Hamilton Family Health Team & Hamilton Developmental Service Organizations Better Health through Collaboration

Agenda 1.Welcome & Introductions - Dr. Ruth Morris & Donna Marcaccio 2.Hamilton Family Health Team: Overview, Interest – Dr. Ruth Morris 3.Overview of Primary Care Guidelines: Annual Physical Recommendations – Tom Archer 4.Overview of HCARDD findings: LHIN 4 group home residents – Tom Archer 5.Barriers and solutions to increase rates of annual physicals (all) 6.Other health care / dental care issues (all) 7.Identify barriers and solutions to address other health and dental issues (all) 8.Next steps (all)

Hamilton Family Health Team - Overview Largest Family Health Team in Ontario 166 family doctors, 250 other professionals (Nurses, Dietitians, Mental Health Counsellors, Psychiatrists, Pharmacists, Physician Assistants, Physiotherapists) Serve more than half of Hamilton residents Multiple locations Work as a team

Canadian Primary Care Guidelines Developed using ‘expert opinion’, feedback from 2006 guidelines, research (UK, USA, Canada) Key recommendation: Perform an annual comprehensive preventive care assessment including physical examination and use guidelines and tools adapted for adults with Developmental Disability. Developed Preventative Care Checklists adapted for people with Dev. Dis.

Why Annual Physicals? “For adults with developmental disabilities, secondary prevention is critical as they may not have the ability to recognize the early signs and symptoms of disease. When comprehensive health assessments were undertaken in other jurisdictions, they often revealed high rates of concurrent treatable conditions.” Lunsky Y, Klein-Geltink JE, Yates EA, eds. Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario. Toronto, ON: Institute for Clinical Evaluative Sciences and Centre for Addiction and Mental Health; 2013.

Why? “…family members or carers who know the person well may not identify signs or symptoms if onset is gradual…” “Carers may under estimate the significance of certain signs and symptoms indicating a health need. This may result in treatment not being sought and conditions becoming …more severe and difficult to treat…” McGrath A (2010) Annual health checks for people with learning disabilities. Nursing Standard. 24, 50, 35 – 40.

Expected Outcome of Annual Physicals Decreased morbidity rate Decreased emergency department visits Decreased hospitalizations Decreased mortality rate Decreased emotional and behaviour disturbances Increased quality of life

Literature Review (38 Publications) 1.New diagnoses: 94%, 88%, 84%, 77%, 75%, 51%, 42%. 2.Number of new diagnoses: 1: 63%, 2: 25%, more than 2: 12% 3. Seriousness of new diagnoses: 9% 4. New diagnoses: cancers,, diabetes,, infections, constipation, hypertension, congenital heart disease, arrhythmias, testicular abnormality, hypothyroidism, GERD, mental health, hearing (wax)/ vision impairment. Janet Robertson, Hazel Roberts, Eric Emerson: Health Checks for People with Learning Disabilities: A Systemic Review of Evidence. June 2010

Research Quote “Of 202 people undergoing a health check, 95% had associated medical conditions, 42%...previously undetected…An average of 5.4 medical conditions per person, 2.3…previously undetected…2.7 conditions were not adequately managed…65% of participants reported no symptoms and 24% of carers said there were no problems…” Janet Robertson, Hazel Roberts, Eric Emerson: Health Checks for People with Learning Disabilities: A Systemic Review of Evidence. June 2010

Research Quote “Health screening of 13 participants referred for behaviour management, whose behaviour was considered by the consulting psychologist to have possible medical etiology was undertaken by a physician. Health conditions… were identified in 10 (77%)…of these, 8 out of 10 people showed improvement in behaviour once medical problems were addressed.” Janet Robertson, Hazel Roberts, Eric Emerson: Health Checks for People with Learning Disabilities: A Systemic Review of Evidence. June 2010

% of Adults receiving at least 1 periodic health exam (April 2009 – March 2011) Lunsky Y, & Heifetz M. The Primary Care of Adults with Developmental Disabilities in Hamilton Niagara Haldimand Brant LHIN: A regional summary based on the Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario. Applied Health Research Question Report prepared for the SNSC by the HCARDD Program, November 2015.

Preventative Care Checklists Canada: Preventive Care Checklist Forms (average risk & adapted for people with DD) UK: OK Health Check & Cardiff Health Check (specific to people with DD) Australia: Comprehensive Health Assessment Program (specific to people with DD) Queen’s FHT: IDD Health Check (adapted from Preventative Care Checklist – DD)

Hamilton DS Annual Physical Forms 5 (n=9) organizations submitted Annual Physical forms 95 Items on Preventative Checklist (adapted). Organization Forms: 31, 12, 6, 30, & 14 items 2 organizations eager to pilot adapted Canadian Preventative Care Checklist

Hamilton DS Other Forms Medical Appointment Records: 8 PRN Forms (behaviour & Physical Health): 4 Hospital Passports: 2 Seizure Protocol: 1 Medication Change: 1 Ability to self administer: 1 OTC Standing Orders: 1 Approval for Intrusive Physical Techniques: 1

Annual Physicals: Barriers & Solutions

Other Health & Dental Issues: Barriers & Solutions

Next Steps? Form a Sub-Group to oversee implementation Form a sub-Group to develop evaluation Adopt a common Annual Physical Checklist Include Checklist in OSCAR system Identify HFHT Primary Care Physicians Train HFHT staff Communicate with other Primary Care Physicians (FHT’s, CHC’s, …) Train DS Staff Communicate with Individuals & Family members Identify & overcome barriers to implementation