Leveraging Innovative Leadership Models within Community and Healthcare Organizations to Support Safe School Reopening during the COVID-19 Pandemic.

Little has been published on successful leadership models within integrated care systems. Within East Toronto Health Partners, there have been considerable efforts at the executive leadership level to empower local leadership, particularly physician leaders, to develop and execute effective solutions across the community. What does distributed leadership look like, and what does it take to implement it? A number of activities demonstrating the impact of a distributed leadership model in East Toronto are outlined in this paper, offering an effective defence against the enormous challenge posed by the COVID-19 pandemic.

Mobilizing a Whole Community: Policy and Strategy Implications of an Integrated Local System Response to a Global Health Crisis.

The East Toronto Health Partners (ETHP) include more than 50 organizations working collaboratively to create an integrated system of care in the east end of Toronto. This existing partnership proved invaluable as a platform for a rapid, coordinated local response to the COVID-19 pandemic. Months after the first wave of the pandemic began, with the daily numbers of COVID-19 cases finally starting to decline, leaders from ETHP provided preliminary reflections on two critical questions: (1) How were existing integration efforts leveraged to mobilize a response during the COVID-19 crisis? and (2) How can the response to the initial wave of COVID-19 be leveraged to further accelerate integration and better address subsequent waves and system improvements once the pandemic abates?

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine.

PURPOSE: Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada. METHODS: We assessed feasibility of the TIP model from the number of referrals from PCPs and emergency departments in Toronto, Canada; the intervention cost; and the satisfaction of patients, PCPs, and team members with the new model. One patient and PCP story highlights the model's impact. We also performed thematic analysis of written feedback. RESULTS: A total of 76 patients were referred from 53 PCPs and 4 emergency departments, and 65 PCPs participated in TIP. All 74 patient survey respondents indicated TIP improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use TIP again, and 90% reported improved confidence in managing their patient's care. Of 87 team member survey respondents, 97% rated TIP as effective. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088). CONCLUSIONS: TIP is a feasible intervention in multiple primary care settings that gives patients an active role in their health management, supported by their team. The model effectively addresses the needs of the most complex patients and their PCPs.

[Family Health Teams in Ontario: Ideas for Germany from a Canadian Primary Care Model]. / Family Health Teams in Ontario ­ Vorstellung eines kanadischen Primärversorgungsmodells und Anregungen für Deutschland.

The German healthcare system is struggling with fragmentation of care in the face of an increasing shortage of general practitioners and allied health professionals, and the time-demanding healthcare needs of an aging, multimorbid patient population. Innovative interprofessional, intersectoral models of care are required to ensure adequate access to primary care across a variety of rural and urban settings into the foreseeable future. A team approach to care of the complex multimorbid patient population appears particularly suitable in attracting and retaining the next generation of healthcare professionals, including general practitioners. In 2014, the German Advisory Council on the Assessment of Developments in the Health Care System highlighted the importance of regional, integrated care with community-based primary care centres at its core, providing comprehensive, population-based, patient-centred primary care with adequate access to general practitioners for a given geographical area. Such centres exist already in Ontario, Canada; within Family Health Teams (FHT), family physicians work hand-in-hand with pharmacists, nurses, nurse practitioners, social workers, and other allied health professionals. In this article, the Canadian model of FHT will be introduced and we will discuss which components could be adapted to suit the German primary care system.

Family medicine training in housecalls: Survey of residency program directors across Canada.

OBJECTIVE: To assess the current landscape of home-based primary care (HBPC) or home visit training for Canadian family medicine residents. DESIGN: Online survey. SETTING: Canada's 17 family medicine residency programs. PARTICIPANTS: Family medicine residency program directors. MAIN OUTCOME MEASURES: Program characteristics, current HBPC training, barriers and enablers to training, and program directors' attitudes toward training. RESULTS: There was a 76% response rate (13 of 17 program directors). Respondents' programs ranged in size from 75 to 300 residents (median 160) and closely reflected actual resident distribution of family medicine residents in Canada. Twelve of the 13 programs offered HBPC training including home visit experiences. Six programs had HBPC-related didactic lectures. None of the respondents had a formal program-wide clinical home visit curriculum, and HBPC training availability and requirements varied across programs. The most frequently cited barriers included logistical constraints, limited faculty availability, and safety concerns. Program directors generally agreed that HBPC training is essential to family medicine training, that it provides valuable learning experiences for family medicine residents, and that it effectively prepares residents in core family medicine competencies. None thought that HBPC training was too difficult to coordinate or that its barriers outweighed its educational benefits. CONCLUSION: There is increasing need for HBPC delivery in Canada, and program directors agree that HBPC training is important and worthwhile. However, barriers exist. Current HBPC training in Canada varies in its availability and requirements, and structured program-wide home visit curricula are absent. We recommend development of a central framework for a structured HBPC curriculum that is competency-based and adaptable.

It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada.

The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.