1. PRIMARY CARE ASTHMA PROGRAM PCAP Dr. Itamar E. Tamari, MD CCFP FCFP Chair, PCAP Advisory Friday, March 1, 2013 Asthma Advisory Committee Meeting

2. PCAP 2012 -YEAR IN REVIEW  2012-2013 Provincial Summary of Activities  Strategic Work Plan 2012-2017  Key Strategic Areas  Collaboration with Key Stakeholders  Moving Forward

3. 2012-2013 Provincial Summary of Activities DateAPA and other groups / Conferences Activities Jan – Oct PCAP Site Visits  19 site visits ( incl 6 new sites) : for support and implementation by Provincial Coordinator: Environmental & Readiness Assessment: Conducted Needs Assessment HCP Learning and Resource needs Site/Coordinator and Educator orientation to PCAP and Program Standards/Tools

4. PCAP CCPP Intervention Model PCAP CCPP Site A Need Identified: Spirometry Training Education/ Interpretation Need Identified: Spirometry Training Education/ Interpretation SpiroTrec - Technical Training PEP Spirometry Interpretation Workshop – 3hrs PCAP Spirometry Orientation ‘Spirometry In Primary Care’ - 60min Spirometry Programs Includes: Spirometry Manual Coordinator training Includes: Spirometry Manual Coordinator training Training includes:  Pre-learning: Online CME  Full day workshop  Post-learning: Review of Quality of Tests for 3 mnths  $450 Training includes:  Pre-learning: Online CME  Full day workshop  Post-learning: Review of Quality of Tests for 3 mnths  $450 CD–Rom Workshops/OTN Available Online Mentorship/ Preceptorship Access to Mentors: - e-mail - telephone - OTN - fax - in-person meetings Access to Mentors: - e-mail - telephone - OTN - fax - in-person meetings Mentor Selection Allied Health Mentors OCFP mentorship training Mentor Orientation o Spirometry Policy & Procedures Review Allied Health Mentors OCFP mentorship training Mentor Orientation o Spirometry Policy & Procedures Review Physician Mentors OCFP mentorship training Mentor Orientation o Spirometry Policy & Procedures Review Physician Mentors OCFP mentorship training Mentor Orientation o Spirometry Policy & Procedures Review Ongoing Programs

5. DateAPA and other groups / Conferences Activities Jan – Oct 2012 PEP – CCPP  Executive Meetings – once a month  All Mentors/Pilot Sites/PODs contacted- Jan  Mentorship Training for all the Mentors by OCFP (Jan)  Initiate communication (Jan –Feb)  Mentee recruitment (Jan- Feb)  EMR discussions on data collections (Jan – May)  Pre assessment completed (March)  AH Mentor Training- on Standardized protocol for spirometry technique and quality assurance (April)  Intervention initiated (April-June)  Pre –intervention Data Collection on spirometry for Allied Health mentees (May – July)  CCPP e-Newsletter (July -Oct )  Video Vignette initiated (July -Oct)  Cases presented online

6. DateAPA and other groups / Conferences Activities _______ Current Status PEP – CCPP  OTN presentations __________________________________________  Intervention complete  administering questionnaires  analysis of data  lessons learned  decisions on: wrap up, continuing machealth portal, continuing mentor support

7. DateAPA and other groups / Conferences Activities MarchPCAP/ OLA/ KOTM – Sioux Lookout FN communities Asthma Education sessions initiated via OTN/KOTM to FN communities for the CHR and community April – MayPCAP AdvisoryFinalizing Strategic Plan JuneAOHCPCAP / RHF promotion of PCAP July - September PCAP-OLA Partnership PCAP Communication Group  Environmental Scan, and LHIN Communication Strategy (includes Communication Package: letter, PCAP Brochure, PCAP Presentation

8. DateAPA and other groups / Conferences Activities AugustWorld Asthma Congress presentation on PCAP September 2012 – January 2013 OLA/AFHTO/AOHC/ HQO RHF planning initiated OctoberAFHTOPresentation on ACM/ COPD Care Maps POSTER presentation on IDAT RTSOPOSTER presentation on PCAP NovemberPCAP AdvisoryCompletion of PCAP Strategic Plan for 2012-2017 January 2013OLA/AFHTO/AOHC/ HQO RHF: 90 FHTs/CHCs/ Hospitals 100 participants each day for 1.5 days

9. Other Activities DateAPA and other groups / Conferences Activities Feb 2012 – Sept 2012PCAP Exec and Working Groups e-Newsletters x 2 PCAP Website OTN presentation by Dr To on the API – April 11 Hosted PHSAP presentation to PCAP sites via OTN at the OLA April 30 OLAAsthma Care Map COPD Algorithm

10. PCAP RESOURCE MANUAL CONTENT  PCAP Background/Overview  Getting Started- Implementation Process Orientation Manual Educator Folder Spirometry Manual Roles/Responsibilities  Communication- PCAP Info Package  Partnerships  Resources CTS / GINA Guidelines CPSO Infection Control Guidelines ATS Guidelines Related web links April 2012

11. RESPIRATORY HEALTH FORUM: JANUARY 2013- EVENT REACH  Forum was hosted by the OLA in partnership with PCAP, HQO, AOHC and AFHTO  100 Primary Health Care Providers: (FP, NP, Pharmacists, RN, RT, others)  90 FHTs/CHCs  Follow up  Ongoing support for the participants provided in terms of Program implementation Resources PEP Workshops: on Asthma & Spirometry Interpretation Navigating the ACM/ COPD Care Maps

12. PCAP CENTRAL PURPOSE Now :  Provision of leadership and expertise to advance strategic initiatives to enhance asthma & lung health care in the primary care setting  Provision of tools, education, best practices and evidence based standards of care for the delivery of a comprehensive asthma management program in collaboration with other programs  Identification of gaps in delivery of asthma primary care 12

13. PCAP STRATEGY FRAMEWORK VISION “Aligned with Ontario’s Chronic Disease and Management Framework, the Primary Care Asthma Program will provide asthma care to the people of Ontario, in collaboration with other providers that is inter-disciplinary, evidence based, patient centered, accountable and sustainable. It supports health care system changes from one that is designed for episodic, acute illness to one that will support the prevention and management of chronic disease.” PCAP STRATEGY FRAMEWORK VISION “Aligned with Ontario’s Chronic Disease and Management Framework, the Primary Care Asthma Program will provide asthma care to the people of Ontario, in collaboration with other providers that is inter-disciplinary, evidence based, patient centered, accountable and sustainable. It supports health care system changes from one that is designed for episodic, acute illness to one that will support the prevention and management of chronic disease.” KEY STRATEGIC AREAS IMMEDIATE PRIORITIES #1 FINANCIAL SUSTAINABILITY AND GROWTH #2 PROGRAM ENHANCEMENT & DEVELOPMENT #3 PERFORMANCE MANAGEMENT #4 SUSTAIN & GROW – IMPROVE REACH #5 HUMAN RESOURCES & DEVELOPMENT #1 Increase # of Lung Health Programs in Ontario #2 Full adoption of ACM and COPD Care Map #3 Development of CQI measurements #4 Program Reach- PCAP Implemented #5 Objectives includes: Succession Plan INDICATORS OF SUCCESS

14. KEY RESULT AREA # 1: FINANCIAL SUSTAINABILITY AND GROWTH The Primary Care Asthma program is delivered based on available resources needs assessment for respiratory care across the LHINS and economic impact analysis in collaboration with key local and provincial stakeholders. 14

15. KEY RESULT AREA # 2: PROGRAM ENHANCEMENT & DEVELOPMENT Facilitate the adoption of PCAP electronic tools in primary care 15

16. KEY RESULT AREA # 3: PERFORMANCE MANAGEMENT PCAP will design and implement a performance management framework that incorporates Patient-specific health outcomes and PCAP program-specific outcomes for Quality Improvement. 16

17. KEY RESULT AREA # 4: SUSTAIN & GROW – IMPROVE REACH PCAP will have continued to support services at existing sites and will have supported expansion of PCAP to other primary care sites to support a lung health model for all children and adults in Ontario including vulnerable populations, under-serviced areas and First Nations communities. 17

18. KEY RESULT AREA # 5: HUMAN RESOURCES & DEVELOPMENT We have a human resource development and succession plan in place that facilitates and supports knowledge translation for primary care practitioners, promotes the role of CRE’s as part of an inter-professional team that fosters enhanced integration of skills and experience and values the contributions of each individual. 18

19. OPPORTUNITIES FOR 2012 – 2017 COLLABORATION WITH KEY STAKEHOLDERS  To continue to collaborate with appropriate stakeholders including APA programs (PEP/PHSAP/EMR) to coordinate resources and avoid duplication valuable effort  Focus on the vulnerable population, underserviced areas and FN communities  120 Community-governed primary health care organizations includes: CHC, AHAC and other FN community health centers  To promote implementation of PCAP and standardized program in other health agency not mentioned above: FHTs, FHO, FHG, CCAC, NP-Led Clinics

22. MOVING FORWARD…  Align with MOHLTC Strategic Direction, Policies and Processes  Health Links announced last December 2012 –  Development of a Lung Health Strategy in collaboration with OLA- approved by the MOH to include COPD education at the PCAP Sites  PCAP will work with LHINs to integrate Lung Health programming  PCAP/OLA / LHIN Communication Strategy  Re -evaluation of the PCAP TOR  Consider the inclusion of COPD Program Standards  Revision of Asthma Algorithm  New Provincial Coordinator