Improving Quality During COVID-19
High quality primary care is more important than ever. Here are a few initiatives we have underway to support family physicians in our sites – and beyond – to continue to improve quality in family medicine.
Measuring and improving the patient experience
In the summer of 2020, the Quality & Innovation Program launched a common patient experience survey across DFCM core teaching sites to better understand patient experience in primary care practice during COVID-19. The 13 participating sites are using a common core set of survey questions as well as a common survey distribution process. Questions relate to modes of access, timeliness and continuity of care, patient-centredness, privacy and security, and more. Results will directly inform site operations and will also provide a more general picture of patient experience of the changes in care during COVID-19.
We are sharing our survey questions and would love to support other primary care practices who are engaging in similar work.
For more details, contact Dr. Payal Agarwal.
View the survey:
A framework for balancing in-person and virtual care during COVID-19
As case counts go up and down, it’s a continual challenge for family physicians to adjust how we deliver care we to ensure it remains safe, effective, timely, patient-centred and equitable.
This framework, developed by Dr. Kiran and published in CMAJBlogs, can help primary care teams work through considerations for balancing in-person and virtual care during COVID-19.
A virtual-first approach to managing type 2 diabetes during COVID-19
Effective management of chronic conditions remains an important part of primary care but how deliver that care has had to change during the pandemic. This practical guidance published in Canadian Family Physician provides practical tips for what aspects of diabetes care should stay the same, what needs to change, and what can stop during the pandemic. It provides a recommended management schedule and points clinicians to helpful resources for their patients. The guidance was developed by faculty from the University of Toronto Department of Family and Community Medicine in partnership with Diabetes Canada and the Centre for Effective Practice to develop practical guidance.
A full copy of the recommendations for family doctors is available at https://cep.health/clinical-products/type-2-diabetes/ and the accompanying article is available at: https://www.cfp.ca/content/66/10/745
Keeping the Doors Open: Maintaining Primary Care Access and Continuity During COVID-19
Primary care is the front door of the healthcare system. Early in the pandemic, there was concern that this front door may have started to close as anecdotal reports suggested some family practices were contemplating closing their doors either completely or for in-person visits. Between May and October 2020, our team reached out to family doctors (FPs) and general practitioners (GPs) providing comprehensive care in the city of Toronto to determine the extent and causes behind practice closures, and explore how to support affected practices and patients.
- During wave 1 of COVID-19, the vast majority of family practices were open and providing care to their patients.
- Closure seemed more common earlier in the pandemic and among physicians who were in practice for more than 40 years.
- The most commonly cited reasons for closure, in rank order, were health concerns, a lack of PPE, and PPE costs.
In addition to an interim report, the team has produce a one-page handout for the public to confirm that family doctors’ offices are largely open; that virtual care is care; and what to do in case your doctor’s office is closed.
View the interim report:
Managing chronic conditions using virtual care during COVID-19
Virtual care is any remote interaction between patients and their circle of care, involving the use of phone, video, email or secure messaging. With some upfront time and effort, virtual care can lead to a more efficient practice and better quality of care both during the pandemic and after. This resource is designed to improve provider confidence in implementing virtual care to support quality chronic disease management.
Using virtual care for chronic disease management can help you:
- Save time by avoiding visits to titrate medications or track side effects by collecting information on symptoms and risk factor control through email/secure messaging.
- Shorten or reduce follow up visits for chronic disease management by sending educational resources and plans for escalation of care.
- Save administrative staff time by using email/secure messaging for preventive care (vaccinations, OBSP, CRC screening) and recalling patients for overdue visits.
The 'Enhancing Management of Chronic Conditions Using Virtual Care During COVID-19' resource, developed by the Centre for Effective Practice and DFCM is available for download.
Screening and Managing At-Risk Drinking and Alcohol Use Disorder During COVID-19
Alcohol consumption has increased by 25% since the start of the COVID-19 pandemic. This resource is designed to support family physicians and primary care nurse practitioners in screening, diagnosing and treating at-risk drinking and Alcohol Use Disorder (AUD) in adults (>18 years) during the COVID-19 pandemic.
Developed by the Centre for Effective Practice in partnership with the University of Toronto's Department of Family and Community Medicine and other provincial stakeholders, this resource can help providers leverage virtual care in order to save time while enhancing patients’ lives. It highlights a variety of methods to help address alcohol risk and AUD including recommended frequency for screening, patient preferences, pharmacotherapy and non-pharmacotherapy options and more. It also lists key patient resources to help provide patient-centred care efficiently.