Four Important Summits

Four Important Summits

This year, ONF is supporting four important summits that are focused on bringing research into practice:

  • Developing Standards of Care in Concussion Clinics in Ontario, April 15, 2016
  • Neuropathic Pain Care and SCI, November 4, 2016
  • Urological Health and SCI Summit, November 11, 2016
  • SCI Primary Care Summit, November 23, 2016

Although each of these summits is focused on an entirely different topic, the purpose for each gathering is the same. Bring together research and subject matter experts, clinicians and policy makers, gather input from those with lived experience, and develop strategies to implement practice guidelines. The results, in each case, lead to improved practice or standards of care, more effective collaboration, new partnerships, and most important, improved quality of life.

Two of this year’s summits are summarized below:

Getting the Right Care, from the Right Provider, at the Right Time: An SCI Primary Care Summit

Dr. Joseph Lee sees the upcoming SCI Primary Care Summit as a natural evolution of the collaborative work, research, and learning to-date on how it is possible to deliver better health care to those with spinal cord injury, and in a more timely way.

Both Lee and the co-leader for the summit, Dr. James Mulligan, have witnessed the challenges faced by those with SCI when it comes to finding primary care providers in their community. Those with SCI are heavy users of the healthcare system. But in too many instances, they are forced to use more costly resources such as emergency care centres for medical issues, which should be considered fairly routine to treat.

“The playing field is not level,” explains Lee, “Individuals with SCI do not have the same access to primary care providers for treating what are considered fairly common health issues, e.g. a urinary tract infection, or accessing routine tests such as a pap smear.”

Such challenges to access primary care are costly to the healthcare system as well as distressful and risky for the individual. Someone with SCI may wait several hours in a hospital waiting room for a condition that should be quickly and easily treated by a primary care provider. As a result, conditions are often left untreated until they became worse, which then lead to a hospital visit that might have otherwise been avoided.

Quality of life is also impacted in terms of family and relationships, productivity, and caregiver burden. In order to better manage one’s health and find treatment, an individual with SCI often ends up moving away from their home community where they have their support network and family in order to be closer to an academic SCI rehab centre.

Few resources, conferences address primary care and SCI

In recent years, Lee and Milligan both realized that none of the conferences they attended on various aspects of SCI placed much, if any emphasis on primary care. It led Lee and Mulligan to a decision to hold a summit with the specific purpose of taking the lead to guide the direction of primary care for those with SCI in Ontario. The summit topic aligns with the goals of the “patient first” agenda of the Ministry of Health and Long Term Care.

The November summit, supported by the Ontario Neurotrauma Foundation, is an opportunity for 90-100 individuals to hear what Lee and others have learned from their own experience with more effective models of primary healthcare for SCI. Much of this experience has come from Lee’s own involvement as one of the leads for the PRISM project (Primary Care and Rehabilitation with Self-Management) and the Primary Care Mobility Clinic at the Center for Family Medicine in Kitchener/Waterloo.

Attendees from across the province have been invited. They include primary care providers, researchers, specialists, LHIN directors, and policy makers drawn to the value of integrated, coordinated care that delivers better results in terms of cost as well as quality of life. People with SCI are participating in the presentations and panels. Those expected to attend are national SCI partners such as the Rick Hansen Institute, one of Canada’s top neurotrauma surgeons, Dr. Michal Fehlings, and leading physiatrist Dr. Cathy Craven. The Deputy Minister of Health and Long-Term Care, Dr. Bob Bell will deliver the keynote address to attendees.

Lee hopes that the summit leads to the creation of other regional centres. “We need to share what we’ve learned over the past several years,” he says, “There is a model for delivering healthcare to those with SCI that is more effective, and it costs less. What’s not to like about that?”

For the past three years, Lee, along with Mulligan and Dr. Dalton Wolfe, have co-led PRISM (Primary Care and Rehabilitation with Self-Management), a project aimed at breaking down barriers across rehabilitation specialist and primary care providers. One of the healthcare models further developed through PRISM was the primary care Mobility Clinic at the Center for Family Medicine in Kitchener/Waterloo. ONF has had an active role in supporting and encouraging the work of the Mobility Centre.

Concussion Standards Summit

Public awareness of concussions has increased in recent years, and with this increase, so has the number of clinics (public, private, and third-party funded) that offer treatment and advice. Those committed to effective, right care, have begun to ask questions such as, “What qualifications should a ‘concussion expert’ have?”, “What are the features that must be included in clinics that offer concussion treatment?” and “What do patients need to know to empower them to know that they have the right provider(s)?”

A few concussions statistics:

In 2013 alone there were 148,710 concussion diagnoses in Ontario,

43% of the patients with diagnosed concussions are under 18 years of age.

44% are within working age from 18-65 years of age, thus impacting the workforce and the economy.

On April 15, 2016, ONF brought together 65 concussion clinic providers, traumatic brain injury experts, people with lived experience of concussion, and organizations and agencies with an interest in concussion from around Ontario. The purpose was to look at how to develop standards for concussion clinics in Ontario.

Those gathered discussed key issues around consistency, quality, access to, and coordination of care for persons of all ages in Ontario who are dealing with the effects of concussion. There are approximately 150,000 people diagnosed with a concussion each year in Ontario. Of particular concern, are the approximately 22,000 with persistent post-concussion syndrome who experience a prolonged, challenging recovery.

Better information, more interprofessional co-ordination

The group’s vision was unequivocal— every Ontarian should be assured of the right concussion management of the highest quality, delivered at the right time, by the right provider. It was agreed that regardless of age, cause of injury or place of residence, providers of concussion care need better information and more inter-professional coordination in order to ensure that every Ontarian receives the most appropriate concussion care.

The first important, and necessary step is the development of minimum standards for concussion clinics. Such standards apply to the early management phase as well as the longer-term management of persistent post-concussion symptoms.

Such an action would set up the “quality standard” across the province to ensure that no matter where someone lives, in a city or a rural northern community, they have access to the right care, delivered by an interdisciplinary group of qualified professionals. The care also has to be evidence-based, with appropriate management protocols that improves chances of recovery and minimizes persistence of symptoms.

As a result of the summit, a strategy has since been developed that revolves around specific objectives, and an action plan for working with various stakeholders, partners, and collaborators including Health Quality Ontario. ONF is leading this work, based on the long-term vision:

Having standards in place for concussion clinics in order that funders and planners know what resources are needed to deliver optimal accessible concussion care, in a timely fashion delivered by appropriate providers, and patients and families are assured that they are receiving the best care.

Over the next few months, working groups with key stakeholders will be developing action plans in order to move forward on the following objectives:

  • Develop standards for concussion clinics throughout Ontario;
  • Establish ‘collective competence’ in concussion care that facilitates networks for regional care. Collective competence focuses on how individuals work collectively as a team, with awareness of each other’s contribution;
  • Build an improved system for management and referrals;
  • Improve the knowledge of patients and families regarding what they can expect as optimal services
  • Develop methods for assessment, coordination and measurement of standards.

To find out more about the developing standards, please contact Corinne Kagan.


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