Forums

Practice Solution Support nightmare

Thu, 18 Feb 2010 00:53:35 GMT

We are 32 DR clinic with dedicated IT department and facing lots of struggle with Practice Solutions to rollout EMR and getting support. Some are as below:

1. Lack of PS staff with project management expertise.

2. Unawareness of process analysis and alignment

3. Lack of experience in large scale technology and deployment

4. Lack of internal process flow, communication, audit within PS.

5. Lack of accountability to DRs.

We fell that PS is getting away from all this due to the affiliation with CMA. Also, typical clinics are small and lack the resources to ask questions or bring their problems forward.

I spoke to a friend of mine who works for Canadian EMR and heard very similar stories about PS support.

Canadian government is pouring money for the EMR rollouts but failed to provide strict guide lines to EMR vendors in order to protect doctors and their investment. This is one of the reason 70% of the EMR rollouts fail in Canada.

Loosely written CMS standards are not sufficient. It is our responsibility to bring this forward to public and to government.

Pls kindly post you comments/stories about your rollout.

Thank you

Forum: Information Technology

Problems with Enrollment Targets

Tue, 21 Apr 2009 15:41:43 GMT

April 20, 2009.

Dear Colleague:

Those of us involved with Family Health Teams (FHTs) may have received a memorandum from the MOHLTC encouraging FHTs to achieve optimistic patient enrollment targets during the next six months. The government has also indicated that approval of our 2009-2010 FHT budgets would be contingent upon developing an acceptable action plan to reach the government’s enrollment target.

The following is some background information that I have accumulated in the four years since I was chosen to lead one of the first FHTs in Ontario.

Background:

1. Primary care enhancement contracts e.g. FHG, FHN, FHO were negotiated, FHT funding agreements were not

2. Roster requirements for FHNs and FHGs were broad and general, i.e. minimum of 500 patients, and a soft cap at 2400 patients per physician

3. According to the OMA, the average number of patients to family doctor is 1240-1250:1

4. MOHLTC intends to unilaterally amend FHT contract to include enrollment targets for FHTs

5. FHT funding approval for 2009-10 is contingent upon FHTs agreeing to amendment and developing a plan for reaching MOHLTC enrollment target goals

6. MOHLTC intends to send out amended contract at the end of April 2009, or to enact a “contingency plan” should amended contract not be available.

Problems:

1. MOHLTC intends to unilaterally amend contract

2. MOHLTC rostering process is inaccurate and haphazard with some government figures for rosters being off by as much as 40%. Most doctors in patient enrollment models complain about the slow, inefficient, and inaccurate rostering process and have concerns about the accuracy of roster numbers.

3. Targets are predicated upon unrealistic assumptions of the amount of work that can be performed by allied health professionals.

4. In my experience, good to excellent well-motivated nurse practitioners can do one third of the work of a physician, and require significant supervision. My four-year experience with NPs indicates that only about one third of them are good and well motivated. Some NPs believe that the current class of NPs are poorly trained and unmotivated.

5. Practice RNs can help with some tasks such as BP, injections, and minor wound care, but do not appreciably affect patient throughput.

6. Mental Health workers do help with patient volume. Our two counselors see one patient per hour, so they reduce our volume by at best 2 patients per day

7. Other allied health professionals that we employ such as nutritionists, psychologists, chiropodists, pharmacists, nurse educators, do provide our patients with increased service and convenience, but their contribution to patient throughput is similar to Mental Health Counselors, and would be, at best, one patient per day

8. In summary, in my experience, all the allied health professionals would allow my to see an additional 8 patients per day for an increase in efficiency and volume of fifteen to twenty percent.

9. If this applies to all physicians and FHTs, a twenty percent increase in patient volume per average family physician would result in a realistic roster target of at most ~1500 patients per physician (assuming that all allied health professionals were good and well-motivated)

I am disappointed in the change in the government’s position over the past several months, and I would like to raise several issues that I believe emphasize the ill-considered position that the ministry has taken.

1.    At no time were enrollment targets discussed or agreed to in the nearly four years that I have been involved in FHTs.

2.    In the case of our FHT, the only bilateral contracts signed were “development grant funding” and “interim funding” agreements signed in August of 2005 and April 2006 which dealt only with human resources issues and did not raise the issue of enrollment targets for FHTs. I would assume that this applies to other FHTs.

3.    The government’s stated position is unilateral and did not involve any consultation with concerned parties.

4.    The number of patients attributed to each physician is based on a flawed, haphazard, and unreliable process; the accuracy of any such figures is highly suspect

5.    Physicians can not predict, influence, nor anticipate the number of patients who will choose to roster with them at any given time. The enrollment targets do not acknowledge the possible competition for new patients between FHTs and other primary care providers including some specialists who provide primary care.

6.    The total number of patients rostered with any given physician is significantly affected by the MOHLTC’s de-rostering process which is at best arbitrary, and at worst quixotic

7.    The assumptions that the MOHLTC has made concerning the contribution to patient through-put made by allied health professionals is hopelessly optimistic

8.    The patient allotment for the average family doctor in the province of Ontario is 1,248, while the final enrollment targets in our case at least, require a much higher patient to physician ratio

9. The enrollment targets do not take into consideration the acuity of any patient, or use any modifiers such as age or sex, which were used in the FHN contracts. A physician will naturally have to spend more time with more acute patients, adversely affecting patient throughput and roster levels.

10. The enrollment targets do not take into account the domestic caregiver roles that many physicians assume, a factor that will place an inordinate burden on many female physicians or other physician caregivers, who will not be able to manage larger practices.

11. The enrollment targets do not take into account the disparity in practice size, and the career goals and comfort levels of the participating physicians.

12. The goal of the primary care renewal projects was to offer improved, comprehensive care to the people of Ontario. The original FHN and FHG contracts had very flexible patient enrollment requirements with a minimum of 500 patients and a soft cap of 2,400. Current enrollment targets are not congruent with the cooperative spirit of primary care renewal.

Action:

1. Amendments to FHT contracts involving hundreds of Ontario physicians should be negotiated bilaterally, not imposed unilaterally

2. The OMA should inform its members not to sign any FHT contract amendments until the bilateral negotiation process is completed

3. The OMA and MOHLTC should agree on to what extent allied health professionals improve patient throughput, and whether roster targets should be imposed

4. The MOHLTC process for determining the ability of allied health professionals to increase patient volumes should be reviewed

5. The MOHLTC rostering process should be reviewed and improved.

Due to the efforts of your section executive, the OMA is now discussing these issues with the MOHLTC.

If groups are concerned with the roster targets being proposed by the MOH, they could contact Adam Farber, of the OMA’s legal department to assist in their negotiation process.

In the meantime, please consult our website http://www.grouppracticeontario.ca frequently for the latest developments and information on this and other issues of interest to front-line physicians.

Yours truly,

Garnet Maley,

Chair,

Section on Group Practice

Forum: Patient Enrollment Target

Lesson IV. Cost

Thu, 21 Dec 2006 20:17:10 GMT

Lesson IV. Cost

I. Financial Cost

II. Human Cost

III. Other Cost

I. Financial Cost

Inaugurating an information technology system is costly in many ways. However, the most striking aspect is the financial cost of any new computer system. We all recognize the need for appropriate hardware, and there are many competing software vendors. The plain truth is that although some software systems are horrendously expensive, they are ALL costly. Following is a spreadsheet with figures derived from the OntarioMD website and from the vendors themselves.

IT Costs vary greatly, and that one is much less expensive than the others. This is the xwave GE Centricity model, the major saving inherent in this model arises from the lack of a local server due to the unique ASP model. This will save not only money but headaches. You can also see that one system is much more expensive than the others. The Clinicare model is the most expensive but many of its purchasers swear by it.

II. Human Costs

One of the major countervailing forces against implementation of the EMR is inertia. Many of us can’t be bothered to replace a proven, workable system i.e. pen and paper, with unproven information technology. Many of us are approaching retirement age and the thought of disrupting a practice that has been functioning well for thirty or forty years is disturbing.

Remember, that your staff harbour the same doubts, especially if they are middle-aged and beyond. Computers are still threatening, forbidding entities that will disrupt their smoothly functioning offices. I have anecdotal reports of office staff quitting rather than face the travails of EMR implementation.

How do we achieve buy-in from our staff?

Good question. We should approach change gradually in incremental steps. We should carefully scrutinize the training programs that our vendors promote, and discuss the costs and benefits with colleagues who have already completed training. From the above table, you can see that training programs do vary among the vendors. Find out the best program and go with it. We should also consider performance bonuses for our staff after they successfully implement the new EMR. Remember that OntarioMD offers a performance bonus of $2500 when you have successfully implemented the EMR and entered a Cumulative Patient Profile for either two thirds of your practice or 600 patients whichever is less. While it is tempting to keep this money, since your life will have been disrupted during implementation, you would be well advised to share this largesse with your long-suffering staff.

III. Other Costs

Now beyond the obvious cash outlay, and human resource issues what other costs will you incur? Perhaps the most important is a decline in productivity. Dr. Michael Thoburn of the Ontario Medical Association provides the following thought-provoking observation:

“Add 60 seconds on to a 7 minute visit and you have lost 14% productivity

Do it across the board (add 1 minute to every 7 minutes of work) and you have lost 14% of gross revenue. If your overhead is 50% (easy figuring) you have reduced your take home pay by 28%. If you want to compensate by increasing throughput and you normally see 30 patients a day you will have to see an extra 4.34 patients at no extra overhead cost.

And all this assumes that there have been no other costs to you regarding hardware, software, training or renovations. Only a time penalty and productivity loss.

In fairness, the counter argument is that you may make more money in the same time or less with the same number of patients by capturing lost charges, doing forgotten tetanus shots, doing better 3rd party responses, etc. and you may make practice a little more fun (if you like toys).”

Speaking personally, in the two months after I implemented our clinical management system in my office I was able to work at only half speed. My patient throughput decreased by fifty per cent (50%). My colleagues in our FHT have experienced similar declines, and many have not yet returned to their normal productivity. Fortunately, we follow the FHN remuneration model and this has helped cushion the blow of our decrease in productivity since our income is not completely volume driven. Needless to say, however, we have had to bear the wrath of disgruntled patients, since we all suddenly developed “waiting lists”, something I personally have never experienced in twenty years of practice.

The corollary to this is:

“If you follow a fee for service model, implementing a clinical management system could cause major financial hardship in the short term”

If you, like me, experience a 50% drop in productivity for two months, your income will decrease by approximately 50% in the two months following CMS implementation.

Can you afford it?

For those family doctors who are involved in the OntarioMD lottery and hoping to receive the MOHLTC/OntarioMD subsidy for IT funding remember the ancient Chinese proverb:

“Be careful what you wish for, it may come true.”

please note that due to technical difficulties a spreadsheet comparing different IT systems cannot be included at this time. I will attach the spreadsheet as soon as I am able

Forum: IT 101

Lesson IV. I Financial Cost b

Thu, 21 Dec 2006 20:01:26 GMT

Comparison of Approved EMR Software (Ontario)
	ASP	LOCAL
	xwave
1 physician + 2 support staff configuration	CMS G.E.	Clinicare

Cost Software One-time	$5,000	$30,173
Cost Software Monthly	$225	$961
Number of Lab Interfaces included	3	1

Cost Server & LAN One-time	nil	$39,329
Cost Server & LAN Monthly	nil	$750

Cost Client Side Hardware One-time	$11,420	$17,393
Cost Client Side Hardware Monthly	$0	$159

Implementation & Other:
Cost Recommended Additional Software One-time	$0	$0
Cost Implementation	$1,761	$16,600
Cost Training	$7,700	$22,524
(Amount of training provided at reported cost)	As required. 24 hrs at least	26.5 hrs

Cost Grand Total One-time	$25,881	$126,019
Cost Grand Total Monthly	$225	$1,870
Cost Grand Total Financing Monthly @6% x 36 mos	$1,012	$5,704

After OntarioMD subsidy averaged over 36 months:
What This Will Cost You After 36 Months	$5,381	$164,739
What This Will Cost You Monthly if Financed	-$218	-$4,909

Forum: IT 101

Lesson IVa. Financial Costs I

Thu, 21 Dec 2006 19:48:01 GMT

Lesson IV. Cost

I. Financial Cost

II. Human Cost

III. Other Cost

I. Financial Cost

Thank God that many of us are eligible for grants from the MOHLTC.

Forum: IT 101

Lesson III: Local Solution vs. ASP

Tue, 12 Dec 2006 01:55:01 GMT

Lesson III. Local Solution vs. Application Service Provider (ASP)

I’ve been involved in the IT wars (and others) for a decade, and I have the scars to prove it. When we originally began talking about PCR and IT we felt that services to patients could be improved if doctors were able to share information, coordinate activities, and improve efficiency by using electronic medical records to aid in the treating of their patients. We envisioned physicians’ offices linked electronically with labs, pharmacies, hospitals, and most importantly, other physicians’ offices. That was ten (10) years ago! How have we done?

Well, for a variety of reasons, many of which I would be happy to privately detail, this is only now beginning to happen.

A. Application Service Provider (ASP)

Beta testing on the first and only ASP system commenced about one year ago, and this product has only been in general release for less than six months. This is the first foray into the brave new world that we envisioned ten years ago. ASP systems are linked by secure internet to a secure central server. Since many offices are using the same central server, it will be much easier for physicians to share information with their colleagues who also use ASP systems. Needless to say, any such program will be encumbered by the enormous bureaucracy spawned by privacy legislation and inevitably, progress will be glacial. However, the first step has finally been taken after a decade of anticipation. Many people feel that ASPs are the way of the future, and requests for proposals are now being developed so that other vendors may develop ASP solutions and enter the market. Enhanced competition should lead to more competitive pricing, better service, and a better range of options.

When we chose an ASP solution as our introduction to electronic clinical management systems, we did so for purely ideological reasons. We recognized that this approach had the most potential and was most likely to achieve the goals that we set ten years ago. We also recognized that using hardware and software that was unproven in the Canadian medical market was risky. I believe that we hit the nail on the head in all aspects. We implemented our ASP system in August 2006 and the volume of irate phone calls questioning our lineage, sanity, and species is only now beginning to decrease.

Summary:

ASP Good: Bad:

No server, less hassle, cheaper Slower, need Internet

Connect with other MDs Unproven technology

Way of the future

B. Local Solution

We currently have over one dozen approved vendors in Ontario for local solutions. Many have been in business for several years, and the use of some of their products is widespread. Many of these products have worked very well for our colleagues.

Local solutions provide faster connectivity. However, since they require a local server they are more expensive. If you, like us, have several sites where you provide services, then you may require more than one server. Since you are developing your own local network, you may have to designate an employee to act as your IT resource. There are numerous anecdotes about the quality of life and life expectancy of IT network people. You will also be responsible for the care, feeding and upgrading of your server.

The potential hazards of a local solution were brought home to me with terrible clarity when the roof in my office leaked last year. The water cascaded down onto my printer, which was fried, and needed replacing. This cost only a couple of hundred dollars. I thanked my lucky stars that my adjacent computer wasn’t drowned. Now, if you have a local server, and it gets wet, then you not only have to replace an expensive piece of equipment, but also replace the vital information it contains. Make sure you have a reliable back up system and use it. Some of our colleagues have agreements with their local hospitals to place their server on the same secure premises where the hospital situates its server. This is a good solution, assuming that your hospital administrator is reasonable and doesn’t take the opportunity to soak you with exorbitant charges. You will still have to be connected by a secure line to the hospital, and this solution begins to look increasingly like an ASP with its attendant shortcomings. Many of us aren’t particularly eager to increase our reliance on hospitals, since historically, our relationships are often less than cordial.

Many of our colleagues have horror stories about the extortionate rates that hospitals charge to develop an interface between physicians’ offices and the hospital server that contains information about OUR patients. Some groups have paid over one hundred thousand dollars to hospitals for the privilege of developing an interface to retrieve their own patients’ data. To extrapolate, if we have thousands of physicians with their own local servers and EMRs how much time, money, and energy will we have to spend to get their thousands of computers speaking to each other? I believe that this is the single largest shortcoming of the local solution.

If you, like us believe that it is worthwhile for physicians’ offices to be linked, then our current state of technology dictates that you consider an ASP.

Summary:

Local Solution Good: Bad:

Faster, Need server,

Proven technology Security issues,

upgrades

Good track record Hard to connect with

other MDs' offices

Forum: IT 101

Lesson 2: Funding

Mon, 04 Dec 2006 22:00:03 GMT

Lesson 2: Funding

We all know one thing about information technology. It’s expensive.

Whereas we can buy enough pens, paper, and file folders with the change in our pockets to supply our offices for a year, only a radiologist could afford to walk into a computer store and buy the necessary equipment to set up a clinical management system on a whim.

We know that Dell advertises desktop computers online for under $700, and some no-name clones go for less, but are these machines that you want to rely on for your livelihood?

After painstaking negotiations involving representatives of the MOHLTC and physicians, the following funding formula was introduced for the “Physician IT Program’:

3.6.1 Comprehensive Package – Under the Comprehensive Package option Participating Physicians will receive funding to acquire, install and implement an Approved CMS Product.

3.6.1.1 A one-time site readiness grant of $4500 per Participating Physician, to be used to prepare the office environment for the installation and use of the Approved CMS product

3.6.1.2 A $600 monthly funding subsidy, per Participating Physician, for a period of 36 months for the acquisition, implementation and maintenance of a CMS

3.6.1.3 A one-time performance recognition bonus of $2500 per Participating Physician on establishment of an EMR for either two-third or 600, whichever is less, of their rostered patients. The EMR is expected to contain elements of the Cumulative Patient Profile.

A smaller, desk-top grant is available if the physician is not implementing the entire CMS system. In addition, while it is only human nature to succumb to the blandishments of persuasive salespeople and buy the latest, hottest, hardware, I would recommend overcoming the impulse to impress your friends, colleagues, and patients with the hottest system. You should try to purchase proven technology from a reputable supplier at a reasonable cost. You should also consider buying both hardware and software from the same supplier so you can avoid the “Bell Telephone scenario”. That is, when your phone doesn’t work you are continuously blown off by company representatives who tell you that it isn’t the telephone line that’s the problem, it’s the cheap phone that you bought at Wal-Mart, and that their corporate responsibilities end at the wall of your dwelling.

You don’t want the hardware/software blame game played out in the middle of your busy office devastating your productivity and well-being.

Remember that this Physician IT Funding program is only available for three years. While we hope that physicians and government can arrive at a funding agreement beyond these three years it’s probably best to strike while the political will is still there. Interested physicians should contact their OntarioMD representative who should offer help in navigating the treacherous IT sea.

Forum: IT 101

IT for Chronic Disease and prevention

Sat, 02 Dec 2006 03:09:28 GMT

Below are suggestions when considering an IT solution if you are wanting to use the tool to practice Chronic Disease and Prevention. These validation criteria are not part of the OntarioMD criteria.

Chronic Disease Management

Validation Criteria for IT

The current IT validation criteria of OntarioMD does not address functionality of CMS which would allow the effective management of chronic disease across a population (such as a practice’s roster). These additional validation criteria pertain to functionality required for chronic disease management.

Register Creation

The EMR must be able to create a list of patients with a selected currently active diagnosis or set of diagnoses, physical measurements, medications or lab test results.

The output must be able to be produced at least as a printed list with selected other demographic data as defined by the user.

Example:

1. List patients with coronary disease, or angina, or a history of an MI who are currently on Vioxx. List their name and phone number and address.

Search Capabilities

The EMR should be capable of searching on a variety attributes related to disease management. These attributes should include any combination of the following:

1. Demographics

2. Current Diagnoses

3. Past Diagnoses

4. Vital signs

5. Current Medications

6. Past procedures

7. Immunizations

8. Lab tests

9. DI Studies

Attributes need to be searchable using Boolean operators:

1. And

2. Or

3. Not

Output of searches should be capable of listing any demographic data and any search criteria. Output should be capable of basic mathematical analysis such as counting, averages and cross tabulation. Output should be capable of printed list or electronic listing capable of being imported into a standard spreadsheet program.

Example:

1. Select currently rostered patients with a diagnosis of Diabetes 1 or Diabetes 2, who do not have a diagnosis of allergy to ASA, and who are not currently on ASA or EC ASA. List the patient’s chart numbers, name, family doctor, and phone number. Cross tabulate the results of the patients with or without ASA or EC ASA by family doctor.

2. Select currently rostered patients with a diagnosis of chronic renal failure, who do not have a record of 2 pneumococcal vaccinations.

Reminders

The cumulative patient profile display of the EMR should be capable of displaying reminders based upon the absence of criteria related to preventive care and chronic disease management. The reminder should only display in the event that there is a deficiency noted in the EMR

Examples:

1. Display the reminder “Consider measuring the BP” when a record has a current diagnosis of hypertension but there is no BP noted on the chart in the past year.

2. Display the reminder “Consider a Pap Smear” when a female patient older than 30, who has not undergone a hysterectomy, has not got a pap smear result within the past 2 years.

3. Display the reminder “Consider ordering a TSH” when a patient who is on Amiodarone does not have a TSH on the record within the past year.

Ease, Cost, and Time

Vendors need to report if register creation, searches and reminders can be created and managed by the end user, or if the vendor’s programmers are needed for the functions (include costs).

Vendors should report the search time for a standard search (such as search example 1) on a live data base with at least 10,000 medical records. Vendor should report the server specifications and the time per 10,000 records.

Forum: IT 101

OSCAR User Group

Mon, 27 Nov 2006 21:58:05 GMT

Welcome to those of you using OSCAR.

What do you to to scan information into your system?

Forum: Information Technology

Lesson I: Introduction to the IT Experience

Mon, 27 Nov 2006 21:55:53 GMT

Lesson I: Introduction to the IT Experience

So you’re interested in introducing information technology (IT) to your practice.

Welcome to the twenty-first century.

Most of us have been using pen and paper to keep records for many years. Now is the time to change. Really?

Why change from something that has been serving physicians well for centuries? It’s hard to say, especially when you’re mired in implementing new hardware and software, the computer crashes, the roof leaks, your server is fried, your secretary wants to quit, your spouse wants a divorce, you’re depressed, suicidal, hallucinating from sleep deprivation, your waiting room is full, and you can hear the grumbling all the way to your consulting room.

And that’s on a good day.

Now sit back, you’re about to embark on a journey to a land where nothing is at it seems and the meaning of what people say is what they mean it to say. This is a contemporary Wonderland, which would do Lewis Carol proud, and which contains just as varied a cast of characters.

Your very being will soon be controlled by two new hitherto unknown agencies, Smart Systems for Health, and OntarioMD. Dealing with them will make the Byzantine OHIP pathways seem like highway 401.

You will be asked to undergo site inspections, training sessions, implementation rubrics, and you will be required to fill out mountains of paperwork, each page of which will be returned to you by an irate bureaucrat if it is not filled in exactly to their specifications. I was told that I would be introduced to an aide who would help me with my application. Help? She tripled my work and then went on maternity leave. You are about to find out that no matter how carefully you plan and how much time you take, something unexpected will always go wrong at the least convenient and most critical time. I can guarantee that after you have dealt with IT people for one month you’ll appreciate just what a good job we do as physicians, and you’ll realize that if you practised medicine the way these people do business you’d be delivering pizzas.

In the near future you will come to appreciate fully Cohen’s Law: Murphy was an optimist.

So why bother? It’s because we are intelligent, well-motivated, curious, and innovative individuals who all embrace change. (LOL)

Forum: IT 101

Course Calendar

Mon, 27 Nov 2006 21:52:55 GMT

Information Technology 101

Course Calendar

I. Introduction

II. Funding

III. Local Solution vs. Application Service Provider

IV. Cost

V. Benefits

VI. Comparison of Systems and Vendors

VII. Smart Systems for Health

VIII. OntarioMD

IX. Theory vs. Practice

X. Recommendations

Forum: IT 101

Smoking Cessation Program

Mon, 23 Oct 2006 17:09:08 GMT

Smoking Cessation Program

Introduction

Smoking is the number one cause of preventable death and disease in Canada. Nearly 7 million Canadians smoke, and an estimated 45,000 of them die every year of smoking-related diseases (16,000 in Ontario). The economic burden of tobacco use is very high; it is estimated that smoking-related diseases cost Canada $3 billion per year in direct health care expenses. This does not include the cost of lost productivity, increased insurance premiums and other indirect expenses, which increase the cost of tobacco use to society to $11 billion annually.¹

Problem

A person’s decision to smoke is the result of a complex interaction of factors that varies from one individual to another. Nicotine is one of the most addictive chemicals known, and cigarettes have been an emotional crutch or an adult pacifier to many people without them even knowing it.

Quitting smoking is the single most effective thing that smokers can do to enhance the quality and length of their lives. Most smokers are not happy with their habit, and the majority would like to quit if they knew how.²

Identified need

Health professionals are in a unique position to help Canadians stop smoking, and are perhaps Canadians’ most credible source of health information. Even a brief intervention by a health professional significantly increases the cessation rate. A smoker’s likelihood of quitting increases when he or she hears the message from a number of health care providers from a variety of disciplines.³

Quitting smoking requires a comprehensive approach e.g., assessment, counseling, pharmacotherapy, ongoing support, relapse prevention strategies. Supportive counseling is important to help patients through their quitting process to address the various aspects of their lives that make them smoke.

Proposal

A Family Health Team is an excellent setting for health professionals to take a leadership role in smoking cessation because many Canadians visit their family physician at least once a year. The Behaviour Counsellor has five years experience in smoking cessation. The one-on-one program had a 60% success rate, and the group program had a 50% success rate (success rates are one-year post quit date). In most smoking cessation programs a quit rate of between 15 and 20% is considered a success.⁴

Proposed program

The Family Health Team setting lends itself to the one-on-one program. The benefit of a one-on-one counseling program is that the program is available when the individual is ready; they don’t have to wait until a group program starts. A comprehensive smoking cessation program that addresses nicotine addiction as well as behaviour change is necessary because behavioural therapy is impossible if someone is in withdrawal. The patients will be referred by their family physician or the nurse practitioner. The program will consist of:

Behavioural addiction assessment
Adjunctive pharmacologic therapy
Relapse prevention

Program structure

4 sessions.

Assessment: nicotine dependence and readiness to quit. Develop plan.
4-5 days post quit date: behaviour counseling – education; replacement activities.
3 weeks post quit date: behaviour counseling – education; relapse prevention planning.
3 months post quit date: behaviour counseling – relapse prevention and maintenance.

Frequency

The program will be provided as part of the Mental Health Counsellor position, and therefore available ongoing.

Program cost

The Mental Health Counsellor/Behaviour Counsellor is already part of the Family Health Team, so there is no additional staffing cost. The patients will purchase their own recommended pharmacologic products, which will be their investment in their health improvement program. A small grant will help with advertising and marketing this program to our patients.

Program expenses

Mental Health Counsellor
Administration (office equipment, stationery supplies)

Cited document

Tobacco: The Role of Health Professionals in Smoking Cessation – Joint Statement

(developed co-operatively by the Canadian Association of Occupational Therapists, Canadian Association of Social Workers, Canadian Dental Association, Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, Canadian Physiotherapy Association, Canadian Psychological Association, and Canadian Society of Respiratory Therapists.)

Forum: Pathfinder's Guide to FHTs

Xwave User Group

Sun, 22 Oct 2006 22:00:42 GMT

What are you currently using to scan information into the EMR?

How does it work?

How can the system be improved?

Forum: Information Technology

Purkinje Usr Group

Sun, 22 Oct 2006 21:59:56 GMT

What are you currently using to scan information into the EMR?

How does it work?

How can the system be improved?

Forum: Information Technology

P & P User Group

Sun, 22 Oct 2006 21:58:53 GMT

What are you currently using to scan information into the EMR?

How does it work?

How can the system be improved?

Forum: Information Technology