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Past COVID-19 Community of Practice sessions

2020

For more information and the latest recordings, go back to the past sessions landing page.

Each item below includes session details, the webinar recording and linked resources.

COVID-19 vaccine, public health collaboration, and supporting our teams (December 11, 2020)

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Panelists:

  • Dr. Jeff Kwong, Epidemiologist, Family Physician, Toronto Western Family Health Team, Toronto, ON
  • Dr. Trevor Arnason, Associate Medical Officer of Health, Ottawa Public Health, Ottawa, ON
  • Dr. Lee Donohue, Family Physician, Your Health-Votre Sante, Ottawa, ON

Guest Speakers:

  • Dr. David Kaplan, Family Physician, North York Family Health Team and Chief, Clinical Quality, Ontario Health, Toronto, ON
  • Dr. Liz Muggah, OCFP President, Family Physician, Bruyère Family Health Team, Ottawa, ON

Moderator:

  • Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team, Toronto, ON

Resources:

Supporting patients with COVID-19, evolving guidance, and fatigue (November 13, 2020)

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Speakers:

  • Dr. Jonathan Fitzsimon, Arnprior, ON
  • Dr. Payal Agarwal, Toronto, ON
  • Dr. Liz Muggah, Ottawa, ON 
  • Dr. David Kaplan, Toronto, ON 

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team.

Resources:

Rising case counts, respiratory assessment centres, and flu shots during COVID-19 (October 16, 2020)

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Speakers:

  • Dr. Jeff Kwong, Toronto, ON 
  • Dr. Allan Grill, Markham, ON  
  • Dr. Lisa Habermehl, Red Lake, ON
  • Dr. David Kaplan, Toronto, ON  

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team.

Resources:

COVID-19 and considerations as we plan for the fall 2.0 (September 18, 2020)

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Speakers:

  • Dr. Jeff Kwong, Toronto, ON
  • Dr. David Kaplan, Toronto, ON
  • Dr. Jennifer Young, Collingwood, ON

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team.

Resources:

COVID-19 and considerations as we plan for the fall (August 21, 2020)

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Speakers:

  • Dr. Jennifer Bondy,  Amherstburg, ON
  • Dr. David Kaplan, Toronto, ON
  • Dr. Jennifer Young, Collingwood, ON

  • Dr. Jeff Kwong, Toronto, ON

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team 

Resources:

Managing chronic conditions during COVID-19 (July 17, 2020)

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Speakers:

  • Dr. Alan Kaplan,  Thornhill, ON
  • Dr. Jonathan Bertram,  Toronto, ON
  • Dr. Tara Kiran, Toronto, ON

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team 

Resources:

Chronic pain and addiction

Diabetes

COPD and Asthma

Ramping-up in person care

  • Ministry of Health - http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_primary_care_guidance.pdf
  • OMA - https://content.oma.org/wp-content/uploads/private/OMA-Preparing-to-Resume-In-Person-Care.pdf 
  • CPSO - https://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians
  • Southwest Ontario - https://swcovidtools.ca/guide-to-re-opening-your-office/
  • Centre for Effective Practice - https://tools.cep.health/tool/pc-ops-covid-19-context/
  • BC Family Doctors - https://bcfamilydocs.ca/wp-content/uploads/2020/06/The-Doctor-is-In-052120.pdf

General Resources

  • OCFP COVID-19 Resources - https://www.ontariofamilyphysicians.ca/
  • PPE - https://www.ontariofamilyphysicians.ca/tools-resources/timely-trending/novel-coronavirus-2019-ncov/ocfp-ppe-for-hpc-visual-june-2020.pdf
  • Covid-19: a remote assessment in primary care -  https://www.bmj.com/content/368/bmj.m1182
  • Healthy Debate Opinions:  ‘Defund the police, resource our communities:’ A call for structural change - https://healthydebate.ca/opinions/defund-the-police-resource-our-communites-a-call-for-structural-change

Supporting patients experiencing social challenges (June 26, 2020)

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Speakers:

  • Dr. Jonny Grek - Family Physician & Street Doctor with Northern Connections, Kenora, ON
  • Dr.  Ritika Goel – Family Physician, Family Physician, Inner City Health Associates, Toronto, ON     
  • Ms. Dawnmarie Harriott - Patient partner, Toronto, ON
  • Mr. Will Lacy - Patient partner, ON

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team 

Resources:

Mental Health and Addictions Services for the Black Community

PPE:

Ramping up in-person visits in primary care (June 12, 2020)

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Speakers:

  • Dr. Sundeep Banwatt - Family Physician, Southdown Medical Centre, Mississauga
  • Dr. Kellie Scott - Family Physician, Thames Valley FHT, St. Thomas
  • Dr. David Kaplan, Family Physician, Chief Clinical Quality OH-Quality, Toronto
  • Dr. Jennifer Young, Family Physician, President OCFP, Collingwood

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team 

Resources:

Soutwestern Ontario COVID-19 tools:

Guidance from other organizations/provinces:

OMA Guidance:

OCFP In-person Visit Guidance: https://www.ontariofamilyphysicians.ca/tools-resources/timely-trending/novel-coronavirus-2019-ncov/ocfp-guidance-in-person-visits.pdf

BC Family Doctor Guidance:

Ministry of Health: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_primary_care_guidance.pdf

Ontario Health: Recommendations for Regional Health Care Delivery During COVID-19: Outpatient Care, Primary Care, and Home and Community Care

CPSO: https://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians

UofT DFCM/North York General Hospital: https://www.dfcm.utoronto.ca/sites/default/files/primary_care_return_guideline_amended_june_1_final_060520.pdf

PPE Guidance:

Ramping Up Blog:

Embracing virtual care (May 29,2020)

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Speakers:

  • Dr. Steve Klassen, Family Physician, Westview Medical, Thunder Bay
  • Dr. Payal Agarwal, Family Physician, Women’s College Hospital Academic Family Health Team, Toronto
  • Dr. Paul Gill, Family Physician, Maitland Valley Family Health Team, Goderich

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team

Resources:

Resource

Link

OntarioMD

https://ontariomd.news/

K Codes

https://swcovidtools.ca/clinical-tools/virtual-care/

Non-OTN Codes

http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4755.aspx

OTN Codes

https://support.otn.ca/sites/default/files/virtual-care-billing-information-manual.pdf

PHIPPA Compliant Vendors

https://ontariomd.news/

PEER Leaders Program

https://www.ontariomd.ca/products-and-services/peer-leader-program/overview

Request a Peer Leader

https://www.ontariomd.ca/products-and-services/peer-leader-program/request-a-peer-leader

South West COVID Tools

https://swcovidtools.ca/

Collecting data on race during COVID-19

https://upstreamlab.org/2020/04/15/data-on-race-covid19/

LTC & RH Consult Line

Call 1-8338-2HELPU

For general inquiries or questions: ltcrh.consult@wchospital.ca

VirtualCare App

Watch a demo: https://vimeo.com/415554798

Homes interested may contact Erika Burns, VCSeniors@thinkresearch.com or call 1-877-302-1861

COVID-19 Guidance: Primary Care

Providers in a Community Setting

http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_primary_care_guidance.pdf

Advice for

in-person visits

https://www.ontariofamilyphysicians.ca

Supporting patients with increased mental distress (May 15, 2020)

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Speakers:

  • Dr. Leah Skory, Family Physician, Barrie Community Health Centre, Barrie
  • Dr. Claudette Chase, Family Physician, Primary Care Health Unit, Sioux Lookout
  • Dr. Javed Alloo, Family Physician, Nymark Medical Centre, CAMH, Toronto

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team

Resources:

Mental health supports for providers:

Resource hubs for practitioners:

General links for patients with collated resources:

Crisis support for patients:

CBT & peer support for patients that are free in Ontario:

Mindfulness for patients:

Addictions & recovery support:

Domestic violence:

Resources from Nishnawbe Aski Nation:

Measurement-based tools:

Resources for child & youth mental health:

Resource for physical health:

Resource for insomnia:

Training for healthcare providers:

Supporting our colleagues and community (May 1, 2020)

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Speakers:

  • Dr. Nadine Laraya, Family Physician, West Toronto FHO and Community Family Medicine Liaison, St. Joseph’s Health Centre
  • Dr. Daniel Pepe, Family Physician, London Lambeth Medical Clinic
  • Dr. Arieg Badawi, Family Physician, Kelso Lake Medical Centre and North Halton Ontario Health Team

Moderated by: Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team 

Resources:

Virtual care:

  • eConsult EMR integration (currently available through QHR Technologies' Accuro® EMR, OSCAR EMR, KAI Innovations' OSCAR, and YES EMR): sign up here and general information here
  • Healthymyself for asynchronous messaging and health myself blasts https://healthmyself.ca
  • OCEAN to send forms securely via email (e.g. PHQ9, antenatal, nippising). These are placed directly back in your EMR after patient completes. Visit https://www.cognisantmd.com/ to download the ocean toolbar that will directly integrate. Tablets are not needed, secure email will work well.  
  • OTN for video visits. Best on google chrome and can be also be used by patients on a mobile device: https://otnhub.ca

PPE:

OMA has a matching service for PPE: https://apps.oma.org/PPEInventory/

You can also contact regional leads for PPE:

Toronto:

Central:

West:

North:

East:

If none of these actions are successful, please escalate to the Ministry’s Emergency Operations Centre (MEOC). The MEOC will be moving to an on-line request form through EOClogistics.moh@ontario.ca to collect and validate your supply and equipment requests.

Building a community to share and learn from each other during this COVID-19 time (April 17, 2020)

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Speakers:

  • Dr. David Kaplan, North York Family Health Team and Ontario Health, Quality
  • Dr. Mercedes Rodriguez, Headwaters Health Care Centre
  • Dr. Kim McIntosh, Couchiching Family Health Team

Moderated by Dr. Tara Kiran, Fidani Chair, Improvement and Innovation, Department of Family & Community Medicine, U of T, and St. Michael’s Academic Family Health Team

Resources:

Questions & Answers:

During the webinar, participants were encouraged to ask questions. Some questions were answered live and can be found on the webinar recording. Others were answered in writing by our moderator or panelists. We have highlighted a few of the written responses here. Please keep in mind that guidance is rapidly changing and what is written may no longer be accurate. 

Question Answer

When will family doctors and their staff get tested?

All health care workers and staff can get tested (if symptomatic) at any of the Covid19 Assessment Centres - https://www.ontariohealthcoalition.ca/index.php/resources-list-of-ontario-covid-19-assessment-centres-their-individual-criteria/

Can people get infected by COVID more than once/ is there any talk about checking the immunity, IGg/IGm?

Here is the paper from Nature last week - Humanity tested - The world needs mass at-home serological testing for antibodies elicited by SARS-CoV-2, and rapid and frequent point-of-care testing for the presence of the virus’ RNA in selected populations. https://www.nature.com/articles/s41551-020-0553-6

I think moving forward it would be very helpful as a specialty to start to amass a comprehensive resource of “virtual approach to” common family medicine conditions in order to help guide us from a virtual clinical perspective to help us be more confident in assessing patients in this new method of care. Has anything similar to this initiative been discussed to date in our regulatory body?

 

 

 

Ontario Health (Quality) and OTN have developed this: https://quorum.hqontario.ca/en/Home/Posts/Guidance-to-support-the-adoption-of-virtual-visits-in-health-care

Agreed that we should think about a virtual approach to common family medicine presenting complaints!

A recent email to our members had some resources for remote management of diabetes and CHF and asthma/COPD has just been added.  Here is a link to the information from Dr. Tali Bogler that goes over well-baby and pre-natal visits.

https://afhto.ca/resource/interim-schedule-children-and-pregnant-women-during-covid-19-pandemic

PPE two issues:  Availability and also cost. During SARS we got kits from the government, nothing this time.

A. OMA has a matching service for PPE = https://apps.oma.org/PPEInventory/

B. Regional Leads for PPE - Regional Leads - PPE and Critical Supplies

Toronto
Co-Leads:
1. Rob Burgess (Robert.Burgess@sunnybrook.ca)
2. Nancy Kraetschmer (Nancy.Kraetschmer@tc.lhins.on.ca)

Central
1. Susan Gibb (Susan.Gibb@lhins.on.ca)

West

Lead:
1. Toby O’Hara (Toby.OHara@hmms.on.ca) – SW

Sub-Lead:
2. Doug Murray (Doug.Murray@grhosp.on.ca) – WW
3. Sue Nenadovic (Sue.Nenadovic@niagarahealth.on.ca) – HNHB
4. Katelyn Dryden (Katelyn.Dryden@transformsso.ca) – ESC

North
Co-Leads:
1. Matthew Saj (sajm@tbh.net)
2. Michael Giardetti (giardetm@tbh.net)

East
Co-Leads:
1. Paul McAuley (Paul.McAuley@3so.ca)
2. Leslie Motz (lmotz@lh.ca)

C. If none of these actions are successful, please escalate to the Ministry’s Emergency Operations Centre (MEOC). The MEOC will be moving to an on-line request form through EOClogistics.moh@ontario.ca to collect and validate your supply and equipment requests.

Prior to the webinar, a few participants sent in some questions. Dr. Kiran prepared responses after consulting with colleagues and we have summarized these here. Please keep in mind that these are not definitive answers to the questions but the opinions of one or more family physicians at a single point in time.

Question Answer

Recent article in JAMA re: affinity of COVID virus to ACE and ARB medications

Pts are asking to be switched to other agents. Is there any consensus on this? Is anyone else facing these requests?

We asked Brenda Chang, pharmacist at St. Michael’s Hospital Academic Family Health Team, for advice. Here is what she said:

“There is concurrently no consensus on this though most Cdn and International authorities/societies (e.g. Cdn Cardiovascular Society)  have suggested that patients continue with their current ACEI and ARB medications as prescribed for HTN/CHF unless there is a compelling reason to stop the drugs (e.g. AKI or hyperkalemia etc.)"

 

UpToDate has answers to most Covid-19 related questions, and they are offering free guest passes right now: https://www.uptodate.com/home/covid-19-access.

Here is what UpToDate says on the topic:

“Managing chronic medications

ACE inhibitors/ARBs — Patients receiving angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should continue treatment with these agents if there is no other reason for discontinuation (eg, hypotension, acute kidney injury). This approach is supported by multiple guidelines panels [26-30].

There has been speculation that patients with COVID-19 who are receiving these agents may be at increased risk for adverse outcomes [31,32]. Angiotensin-converting enzyme 2 (ACE2) is a receptor for SARS-CoV-2 [33], and renin-angiotensin-aldosterone system inhibitors have been shown to increase ACE2 levels in some, but not all, animal and human studies [34,35]. Although cardiovascular disease, hypertension, and diabetes mellitus are associated with more severe disease in the setting of SARS-CoV-2 infection, there is no evidence to support an association with these agents specifically. In addition, stopping these agents in some patients may exacerbate comorbid cardiovascular or kidney disease and lead to increased mortality [36].

Conversely, ARBs have also been proposed to have potential protective effects based on their mechanism of action [37], but there is no empiric evidence to support this hypothesis. We do not use ACE inhibitors or ARBs as potential COVID-19 treatment."

I have some of my patients calling to get pneumonia shots as they think it will help. Of course, pneumonia shot helps for Pneumonia but not COVID-19 pneumonia.

Do we take the risk to give the shots - can we delay it?

 

We reached out to our colleague Jeff Kwong, family physician at Toronto Western Hospital Academic Family Health Team, public health physician at Public Health Ontario, and Senior Scientist at ICES. This is what he said:

“Our clinic is still giving pneumococcal vaccines in adults, but delaying/deferring HPV and Shingrix.”

So many are calling regarding their short-term disability forms and sick notes for staying home from Covid -19

How to handle this?

On March 19, 2020, Ontario passed Bill 186, Employment Standards Amendment Act (Infectious Disease Emergencies), 2020, which provides that an employee will not be required to provide a medical note if they need to take a leave related to COVID-19. Here is a link to more information on employee rights: http://www.ohrc.on.ca/en/news_centre/covid-19-and-ontario%E2%80%99s-human-rights-code-%E2%80%93-questions-and-answers-0 

Insurers are still asking for STD forms unfortunately. Ideally patients can scan and send these to you so you can fill remotely. We need more system advocacy around this.

Should patients taking Truvada continue to do their regular blood work (typically HIV q 3 mon + Creat q 6 mon) in order for us to refill their prescriptions?

We asked advice from our colleague Dr. James Owen, a family physician at St. Michael’s Hospital Academic Family Health Team who cares for many patients who are HIV positive. Here is what he said (he also said he would be happy to be contacted directly at james.owen@unityhealth.to):

“There's no guidelines on this so I expect advice is provider-dependent, but here's what I'm doing:

For people on PrEP, it depends if they're still sexually active:

- If they're still sexually active AND still conceivably at risk of HIV, I'm recommending continuing PrEP without interruption. If asymptomatic for STIs, I'm deferring routine PrEP labs in most cases and just providing additional scripts for patients to bridge them till physical isolation has ended (I'm assuming we'll be free in July). What the writer has indicated is reasonable. Of course, if someone is symptomatic I'm inclined to test + treat for the presumptive STI if possible at the same visit, to minimize separate visits eg to clinic, lab, then clinic again.

- If they're still sexually active and NOT conceivably at risk of HIV, they could stop PrEP. The only situation where I think this applies is if someone has a regular household sexual partner ("HSP".. this great new term I'm seeing in some literature) and neither of them has any other sexual partners for the duration of physical distancing. In that case, I'm having a discussion about the pros and cons of "pausing" PrEP for the duration of physical distancing

- If they're NOT sexually active and do not foresee any further sexual activity for the duration of COVID, I'm advising it's also OK to pause PrEP. In all cases, I'm recommending they take PrEP for at least 48 hours after their last sexual activity

There is one clinical trial of COVID prophylaxis for health care providers with TDF+FTC (aka PrEP medications) starting in Spain based on in vitro modeling that suggested that PrEP meds may inhibit COVID replication. It's a limited trial in health care providers only, so I haven't felt (yet) that this impacts my advice to patients about whether to stop or continue PrEP.

Good resources:

For people who are HIV+, if they are asymptomatic and have no other health concerns and are otherwise just doing regular monitoring b/w, I'm telling everyone to defer routine labs till physical isolation has ended, likely July, and always continue cART”

2022

2021