OCN: Clinic Updates Quarterly Meeting June 8-9, 2017

Overview Hospital / Staffing issues Trends (referral, clinical) Engagement in care (strategies) Community issues or trends New tools

Who we heard from 13 responses received 21 clinics invited 62% response rate

1. Staffing issues Key themes

Staffing issues New staff Change in location Vacancies SIS team leader, NP relief, 4 new RN relief (OASIS, Ottawa) New clinic coordinator (St. Joseph’s, London) New clinic medical director (Elevate NWO, Thunder Bay) Change in location Move to new location out of hospital went well (SIS, Hamilton) Vacancies Psychologist (CHEO) Nurse on leave due to surgery, no replacement (Sunnybrook) Staff turnover (medical reception, NP on leave) (OASIS, Ottawa) Applied for more funding for NP (Univ of Ottawa Health Services)

2. Trends Referrals & Clinical

Refugee claimants / foreign students Newly returned to clinic Trends: New referrals Increased testing Increase in number of people coming in for testing (St. Joseph’s, London) PREP More referrals (St. Mikes 410 Sherbourne, Lakeridge, Whitby) Refugee claimants / foreign students Refugee claimants, foreign students illnesses (Sunnybrook, Toronto) HCV Increase referrals (St. Mikes 410 Sherbourne, OASIS Ottawa) More new patients infected with Hep C (St. Joseph’s, London) Newly returned to clinic 1 out of 6 new patients are patients not seen for a few years (Sunnybrook, Toronto) Transfers to adult care Referrals from Sick Kids (Sunnybrook, Toronto) Increased referrals Increased referrals for people whose risk factor is IDU (St. Joseph’s, London) Referrals to mental health support (Bloom, Brampton) Referrals for primary care (Univ of Ottawa Health Services) 1 newly diagnosed patient resistant to treatment (Univ of Ottawa Health Services)

Trends: Clinical Treatment Community Care issues Patient profile - RAPID antiretroviral initiations for newly diagnosed on intake visit (Lakeridge Whitby) Community Refugee referrals with court dates in 3 weeks and need results returned in 2 weeks (Sunnybrook Toronto) Care issues Syphilis (St. Josephs London, ) Cluster of HCV in MSM with HIV with gen 4 HCV (St. Mikes 410 Sherbourne) Increased health care needs related to chronic disease and aging (Bloom, Brampton) Case of poor compliance following pregnancy and denial of diagnosis leading to poor health outcomes (Univ of Ottawa Health Services) Patient profile MSM and young gay men new diagnoses (Lakeridge) HIV epidemic for PWUD (St. Josephs London) New infections in patients prescribed PREP (St. Mikes 410 Sherbourne) Increased use of fentanyl (OASIS Ottawa)

3. Engagement in care Strategies

Engagement in care: Strategies Collaboration Outreach contacts, assistance from community partner, OTN MD & psychiatry (Lakeridge, Whitby) Community planning committee for all agencies to work together (St. Joseph’s London) Patients lost to follow-up decided to see family doctor only (Sunnybrook Toronto) Collaboration with onsite programs (food bank, complimentary therapy) (Elevate NWO Thunder Bay) Communication with patients Reminder calls, emails, texts, (Lakeridge Whitby, UHN Toronto General Hospital) Scheduling Stagger staff schedule for better coverage (Lakeridge Whitby) Flexible scheduling, walk-in appts (St. Mikes 410 Sherbourne, OASIS Ottawa, Elevate NWO Thunder Bay) NEW Tracking tools in EMR to look at engagement strategies (Lakeridge, Whitby) NEW Report of ER visits for patients that have fallen out of care (HAVEN Sudbury)

4. Community Issues & Trends

Community Meeting with women’s health providers (CHEO Ottawa) Referrals to CMHA health link to better coordinate care (Haven Sudbury) Social worker meets weekly at ASO (Lakeridge Whitby) ASO community forum (St. Mikes 410 Sherbourne) Application for SIS ongoing (OASIS Ottawa) Drug strategy and local groups working towards SIS application (Elevate NWO Thunder Bay) Collaboration with health unit, ASO and community partners to coordinate response to HIV epidemic (St Joseph’s London)

5. New tools Examples

New tools Intimate partner violence (IPV) screen collaboration with social work and nursing. A safety initiative is being developed for a gender neutral IPV assessment tool and strategy. (UHN Toronto General) Cryogun and cryocontainer (ARCH Guelph) Multi-agency consent form to improve communication among partners (St. Joseph’s London) New EMR coming soon (Windsor) QI on syphilis management and follow-up (St. Mikes 410 Sherbourne)

Thank you Comments? Reflections? Presentation template by SlidesCarnival Photographs by Death to the Stock Photo (license) Icons made by Freepik from http://www.flaticon.com and is licensed by Creative Commons BY 3.0 http://creativecommons.org/licenses/by/3.0