Engaging Communities in the RAAM Clinic Process Blood, sweat and tears: Tragedy, turmoil, sacrifice and frustration. The northern experience in opening de-centralized RAAM clinics and engaging Primary care in addictions medicine September 20, 2018 Dr. Mike Franklyn, MD CCFP, NE LHIN Regional RAAM Lead Stephanie Paquette, Mental Health and Addiction Lead, NELHIN Paola Folino, Regional RAAM Coordinator, Health Sciences North

DISCLOSURE OF FINANCIAL SUPPORT CFPC COI Templates: Slide 1 DISCLOSURE OF FINANCIAL SUPPORT This program has received financial support from [organization name] in the form of [describe support here – e.g. an educational grant]. This program has received in-kind support from [organization name] in the form of [describe support here – e.g. logistical support]. Potential for conflict(s) of interest: [Speaker/Faculty name] has received [payment/funding, etc.] from [organization supporting this program AND/OR organization whose product(s) are being discussed in this program]. [Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: [insert generic and brand name here]. This slide must be visually presented to the audience AND verbalized by the speaker. Where a program has received no external financial or in-kind support, indicate No External Support

FACULTY/PRESENTER DISCLOSURE CFPC COI Templates: Slide 2 FACULTY/PRESENTER DISCLOSURE Faculty: [Speaker’s name] Relationships with financial sponsors: Grants/Research Support: [PharmaCorp ABC] Speakers Bureau/Honoraria: [XYZ Biopharmaceuticals Ltd.] Consulting Fees: MedX Group Inc. Patents: [Widget ABC] Other: [Employee of XXY Hospital Group] This slide must be visually presented to the audience AND verbalized by the speaker. Where a faculty/speaker has no relationships to disclose, indicate Not Applicable under relationships with Financial Sponosrs

MITIGATING POTENTIAL BIAS CFPC COI Templates: Slide 3 – This slide may be omitted if there is no C)I declared in the previous 2 slides MITIGATING POTENTIAL BIAS [Explain how potential sources of bias identified in slides 1 and 2 have been mitigated by the scientific planning committee]. Refer to “Quick Tips” document This slide must be visually presented to the audience AND verbalized by the speaker. When speaker/facilitator has no relationships that might pose a potential conflict of interest AND the program has been developed without external support, this slide may be omitted.

Objectives of Presentation To describe how a Hub and Spoke model has supported the development of RAAM clinics in Non-Urban centres. To describe how a Coordinated Approach has facilitated the development of RAAM clinics in Non-Urban centres. To describe how to overcome Access Issues related to non-urban centres. To describe outstanding challenges and next steps for north eastern Ontario. Stephanie

Hub & Spoke Model Stephanie – Will show the visual model that we have put in place (identifying timelines/where we are at/next steps).

Hub & Spoke Model Support in Each Sub-Region is consistent, fairly distributed, and conducted in a standard way. Fidelity to the Meta-phi model is maintained through a standard approach to development. Successes and Challenges are shared Stephanie – Will describe how the NELHIN/HSN partnership has helped to create a standardized model that works to ensure equity and fidelity to the RAAM Model (identify key pieces of that partnership that make this work and key issues that we have been resolute in re: fidelity).

Hub Site Role Development of RAAM clinic within Hub Site (followed a “timeline” across NE) Phasing into respective spoke sites Participate/engage in conversations support across region, attending 1-1’s, attending COP, etc. Paola

What is HSN’s Role? Regional role supporting the development of clinics for the Hub Sites and the expansion to our districts spoke sites (Manitoulin Island, Parry Sound, Espanola) What does this look like? Sharing resources, templates Monthly 1-1 touch points Quarterly regional community of practice meetings Engagement sessions Education & Academic detailing sessions Paola Sample templates that we have shared: Daily routines, clinic flow, job descriptions and postings, interview guides for hiring, order sets, pamphlets Picture: http://www.nelhin.on.ca/subregions.aspx

Phasing into Spoke Sites Varies across the region, however most have been following sample action plan developed as a step by step Trying to phase in 1 site at a time to ensure proper supports are in place and linkages to hub site however goal is to build capacity locally Paola - Process attached indicates our pathway for our Hub Draft workplan attached for reference

Data from our 1st COP (July 2018) Paola - Reviewed as a region together, conversations about different things including challenges transitioning back to primary care – how can we ensure stabilization clinic, not a management clinic? Compared how some clinics see higher opiates VS alcohol, etc. and allows us to learn from each other – i.e. how do some clinics see people so quickly, where others have higher waits?

OPOC – Pt Satisfaction Tool Paola - Mandated within our region to be used by March 2019 – therefore we implemented during inception of program Example from HSN results only

What we did…and didn’t do First we opened (Dec 2015) … then we starting planning Who we wanted to engage: Communities, physicians, departments What we did well: seeing and treating patients What we needed to work on: building capacity, reintegrating patients into PC Mike

Physician Engagement Academic Detailing V1.0 Dinner with physicians. Impact level C V 2.0 Small group information sessions. Impact level B- V 3.0 Small group case based sessions Impact level B+ V 4.0 Above with followup in office addiction consultation. Impact Level A- V 5.0 Above with followup office based OST induction and ongoing support. Impact Level A+ Mike

Sudbury Dec 8/9 RAAM Summit Sudbury Feb 1 (2 NAS workshops) Timmins Feb 6-8 Moose Factory Feb 9 Espanola Feb 13 Parry Sound Feb 26 North Bay March 6 Manitoulin March 15 North Bay March 20 Collingwood March 22/23 Parry Sound March 27 PH Emergency Management Opioid Workshop Sudbury March 28 SSM/Algoma March 29/30 Sudbury April 3 (NAS Training) Thunder Bay April 16 SSM/Algoma April 27/28 Overdose Death Summit North Bay ….I forget the date I have been on the road so long……… Sudbury RAAM May7/8 preceptorship Temiskaming May 3/4 Thunder Bay May 28 Day of Learning Timmins June 20/21 Mike

Mike https://www.pictramap.com/app/view?p=d251fe

RAAM Duties Review META-PHI documents Handling physician initiated: -Calls -Consults -other RAAM docs and leads Pharmacy calls Conference calls META PHI COP other docs/LHINs Supervising mentoring docs/NP Attending community meetings: -Mental health -Addictions -Crisis planning -Education -FHT’s -Public Health -Local opiate crisis strategy/Task Force -Psychiatry - HSN pain clinic -HSN addiction consult service RAAM QAC RAAM physician recruiting Attending RAAM summits Attending OCFP regional MMAP meetings Budget meetings and planning Hospital based CME OB nurses ICN nurses Pediatricians ED Department Academic detailing sessions Visiting PCP offices for addiction consults Visiting PCP offices for inductions work on NOSM CPED Work on U of T CPED Work on META-PHI handbook and revisions Contribute to MET-list serve Meeting and calls with OTN Work of HQO committees Work on MOHLTC committees

Mike

What have we learned Providers are interested … but hesitant They would rather refer They don’t want to act alone …. Need backup and support Teachable skills …. Lots of education needed Providers are sometimes willing to go outside their comfort zone for their own patients Need to make it an introspective exercise … “look into your own practice” Having a group approach to share resources & expertise has been very helpful Mike

Challenges Keeping the “R” in Rapid Pathway back to Primary Care Engaging primary care providers Privacy concerns (i.e. using multiple organizations to support clinic, different EMRS…) Mike

Delicate situations Task forces to inform decisions Why it is important to have the right provider Leveraging community resources Mike

Questions?