HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH … › goalsandachievements...Multidisciplinary HCP ....

HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH INTEGRATION NETWORK

CLINICAL SERVICES PLANNING PROJECT

Endocrine

PLANNING ADVISORY GROUP MEETING GUIDE

May, 2009

HNHB LHIN Clinical Services Planning Project, Planning Advisory Group Meeting Guide

1. Complete Template #1. Describe the strengths and challenges within the existing health care system in addressing population

health care needs for the PAG’s patient/client population. Primers for discussion: ‘Summary of Community Values and Preferences’ (Appendix A), ‘Criteria for PAG Service Delivery Models’ (Appendix B) and ‘Guiding Principles for PAG Service Delivery Models’ (Appendix C).

Template #1: Strengths and Challenges within the Current System in Addressing Population Needs PAG Name

PAG Facilitator

Strengths Challenges

DIABETES Haldimand-Norfolk Diabetes Program – shared cared visits – RN/Rd

come to physicians’ office to see diabetes patients together for the day

2008 Canadian Diabetes Association Clinical Practice Guidelines Available and better dissemination has occurred

Chiropody and specialized foot care available LHIN wide approach to diabetes is advancing i.e. collaborative Increasing number of endocrinologists Family Physician Care for diabetes is done well throughout most of

the LHIN Pre-diabetes treatment is positive World class, global research occurring within our LHIN that changes

care around the world

DIABETES Diabetes requires team care Clear gaps in services for diabetics i.e. wound care, foot care that’s

not costly Lack of systematic approach to chronic neuropathic pain Chiropody not available to all – equity of access does not exist Uptake of Clinical Practice Guidelines Standardized endo tests not available throughout the LHIN No coherent wound care system throughout the LHIN that follows

evidenced based best practice – large service gap PATIENT RELATED Denial among patients Patient non-compliance Patients’ belief that they’re immortal Traditional issues for diabetes and non-diabetes patients Self-management – engaging the patient – provide multiple

opportunities to capture many different people in many different ways Care is not currently offered to great extent in other languages

FINAL 2 of 24


SYTEMS Partnerships developed and in place; opportunities for change to

occur Role clarification in process Universal Health Care System Womb to Tomb Focus Legislations that have changed behaviours can be learned from i.e.

seat belts Social Determinants of health Prevention efforts are increasing Evidenced Based care is increasing Primary Care models that have patient-focused care and a

collaborative approach to patient care are increasing in the LHIN i.e. Family Health Teams and Community Health Centres

SYSTEMS Uptake of clinical practice guidelines Primary Care doesn’t measure outcomes, number of diabetic

patients, etc. Lack of ehealth across the LHIN Lack of disease management systems that can be implemented in

primary care and specialist settings – data management staff key to implementation of this

Transitions between providers Wait lists to see endocrinologists Lack of money for culturally diverse and sensitive models of care and

patient education materials No organization mandated to increase the uptake of best care Fee For Service family doctors don’t have access to an

interdisciplinary team Ability to work together, too many silos Population health care –family physicians are used to caring for

individuals not populations Patient centered care – who teaches it? Does it work? Diabetes Education Centres are stretched thin for resources Need additional funding for insulin pumps Silos need to be removed where public health is concerned and

clarity among public health departments related to there mandate; a clear delineation between health services and public health needs to occur

Health promotion infrastructure in communities is lacking that is population based not patient based (not a provider – patient relationship i.e. non-duty of care)

Lack of coordinated access to diabetes services Lack of coordinated, LHIN wide approach to chronic disease

management More resources to facilitate self-management

FINAL 3 of 24


Non-Diabetes I131 Program Health Service Providers Strong collaborative endocrinology model in Hamilton among

providers Residency training program Primary care handles hypo-thyroidism very well Good relation between primary care and tertiary care Primary care prepares well for referral to secondary and tertiary Specialists have respect for family physician resulting in educational

opportunities for family doctors Standardized endocrine tests that are occurring at HHSC

Non-Diabetes Primary care knowledge of thyroid and para-thyroid disease Lack of co-ordinated cancer care; there is an opportunity to capture

data when care is coordinated No system for thyroid cancer Limited opportunity for I131outreach to other areas (currently only in

Hamilton) due to limited infrastructure Thyroid cancer is not a ‘reportable’ disease Lack of infrastructure to deal with non-specific endocrine issues i.e.

polycystic ovary disease patients often over weight, development of diabetes is highly probable amongst this patient population but no services available to them for prevention of diabetes

Other rare diseases of that endocrinologists see (Cushings, Pituitary Disease)

Not enough endocrinologists

FINAL 4 of 24


2. Complete Template #2: Describe the leading factors that are most likely to increase or decrease the demand for health care by the PAG’s patient/client population by 2013. For each of these factors, indicate whether it will have a modest or significant impact on the future demand for health care. And, list factors that may influence the demand for care beyond 2013

Template #2: Factors Most Likely to Increase or Decrease the Future Demand for Health Care: PAG Name: Endocrine

Describe the Factor that will increase or decrease the demand for health care by 2013: Will this

factor have a modest or significant impact on future demand for health care?

Diabetes epidemic increasing rapidly SI Aging population SI Type 2 Diabetes occurring in 20 and 30 year olds SI Immigration SI Westernization of Aboriginal Population SI High birth rate among Aboriginal population SI Diabetes is a risk factor for dementia; as cognitive challenges increase one’s ability to self-manage decreases MI Poverty – impact on social-determinants of health, stress, increase likelihood of developing diabetes SI Decrease in blindness MD In order to maintain decrease in number of cases of blindness an increase in support services are needed SI

SI SI SI SI SI SI MI SI MD SI

FINAL 5 of 24


PAG Name: Endocrine

Describe the Factor that will increase or decrease the demand for health care by 2013: Will this factor have a modest or significant impact on future demand for health care?

Early prevention and identification of disease MI Higher rates of gestational diabetes SI More people with pre-existing diabetes choosing to get pregnant MI Redefinition of diabetes (ADA position statement that diabetes should be diagnosed on an HbA1C of 6.5% or higher) MD Decreased daily Physical Activity in schools MI ADP Pump use for Type 1 Diabetes SI Slight increase in auto-immune disease MI Better imaging SI Increasing Obesity Rates SI Advances in research (depends on results of research) MD/MI

MI SI MI MD MI SI MI SI SI MD/MI

FINAL 6 of 24


PAG Name: Endocrine

Describe the Factor that will increase or decrease the demand for health care by 2013: Will this factor have a modest or significant impact on future demand for health care?

What factors are expected to influence the demand for health care beyond 2013? Fee schedule compensation – consider using this both ways don’t just assume to pay docs to get them to do stuff, reward them for not doing unnecessary things as well Lack of health human resources Health human resources that are trained too specifically to handle multiple co morbidities seen in patients Evidence based best practice guidelines Decision support systems Technology Scope of practice Patients being better self-care managers Recognize patients can’t always manage ‘self-care’ need to find alternative for some patients i.e. family member, etc. More people suffering from dementia that are unable to care for themselves Research advances Aging population Strong sense of entitlement among patients Mental Health Patients experiencing high diabetes rates

FINAL 7 of 24


3. Complete Template #3. Describe the key components of an ideal service delivery model for the PAG’s target population.

Template #3: Components of an Ideal Service Delivery Model PAG Name: Endocrine PAG Facilitator: Deanna Bryant

Component of service delivery model

Services associated with this component of the model

Clinical and non-clinical interdependencies (e.g., DI, lab, other programs/services, other PAGs)

Linkages to community services

Health Promotion/Disease Prevention

Increase Physical Activity and healthy eating in the general population in order to decrease obesity rates. This service can be provided by 1-800 dietitian line, grocery stores, Public Health Programs High Risk Groups Recreational programs Sports Teams, Clubs, Groups Fitness Centers CDA Mental Health and Addictions Grocery Stores Meals on Wheels Churches Lifestyle Groups, Clubs, e.g. Walking Clubs Cultural and Faith Based Groups Public Education Providers (non-duty of care) Heart and Stroke Housing Help Centres Food Banks Poverty Reduction Strategies Walkable Communities Healthy Food Subsidy

Primary Care Labs Pharmacies Mental Health and Addictions Public Health Kinesiology Exercise Physiology Ministry Child and Youth Services Ministry of Community and Social Services Ministry of Health Promotion

Community Health Workers (like SOADI model) Public Health Municipalities Provincial Legislation Community Care

FINAL 8 of 24


PAG Name: Endocrine PAG Facilitator: Deanna Bryant





Primary Care

Family Physicians (FFS, FHG, FHN, FHT, CHCs, etc.) Nurse Practitioners Multidisciplinary HCP Psychology Consider areas with low access to physicians Chiropody Lab Pharmacy Lifestyle Coaches Adult mental health and Addictions Depends on other health conditions that may have precipitated the diabetes Physiotherapy Diabetes networks Social Services Kinesiologists Wound care ***all these services would be immediately accessible to the primary care provider and patient

All specialties More required in areas with limited physician support Dietary Support in community Walk-in Clinics Dentist Optometrist/Ophthalmologist Chiropodist CCAC

Expanded Role for Outreach Workers (like North Hamilton CHC) has for language specific programs. Base outreach on Six Nations model of community health workers who can communicate in different languages and are culturally sensitive. Expanded role for areas that lack full multidisciplinary teams. Ehealth enabled linkages

Pre-hospital Care (interpreted as scheduled pre-admission care for elected hospitalization)

Primary Care Pre- op clinics Complication Prevention Clinics Labs Pharmacy Diabetes Teams, Networks Mental Health and Addictions Diabetes and Pregnanc

Lab, DI, Pre-op Nurse CDA All specialties Pre-natal clinic

Pre-op link with MRP and diabetes Team- E.g. Plan or prepare for insulin/diet changes pre-op. Always a mystery and challenge for the patient Ehealth enabled linkages

FINAL 9 of 24







Acute Hospital Care

Diabetes support required for health service providers in all hospitals. Workload management reflects this to enable participation in knowledge transfer. Integrated into HSPs role through support of hospital leadership and LHIN. Standard approach to in patient care across the LHIN supported by the LHIN.

All specialties Dietary support Pharmacy Encourage self-management in hospital setting

CCAC Medication Reconciliation Clinician would facilitate discharge planning with family and services needed. CCAC, Senior Support, meals on Wheels Pre-printed orders Ehealth enabled linkages

Non-acute Hospital Care

Diabetes support required for health service providers in all hospitals. Workload management reflects this to enable participation in knowledge transfer. Integrated into HSPs role through support of hospital leadership and LHIN.

All specialties CCAC Medication Reconciliation Clinician would facilitate discharge planning with family and services needed. CCAC, Senior Support, meals on Wheels Pre-printed orders Ehealth enabled linkages

FINAL 10 of 24







Post-Hospital Care

Primary Care CCAC Variety of home services depending on the pt needs. Pharmacy Lab Meals on Wheels Chiropody Diabetes Management Programs

Lab Meals on Wheels Aging at Home Programs Alzheimer’s Society CNIB CDA Pharmacy

CCAC and Hospital Discharge Planner to Coordinate homecare based on Pt need Ehealth enabled linkages

Community-based Acute Care

See primary care, post-hospital care

Community-based Non-Acute Care

See primary care, post-hospital care

Long-Term Care

Primary Care Diabetes support required for health service providers in all hospitals to increase competency for diabetes care. Workload management reflects this to enable participation in knowledge transfer. Integrated into HSPs role through support of hospital leadership and LHIN.

All specialties Advanced Practice Nurses Primary Care Lab CCAC

Shared Care with Diabetes Teams Contracts shared between facilities Ehealth enabled linkages

FINAL 11 of 24


Diagram of

Ideal Service

Delivery Model:

FINAL 12 of 24


Template #4. Assess and Describe the PAG service delivery model using the HNHB LHIN Criteria PAG Name

Domain Criteria Assessment Description Strategic Fit Alignment with LHIN

priorities for health improvement

The Service Delivery Model for Diabetes will offer the right service, for the right people, at the right time. It will be built on Quality, Sustainability and Accessibility Strategies.

Alignment with trends in health care needs and system transformation

This model will allow building on existing services strengths that are unique to the different populations and geographical changes of the different parts which comprise LHIN 4. It will also allow for sustainability as demands grow in the future and allow linkages with other LHINs and eventually a provincial model of chronic care.

Health status (clinical outcomes & QOL)

This model through its linkages and coordination of services will improve outcomes across the continuum of care for all persons affected by diabetes.

Prevalence This model structure will assist the LHIN for future prevalence rates with their strategic plan.

Population Health

Health promotion & disease prevention

Health Promotion Strategies will reflect up and down the pyramid and be a constant common theme among all the linked services. Opportunities for Primary care input through the LHIN Service Manager will help drive public policy facilitate health promotion to be a common theme from top to the bottom of the pyramid of services.

Client-focus Within the core of this Service Delivery Model is the patient with Diabetes with their continuum of care. Cultural, economic, and unique learning characteristics will be addressed at every level of the pyramid.

Partnerships Unique population needs and current services will be respected and provided areas for growth within their services. Sharing of services will be coordinated/facilitated by the LHIN Service Manager to reduce duplication.

System Values

Community Engagement This model reflects the Community Values and preferences by being built on Quality, Sustainability and Accessibility. A component of the Service Manager Role is also to engage consumers for input.

FINAL 13 of 24


PAG Name

Domain Criteria Assessment Description Innovation

The service model is a compilation of a variety of chronic care and current diabetes models designed to suit the unique needs of our LHIN. Based on the input of the PAG members from the various disciplines involved with diabetes from both the rural and urban areas. This model links all the necessary services with information technology.

Equity The model will facilitate underserviced areas to receive equal “Best Practice” care as tertiary care levels through the design of the multidisciplinary teams which will be different and unique based on identified gaps and strong linkages with neighbouring services.

Efficiency (operational) The linkages within this model facilitated by the Service manager will optimize the services available.

Access The model will identify gaps in services through HCP portals that have not previously existed. This will be facilitated by the LHIN Service manager and be driven by the ongoing HCP communication established.

Quality Quality is part of the foundation in which this model will develop a sturdy support to enhance and continually allow growth for best practice, patient safety, and system efficacy.

Sustainability

This model has all the qualities needed to be feasible with specific timelines. It will offer a very tangible design which will connect with future provincial strategies for a chronic disease model.

System Performance

Integration

The theme throughout this model is one that offers a strong support for continuity of care across the continuum of care for a person and their families living with diabetes.

FINAL 14 of 24


4. Complete Template #5. Describe the pre-requisites, enablers and challenges to implementation of the ideal service model.

Template #5: Description of Pre-requisites, Enablers and Challenges to Implementation: Category Pre-requisites Enablers Challenges Policy/legislation o Public policy to improve

individual and population health and address inequities

o Sustainable funding for diabetes programs o Diabetes funding under LHIN mandate o Funding that allows for culturally sensitive

service delivery o Policies that positively impact the

determinants of health such as food, shelter, basic literacy and education.

o HSAA, MSAA, etc. accountability agreements that ensure competency in diabetes care e.g. acute and chronic institutional care, including mental health and addictions and ensure achievement of outcome measures

o Economic recession, increasing poverty and negatively impacting determinants of health

o

Resources (e.g., human, fiscal, capital, etc.)

o Increased primary care throughout the LHIN

o IT disease management and decision support systems built on health records

o Quality, Accessibility, Sustainability

o Development of a strong, well supported, managed, interdisciplinary, primary care service that is responsive to local population needs

o Information technology is essential for knowledge transfer, managed care, continuous improvement, innovation and sustainability

o Dietitians, foot care specialists and diabetic educators etc are

o Standalone bank of allied health providers that would support fee-for-service primary care including diabetes education and management

o Providing comprehensive allied health services in diabetes which is more then the traditional MOHLTC funded, RNs, dietitians, social work

o Increased numbers of endocrinologist in our LHIN

o Primary Care models that have patient-focused care and a collaborative approach to patient care are increasing in the LHIN i.e. Family Health Teams and Community Health Centres

o Consistent approach to e-health across the LHIN which would enable patient care to flow between the sectors and

o Diabetes requires team care o Clear gaps in services for

diabetics i.e. wound care, foot care that’s not costly

o Lack of systematic approach to chronic neuropathic pain

o Chiropody not available to all – equity of access does not exist

o Uptake of Clinical Practice Guidelines

o Standardized endocrinology tests not available throughout the LHIN so develop a regional center

o No organization mandated to increase the uptake of best care

o Access to lifestyle approaches

FINAL 15 of 24


details about the support and knowledge transfer that is part of the model and will be different for different centres e.g. rural or urban

o Knowledge based on best practice/current evidence

secure messaging for dialogue o Fee For Service family doctors should

have access to an interdisciplinary team of allied health professionals

o Increased number of Nurse Practitioners for chronic disease management clinics including diabetes

o Expansion of the current scope of practice for Primary Health Care Nurse Practitioners to include diabetes management

o Creation of Regional Service Management for our LHIN that provides integrated, analytical diabetes planning at the LHIN level i.e. system advocacy, coordination of access for diabetics

o Identification of diabetes resources in our LHIN

o Evidence based best practice, clinical guidelines and pathways

are limited which challenges the individual’s ability to make the necessary changes – it needs to be made easier

o TRANSPORTATION o Capital o Ongoing funding o Under resourced fee for

service physicians

Community readiness

o Effective community programs o Programs to promote healthy o lifestyles o Diabetes networks/Association o Recreational activities o Pre-diabetes care o Transportation

o TRANSPORTATION o Sustainable funding o Individuals that are not

prepared for behaviour change o Improved access to lifestyle

modification approaches

FINAL 16 of 24


Category Prerequisites Enablers Challenges Services

o Standardized endocrine tests o Uptake of CDA Clinical

Guidelines by all Health Service Providers

o Increased availability of primary care throughout the LHIN

o Appropriate management of diabetes care in primary care

o Strong self management component and organize services around this

o Delivery system design focused on prevention and improving access, continuity of care and flow through the system

o Chiropody and specialized foot care available to diabetics

o Strong network of, preventative, primary, secondary, tertiary care and centres of excellence based both in the community and institutions (e.g. hospital, LTCHs, etc)

o Clearly defined roles of services within the system

o Multidisciplinary teams at all levels and locations

o Inclusion of populations with special needso Responsiveness to local population needs

o TRANSPORTATION o Current services need gaps

identified

Partnerships/linkages

o Shared cared visits – RN/Rd come to physicians’ office to see diabetes patients together for the day

o Strong linkages supporting the linkages for patient care between providers/services, between various levels of care (preventative, primarily, secondary, tertiary) and between care settings (hospital, community, LTC)

o Provide information on foot care for diabetic patients when they come in for flu shots

o Provide health fairs in ethnic centres where information on healthy eating that’s culturally sensitive can be provided

o Transitions between providers needs to occur more seamlessly

o Development of a network of networks for diabetes care in our LHIN

o Multidisciplinary teams o Development of formal and informal

linkages/partnerships o Care pathways that extend between

partners o Integration between healthcare and social

programs

o TRANSPORTATION

FINAL 17 of 24


Patients

o Appropriate self-management o Cultural sensitivity o Commitment to client centred

philosophy by all o Accessibility to health service

provider o

o Innovative patient interactions o Patient plays a central role in managing

health care o Access to behavioural modification

resources

o Denial among patients o Patient non-compliance o Patients’ belief that they’re

immortal o Traditional issues for diabetes

and non-diabetes patients o Self-management – engaging

the patient – provide multiple opportunities to capture many different people in many different ways

o Care is not currently offered to great extent in other languages

o TRANSPORTATION Non-Diabetes o Existing referral pattern to

endocrinology to continue o Development of a 1-800 for referrals to

endocrinologist e.g. CCAC Care Connectors as a model for this service

o Decision aids/algorithms need to be developed

o Model LHIN approach after Hamilton’s approach to endocrinology care

o I131 outreach to areas outside of Hamilton can occur

o Infrastructure may need to be enhanced in some communicates to allow for I131 outreach to occur

o TRANSPORTATION

FINAL 18 of 24


Appendix D: Meeting #1: PAG Meeting Summary Form: PAG Meeting Summary Form Meeting #1


Summary of PAG progress PAG was able to work through the strengths and challenges related to endocrinology. They have taken the approach of addressing diabetes and non-diabetes care separately. The PAG also determined factors the feel will impact the demand for endocrine related services between now and 2013. Instead of listing the key components for the ideal service delivery model (Template #3) the members chose to focus on two models that had been developed as straw-dogs and work backwards. They will review the completed templates, populate Template #3 and contemplate the ideal service delivery model before the next meeting. In addition they will consult with relevant peers over the next few weeks to complete Appendix G as this is a highly important part of the process. It’s important to note that the group has not yet addressed in-patient care. Outstanding questions or Issues for follow-up Who will address pediatric endocrinology, not just Type 1 diabetes? Information and questions to be communicated to other PAG(s) Linkages with renal, maternal, ophthalmology, cancer need to occur. Other comments

FINAL 19 of 24


Appendix E: Meeting #2 PAG Meeting Summary Form: PAG Meeting Summary Form Meeting #2

PAG Name: Endocrine Facilitator: Deanna Bryant

Summary of PAG progress Templates 1, 2 and 3 updated and completed. Members contacted colleagues – one member even conducted a survey with 60+ physicians in their area Group decided to work on diagram of service delivery model for diabetes rather than complete templates as they found this more useful. Agreed to complete Templates 4 and 5 as homework as a result of this decision. Outstanding questions or Issues for follow-up Information and questions to be communicated to other PAG(s) Other comments

FINAL 20 of 24


Appendix F: Meeting #3 PAG Meeting Summary Form: PAG Meeting Summary Form Meeting #3

PAG Name: Endocrine Facilitator: Deanna Bryant

Summary of PAG progress Completed Templates 1, 2, 3 and 5 as a group. Template 4 was completed individually by a few members and what is captured in template 4 is currently (as of June 18) an unedited compilation of a few member’s responses; it has yet to be reviewed by the entire PAG. The diagram of the service delivery model was modified somewhat last night and will be circulated by Les once the revisions are completed. Evaluations were completed by the group. Outstanding questions or Issues for follow-up Members need to review the templates for an outstanding items/issues and respond to Deanna with comments by June 26, 2009 Information and questions to be communicated to other PAG(s) – Indicate if a joint meeting with another PAG is desired. Other comments

FINAL 21 of 24


Appendix G: PAG Feedback Form PAG Name: Facilitator:

FINAL 22 of 24


FINAL 23 of 24

Source of information: Cindy Gekiere RN, CDE Haldimand-Norfolk Diabetes Program Coordinator Survey of Colleagues

Key points: 1. What do you see to be the Strengths and Challenges within our current Healthcare System in

Addressing Population Needs? Strengths- Established Diabetes Clinics , with CHC coming to Brant they will be able to manage less complex patients, variety of programs currently available, we have the ability to change or program to suit the needs of our pop. with reasonable access, Good communication, Prediabetes Program at FHT compliments diabetes program, provincial commitment to address diabetes in a coordinated manner throughout Ontario, effective Diabetes program exists, current services are free, current services exist with medical Directives, Challenges- Lack of electronic health record for all services, not utilizing best practices uniformly, need more health promotion, communication about perceived wait times not usually accurate, certain practitioners not current on guidelines and prescribing in antiquated ways, mobility of clients, increasing numbers diagnosed, increased acuity of pts seen, large pay disparity between community and hospital-based programs, variability of qualified people, poor care of in hospital patients, not enough space is many current facilities, many have no doctors, not enough gov funding for pumps providers to be covered, lack of primary prevention needs, lack of human resources needed and funding for them,

2. Identify factors you see that will most likely increase or decrease this demand. Demand will increase with aging pop, lack of family physicians will fragment approach to care, aging, obesity, poor lifestyle, tightening diagnostic criteria.

3. What do you see to be an ideal service delivery model for Diabetes Care in our LHIN?

Coordination of care amongst all diabetes healthcare professionals, less duplication of services, define roles, agree and focus, a combination of on-site practical nurse driven programs with hospital based resourceteams, teams of physician, diabetes nurse educator, dietitian, linked with Diabetes Daycare programs, current model is good but more funding for outreach for RN/RD team to share care with physicians offices for patients with mobility issues who are not part of FHT’s, Primary Care- newly diagnosed and some education classes, Hospital based- advanced care- Type 1, peds, pumps, MDI/FIT, medically complex who is linked with an endocrinologist., inpt CDE’s to oversee inhosp pts, we need a continuum of care for patients including an accurate health record, ongoing education for all providing care, accountability for providers to achieve provincial goals/benchmarks. Accessible diabetes care centers, multifaceted- chiropody, RN, RD, with primary care involvement.


FINAL 24 of 24

4. Describe what you see to be pre-requisites, enablers, and challenges to the Implementation of an

Ideal Service Delivery Model for our LHIN. Shortage of HCP is an issue, resources are not equitable across the LHIN, obtaining buy-in to the plan being developed by your planning advisory group from all providers, key enabler is the electronic health record, lack of adequate public transportation is required by many patients, funding, human resources, dedication of staff, acceptance and development of more FHT’s, stakeholder participation, provider education, implementation or standards of care, set-up the DEC’s to be the resource and train the community and hospital personnel, the HCP delivering the care and the consumer needs to be included in the planning process, funding for diabetes cannot be dependent on other global budgets, don’t forget rural vs. urban issues are very different.

HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH … › goalsandachievements...Multidisciplinary HCP ....

Documents

Transcript of HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH … › goalsandachievements...Multidisciplinary HCP ....