralized urban core of those cities.
Scope of problem is much bigger
https://www.cdc.gov/drugoverdose/pdf/PolicyImpact-PrescriptionPainkillerOD-a.pdf
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Minister’s Opioid Emergency Response Commission
Inception: May 31, 2017
Mandate: to develop recommendations for, and facilitate implementation of, urgent coordinated actions to effectively address the crisis.
As of November 2017, the Commission has made 12 publicly posted recommendations.
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What is the Issue?
This is an issue in Primary Care – opioid use affects people in all walks of life
Primary Care requires additional resources to support them in treating patients in what has been historically been considered a specialty service
We need Primary Care involvement in order to increase access to treatment
We need to increase understanding and acceptance across the health system for a harm reduction approach to patients
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MOERC Recommendation The Commission recommends the Minister support the proposal and funding request from Primary Care Networks and their partners to increase and accelerate the participation of primary care in the urgent opioid response in the following areas:
Urgent Treatment Optimization of existing Primary Care Networks Programming Opioid related population based health service planning and
integration Education and knowledge translation targeted to primary care
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Why the Primary Care Initiative Matters
Ability to reach more Albertans than any other Commission recommended initiative
Will improve access to Overdose Response (Take Home Naloxone) kits, expand and improve Opioid Agonist Therapy and related primary care services, and better equip physicians to be able to treat patients with Opioid Use Disorder, using a harm reduction approach
Plays an important supporting role to other response activities
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Key Opportunities
Opioid Response Initiative can act as a test case for the Zone Service Planning approach; there are resources to enable, engage, and involve
Opportunity to impact key priority areas for action
Builds on foundational work underway to strengthen the primary health care system in Alberta
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PCN Objectives
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Catalyst for Patient’s Medical Home
Accessible Continuous Care Patient and Family
Centered Comprehensive Team-
Based Community and
Population Focused
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The Primary Health Care Opioid Response Initiative Overview of the Initiative
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PHC Opioid Response Initiative Grant
$9.5 million in one-time funding, focused on three key priority areas for action:
Urgent Opioid Response
Enhanced Opioid Related Service Delivery through PCN Zone Committee Engagement, Planning and Implementation
Enhanced Provider Decision Support, Knowledge Translation & Education in Primary Health Care
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Provincial Response and Support
Multi-partner initiative focused on supporting coordination and integration of activities across primary care.
Zone PCN Committee Support Teams
Alberta College of Family Physicians
AMA Integrated Programs (TOP, PMP, PCN PMO)
Alberta Health Services
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Goal 1: Improve access, continuity and care delivery within primary care settings for individuals using opioids. Objectives 1.1 Albertans using opioids have access to a primary care provider and team that they know and trust
1.2 Patients with complex health needs including Opioid Use Disorder are engaged to develop a plan of care with their primary care provider and team
1.3 Expand and improve the capacity within PCNs to support member practices to implement practice changes related to opioid prescribing, monitoring of opioid use, pain management, patient self-management support, and Opioid Agonist Therapy (OAT)
1.4 AHS zone services and PCNs support primary care clinics to increase access to and distribution of Overdose Response Kits (THN) and OAT
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Goal 2: Implement relevant and practical evidence informed decision supports and knowledge translation tools, including mentorship to better equip and educate primary care providers and teams, including clinics and PCNs; to support patients using opioids and/or with Opioid Use Disorder.
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Objectives 2.1 Within a harm reduction, approach develop and support implementation of provider and
patient education, decision support tools, knowledge translation strategies, practice change
tools and resources
2.2 Engage primary care providers to participate in the PACT initiative (Care Planning
initiative) to facilitate the identification of patients using opioids and proactively reach out to
those patients identified to develop a person centred care plan
2.3 Develop and implement a capacity building plan and approach to support distribution and
uptake of decision supports, tools, resources and education in zones, PCNs and primary care
practices
2.4 Develop and coordinate a mentorship collaborative network(s) within each zone related
to opioid use
Goal 3: Enhance coordination of care between primary care practices and other service delivery partners for patients using opioids including those with Opioid Use Disorder.
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Objectives 3.2 Primary, specialty care and community teams work together to identify opportunities for
improved coordination and continuity of care across or within service areas; such as primary care
clinics, Primary Care Networks, specialists, AHS specialty care programs, hospitals, acute care
services, community services, social services, and other community supports.
3.2 Primary care teams work together to develop comprehensive and accessible care pathways
exist, for patients using opioids, including Opioid Use Disorder, between primary care, specialty
programs, specialists and hospital in each zone
3.3 Utilizing a harm reduction approach, interdisciplinary teams of providers within primary care
settings work collaboratively with patients and their families to develop and implement
successful care planning processes
3.4 Patients using opioids are collaboratively supported to transition between primary and
specialty care as needed
Goal 4: Use a population health based approach to develop and implement a service plan for the integrated delivery of opioid related care.
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Objectives 4.1 Based on identified population and community needs, PCN Zone Committees
develop and implement a service plan focusing on opioid related care
4.2 PCN Zone Committees are able to gain experience and apply learnings from
opioid service planning in identifying and responding to other health needs of a
population
4.3 PCN Zone Committees prioritize the development of comprehensive and
accessible care pathways across the continuum
Populations of Focus
Sub-populations of relevance in optimizing care for patients using opioids: Non-medical - often referred to as ‘recreational’ use or the well at risk
Pain management – individuals with acute, sub-acute and chronic pain; implications include prescribing practices for opioids and non-pharmacological treatments of pain
Substance misuse and addiction – individuals whose day to day functioning has been negatively and substantially impacted by opioid use, including individuals with Opioid Use Disorder; often unattached (do not have a family physician or medical home)
** Mental Health – individuals with complex health issues frequently have underlying mental health needs
Proposal Development Flexibility to identify and address particular zone service level gaps and priorities
Identified actions must align with the parameters of the Opioid Response Initiative as outlined by MOERC
Approval process for proposals will be an iterative Opportunity for feedback and discussion to ensure
alignment
The patient’s journey through the health system is central in system level health service planning.
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Funding Allocation
Funding distribution across zones is guided by the following principals:
Each zone will be eligible for up to $500,000 to support planning, operational components, education, support project planning, operations, education, support for practice change, and the delivery of their opioid response service plan
Each zone is eligible for additional population-response based funding
Funding Allocation Sample distribution of zonal Opioid Response funds.
Zone Project Planning, Operations Design, Delivery, Education and Evaluation
Population Response
Total*
South 500,000 280,000 780,000* Calgary 500,000 830,000 1,330,000* Central 500,000 280,000 780,000* Edmonton 500,000 830,000 1,330,000* North 500,000 280,000 780,000* 2,500,000 2,500,000 5,000,000
*Totals in table are estimates based on equal distribution. These totals may be different based on specific requests and in response to cross-zonal partnerships
• This allocation of funds by zone is designed to recognize the different contexts of each zone.
• Shared approaches and allocations may be negotiated between the Zone PCN
Committee dyads based on existing care corridors, options for telehealth/alternative visits, mentorship and other innovative and sustainable solutions.
Proposal Submission and Timelines
A Letter of Intent (LOI) must be submitted by the Zone PCN Committee Dyads by March 15, 2018
Complete Proposals including Application for Funding, High level Budget, and Letter of Endorsement must be received by either intake date and time specified below:
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Intake Proposal Submission Date Target Award Date
1 May 17, 2018 at 12 noon MST May 30, 2018
2 June 21, 2018 at 12 noon MST June 28, 2018
Proposal Toolkit
An Opioid Response Toolkit has been developed to support planning efforts, and includes:
Population health data specific to the zone Key messages and communication related to the
primary care opioid response Information on other opioid related grants Contact list Glossary of terms and acronyms
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How Do Physicians Answer Questions and Keep Up to Date?
• Primary care physicians spend on average < 2 minutes answering clinical questions1,2
• To read top medical journals relevant to primary care would take ~ 627.5 hours/month, or 21 hours a day3
1) JAMA Intern Med. 2014;174(5):710-718 2) BMJ 1999; 319: 358-61. 3) Alper et al. J Med Libr Assoc 2004;902(4):429-37 4) Can Fam Physician. 2015 Jan;61(1):52-8. 5) J Contin Educ Health Prof. 2009 Winter;29(1):63-7.
A Primary Care Day:
Chronic Disease
10.6 hours
Preventive Services
7.4 hours
Acute Issues
3.7 hours
Miscellaneous
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12
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Ann Fam Med. 2005;3:209-14. Am J Public Health. 2003;93:635-41. Ann Fam Med 2012;10:396-400.
If we follow Clinical Practice Guidelines: 18 hours every day for prevention & chronic disease
The Trouble with Normal is,… It Always Gets Worse
JAMA. 2009;301:831-41. Ann Fam Med. 2014;12(3):202-3.
The Trouble with Normal is,…
0 1000 2000 3000
It Always Gets Worse Cardiology Guideline Recommendations
Original
Revision
JAMA. 2009;301:831-41. Ann Fam Med. 2014;12(3):202-3.
The Trouble with Normal is,…
0 2000 4000 6000 80000 1000 2000 3000
It Always Gets Worse Cardiology Guideline Recommendations
Original
Revision
1990
2012
Mentions of Guidelines On Pubmed
JAMA. 2009;301:831-41. Ann Fam Med. 2014;12(3):202-3.
Family doctors provide
~70% of all the nation’s healthcare
Can Fam Physician 2015;61:449-53
An increase of 1 primary care physician per 10,000 persons was associated with a reduction of 3.5 deaths per 10,000.
Background
• Only 17% of Continuing Professional Development designed for primary care is presented by primary care5
• Family Physicians make up only 17% guideline authors, majority are specialists4
1) JAMA Intern Med. 2014;174(5):710-718 2) BMJ 1999; 319: 358-61. 3) Alper et al. J Med Libr Assoc 2004;902(4):429-37 4) Can Fam Physician. 2015 Jan;61(1):52-8. 5) J Contin Educ Health Prof. 2009 Winter;29(1):63-7.
Podcast ≥30,000 month
TFP: Written brief updates >31,000 clinicians: most Canadian FP Every 2 weeks.
Academic Detailing Pharmacists visit ~500+ docs in clinics
Local Conferences 30 events, 17 different communities in ~6 yrs
Annual Pricing Update Improving Cost Awareness
Large Edmonton Event Sold out every yr, >450, now added webcast!
Opioid Tools and Resources Develop 2 Guidance Documents • Infographic tools • On-line learning modules • On-line apps • Educational pamphlets 3-6 Tools for Practice Two podcast series (2-3 each) Foundation of Medical Practice Education (McMaster) module
Deliver talks at largest conferences in primary care Develop workshop Academic detailing, audit & feedback Roadshow presentations
PEER
Toward Optimized
Practice
Patients Alberta College of
Family Physicians
Physician Learning Program
Primary Care
Networks
LifeLong Learning (U of A)
Continuing Medical
Education (U of C)
College of Family
Physicians of Canada
National KT (FMPE, CADTH,
Choosing Wisely, RxFiles, etc)
Simplified Guidelines
Simplified Tools
Timelines
• First Guidance Document: Identification and Management of Opioid Use Disorder in Primary Care
• Ready for dissemination early 2019 – including associated tools, academic detailing, roadshows, workshops
Questions and Panel Discussion
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Presenter Contact Information Shannon Berg: shannon.berg@gov.ab.ca Bill Hnydyk: bill.hnydyk@albertadoctors.org Dr. Christina Korownyk: cpoag@ualberta.ca Grant Oversight Terri Potter: terri.potter@acfp.ca Grant Letters of Intent and Proposal Submissions Cora-Lee Polansky: cora-lee.polansky@acfp.ca For assistance, contact any member of your PCN Zone Support Team.