1. 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

2. 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

3. 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

4. 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.

5. 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

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

7. 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).

8. 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

9. 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:

10. 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

11. 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?

12. 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

13. 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

14. 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

15. 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

16. Mike

17. 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

18. Mike

19. 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

20. 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

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

22. Questions?