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Clinical prevention prerequisites A framework for health authorities Ak’ingabe Guyon MSc MD CCFP FRCPC Public health and preventive medicine specialist.

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Presentation on theme: "Clinical prevention prerequisites A framework for health authorities Ak’ingabe Guyon MSc MD CCFP FRCPC Public health and preventive medicine specialist."— Presentation transcript:

1 Clinical prevention prerequisites A framework for health authorities Ak’ingabe Guyon MSc MD CCFP FRCPC Public health and preventive medicine specialist Montreal Public Health Unit Framework developped in collaboration with David Kaiser, Valérie Lemieux and Robert Perreault Thursday, May 29th 2014 CPHA conference, Toronto

2 Plan 1.Background and objectives 2.Clinical prevention prerequisites 3.Regional and provincial applications Clinical prevention prerequisites A. Guyon, May

3 Prevention: an essential public health function Public health Prevention Last 2006, Starfield 2008, BC Clinical prevention policy review committee 2009, It includes at least : Immunisation Counseling Screening and early detection Preventive treatments SurveillanceProtection Health promotion 3 Clinical prevention prerequisites A. Guyon, May Background and objectives

4 Clinical prevention prerequisites A. Guyon, May Initial project Montreal Public health unit within regional health authority Strategic planning exercise Clinical prevention services 1. Background and objectives

5 Clinical prevention prerequisites A. Guyon, May Drifting project …define public health’s role (regional and provincial) in clinical prevention 1. Background and objectives

6 Clinical prevention prerequisites A. Guyon, May Clinical preventive services USTFPHS, CTFPHC, Thivierge et al Clinical prevention prerequisites Walsh & McPhee 1992 Barr et al Groulx 2007, CSBE 2010 BC Lifetime of prevention 2009, BCMA 2010 US National prevention strategy 2011 UK Department of health Background and objectives

7 Objectives Clinical prevention prerequisites A. Guyon, May Propose a framework of clinical prevention prerequisites As a tool to rapidly identify who supports clinical prevention and how at a regional and provincial level Apply the framework at a regional level (Montreal Public health unit) at a provincial level (clinical prevention services taskforce among Quebec’s public health units)  Redefine public health’s clinical prevention mandates Assist the regional clinical prevention team as it reassesses its responsabilities over clinical prevention 1. Background and objectives

8 8 Clinical prevention prerequisites A. Guyon, May 2014 Transversal functions necessary for clinical prevention Orchestration Scientific leadership Direct support to clinicians Monitoring and surveillance Patient empowerment 2. Clinical prevention prerequisites

9 Clinical prevention prerequisites A. Guyon, May Clinical prevention prerequisites framework Orchestration Monitoring and surveillance Scientific leadership Patient empowerment Direct support to clinicians

10 10 Clinical prevention prerequisites A. Guyon, May 2014 Orchestration  Overall leadership and planning Responsibility for vision and planning Balancing prevention with other public health functions Ensuring a health equity focus  Stakeholders roles and engagement Role and boundary negotiation among institutions, multiple clinicians, NGOs, industry Workforce planning  Health care services that strenghten prevention Access, comprehensiveness, continuity, coordination  Funding and incentives Publicly funded coverage decisions on clinical preventive services Incentives to clinicians for quality and access to preventive services  Logistics for clinical prevention Patient recall and clinician reminder– Electronic health records  Populational prevention programs For example: cancer screening, immunisation, smoking cessation, etc. 2. Examples of clinical prevention prerequisites References on slide 6, Valaitis et al. 2009, Parks et al. 2012, Bodenheimer et al 2014.

11 11 Clinical prevention prerequisites A. Guyon, May 2014 Scientific leadership  Evidence based clinical prevention Assess new trends, evidence Priority setting of clinical preventive services and schedule Evidence based practice guidelines  Training and knowledge transfer Initial training of clinicians in clinical prevention Continuing professional education  Research on clinical prevention Clinical preventive services research Public health and health services systems conducive to prevention 2. Examples of clinical prevention prerequisites BC Lifetime of prevention 2009 Maciosek et al. 2009

12 12 Clinical prevention prerequisites A. Guyon, May 2014 Direct support to clinicians  Practice support Quality improvement teams Facilitation Communities of practice  Support of motivational interviewing techniques  Clinical decision support at point of care (web, apps, consultations to expert clinicians…) 2. Examples of clinical prevention prerequisites AHRQ, Put prevention into practice, 2005 Provost et al. 2007; Martel & Leaune, 2009; NICE 2014

13 13 Clinical prevention prerequisites A. Guyon, May 2014 Monitoring and surveillance  Monitoring Clinical prevention services access, uptake Quality improvement of clinical preventive services  Evaluation Of clinicial prevention services effectiveness and efficacy Of clinical prevention system’s implementation, relevance, efficacy, efficiency  Surveillance Preventable disease and injury trends 2. Examples of clinical prevention prerequisites References on slide 6 and Bodenheimer et al 2014

14 14 Clinical prevention prerequisites A. Guyon, May 2014 Patient empowerment  Vision of patients as partners  Supporting population demand for clinical prevention Media campaigns  Literacy friendly patient education material Unbiased and public prevention focused website(s)  Self management support Web-based personal health plans Self care guidelines for prevention 2. Examples of clinical prevention prerequisites References on slide 6 and Bodenheimer et al 2014

15 15 Clinical prevention prerequisites A. Guyon, May 2014 Usefulness of the clinical prerequisites framework Montreal public health unit Identification and analysis of all clinical preventive mandates Shared understanding of clinical prevention prerequisites across the public health unit’s divisions  Strategic support for the upcoming regional public health plan Provincial taskforce on clinical prevention among Qc public health units (Groupe de travail de la Table nationale de concertation en prévention clinique) Identification of local, regional and provincial stakeholders Diagnosis of current stakeholders’ involvement Systematic identification of gaps and overlaps  Strategic support for the upcoming provincial public health program 3. Regional and provincial applications

16 Clinical prevention prerequisites A. Guyon, May Stakeholders weakly coordinated and involved Towards a clinical prevention system Clinical prevention system Clinical and public health expertise centres (INSPQ, INESS) Ministry of health (public health, primary care, hospital services, RAMQ insurance plan, …) Regional health authorities and local centres (ASSS, CSSS) Public health (local, regional, provincial) Health care services (CLSC, clinics, hospitals pharmacies, etc.) Professional organisations (MD, nurses, pharmacists, etc.) Patients, NGOs, etc. 3. Regional and provincial applications

17 Clinical prevention prerequisites A. Guyon, May Questions ? Comments ? Regional or provincial experiences in planning a comprehensive clinical prevention system? Ak’ingabe Guyon

18 References Agency for healthcare research and quality (AHRQ). Put prevention into practice – website current as of November 2005 Barr V et al The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model. Healthcare Quaterly, 7(1) Bodenheimer T et al The 10 building blocks of high-performing primary care. Annals of family medicine 12(2) British Columbia (BC) Clinical prevention policy review committee A Lifetime of prevention. Ministry of health, Governement of British Columbia, Vancouver. BC. British Columbia Medical Association(BCMA) Partners in prevention. Implementing a lifetime of prevention plan. BCMA, Vancouver. Canadian task force on preventive health care (CTFPHC). Website consulted on may 19th Thiverge et al Évaluation Médicale Périodique. Direction de santé publique - Agence de la santé et des services sociaux de Montréal et Collège des médecins du Québec, Montréal, Québec. Commissaire à la santé et au bien-être du Québec (CSBE) Rapport d’appréciation du système de santé et de services sociaux. Adopte une approche intégrée de prévention et gestion des maladies chroniques: recommandations, enjeux et implications. Québec, Québec. Groulx S L’intégration des pratiques cliniques préventives. Guide pour la promotion et le soutien des pratiques cliniques préventives. MSSS. Québec. Last J A dictionary of epidemiology. New York: Oxford University press. Maciosek, M. V., Coffield, A. B., Edwards, N. M., Flottemesch, T. J., & Solberg, L. I. (2009). Prioritizing clinical preventive services: a review and framework with implications for community preventive services. Annu Rev Public Health, 30, Clinical prevention prerequisites A. Guyon, May

19 References Martel D., Leaune V L’amélioration des pratiques cliniques préventives à l’ égard des habitudes de vie. Recension des écrits. Direction de santé publique, ASSS de Montréal. National institute for health and care excellence (NICE) Behaviour change: individual approches. NICE public health guidance 49, National prevention council. National prevention strategy. America’s plan for better health and wellness. US Dept of health and human services. Office of the surgeon general, Washington, DC. Parks AV et al Opporunity knocks for public health departments: increasing the use of clinical preventive services by older adults. Policy note. UCLA center for health policy research. LA, California. Provost, M.-H. (2007). Description, impact et conditions d'efficacité des stratégies visant l'intégration de la prévention dans les pratiques cliniques : revue de la littérature. Québec, QC: Ministère de la Santé et des Services Sociaux. Starfield B, Hyde J, Gervas J, Heath I The concept of prevention: a good idea gone astray? J Epidemiol Community health 2008 (62) Walsh JME, McPhee SJ A systems model of clinical preventive care: an analysis of facotrs influencing patient and physician. Health Education Quarterly 19, United Kingdom’s Department of health Living well for longer. National support for local actions to reduce premature avoidable mortality. April London, UK. U.S. Preventive services task force (USPST). Website consulted on may 19th Valaitis R et al A scoping literature review of collaboration between primary care and public health. Report to the Canadian health services foundation. Clinical prevention prerequisites A. Guyon, May


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