Hamilton Family Health Team &
Hamilton Developmental Service
Organizations
Better Health through Collaboration
Agenda
1. Welcome & Introductions - Dr. Ruth Morris & Donna
Marcaccio
2. Hamilton Family Health Team: Overview, Interest – Dr.
Ruth Morris
3. Overview of Primary Care Guidelines: Annual Physical
Recommendations – Tom Archer
4. Overview of HCARDD findings: LHIN 4 group home
residents – Tom Archer
5. Barriers and solutions to increase rates of annual
physicals (all)
6. Other health care / dental care issues (all)
7. Identify barriers and solutions to address other health
and dental issues (all)
8. Next steps (all)
Hamilton Family Health Team Overview
• Largest Family Health Team in Ontario
• 166 family doctors, 250 other professionals
(Nurses, Dietitians, Mental Health Counsellors,
Psychiatrists, Pharmacists, Physician
Assistants, Physiotherapists)
• Serve more than half of Hamilton residents
• Multiple locations
• Work as a team
• www.hamiltonfht.ca
Canadian Primary Care Guidelines
• Developed using ‘expert opinion’, feedback
from 2006 guidelines, research (UK, USA,
Canada)
• Key recommendation: Perform an annual
comprehensive preventive care assessment
including physical examination and use
guidelines and tools adapted for adults with
Developmental Disability.
• Developed Preventative Care Checklists
adapted for people with Dev. Dis.
Why Annual Physicals?
“For adults with developmental disabilities,
secondary prevention is critical as they may not
have the ability to recognize the early signs and
symptoms of disease. When comprehensive
health assessments were undertaken in other
jurisdictions, they often revealed high rates
of concurrent treatable conditions.”
Lunsky Y, Klein-Geltink JE, Yates EA, eds. Atlas on the Primary Care of Adults with
Developmental Disabilities in Ontario. Toronto, ON: Institute for Clinical Evaluative
Sciences and Centre for Addiction and Mental Health; 2013.
Why?
“…family members or carers who know the person
well may not identify signs or symptoms if onset is
gradual…”
“Carers may under estimate the significance of
certain signs and symptoms indicating a health
need. This may result in treatment not being sought
and conditions becoming …more severe and
difficult to treat…”
McGrath A (2010) Annual health checks for people with learning disabilities. Nursing
Standard. 24, 50, 35 – 40.
Expected Outcome of Annual Physicals
• Decreased morbidity rate
• Decreased emergency department
visits
• Decreased hospitalizations
• Decreased mortality rate
• Decreased emotional and behaviour
disturbances
• Increased quality of life
Literature Review (38 Publications)
1. New diagnoses: 94%, 88%, 84%, 77%, 75%,
51%, 42%.
2. Number of new diagnoses: 1: 63%, 2: 25%,
more than 2: 12%
3. Seriousness of new diagnoses: 9%
4. New diagnoses: cancers, , diabetes, ,
infections, constipation, hypertension,
congenital heart disease, arrhythmias,
testicular abnormality, hypothyroidism,
GERD, mental health, hearing (wax)/ vision
impairment.
Janet Robertson, Hazel Roberts, Eric Emerson: Health Checks for People with Learning
Disabilities: A Systemic Review of Evidence. June 2010
Research Quote
“Of 202 people undergoing a health check, 95%
had associated medical conditions,
42%...previously undetected…An average of 5.4
medical conditions per person, 2.3…previously
undetected…2.7 conditions were not adequately
managed…65% of participants reported no
symptoms and 24% of carers said there were no
problems…”
Janet Robertson, Hazel Roberts, Eric Emerson: Health Checks for People with Learning
Disabilities: A Systemic Review of Evidence. June 2010
Research Quote
“Health screening of 13 participants referred for
behaviour management, whose behaviour was
considered by the consulting psychologist to
have possible medical etiology was undertaken
by a physician. Health conditions… were
identified in 10 (77%)…of these, 8 out of 10
people showed improvement in behaviour once
medical problems were addressed.”
Janet Robertson, Hazel Roberts, Eric Emerson: Health Checks for People with Learning
Disabilities: A Systemic Review of Evidence. June 2010
% of Adults receiving at least 1 periodic health
exam (April 2009 – March 2011)
60
52.2
50.9
50
40
30
No Dev Dis
26.4
22.0
25.3
22.9
Dev Dis
GH Res
20
10
0
Ontario
LHIN 4
Lunsky Y, & Heifetz M. The Primary Care of Adults with Developmental Disabilities in
Hamilton Niagara Haldimand Brant LHIN: A regional summary based on the Atlas on the
Primary Care of Adults with Developmental Disabilities in Ontario. Applied Health Research
Question Report prepared for the SNSC by the HCARDD Program, November 2015 .
Preventative Care Checklists
• Canada: Preventive Care Checklist Forms
(average risk & adapted for people with DD)
• UK: OK Health Check & Cardiff Health Check
(specific to people with DD)
• Australia: Comprehensive Health Assessment
Program (specific to people with DD)
• Queen’s FHT: IDD Health Check (adapted from
Preventative Care Checklist – DD)
Hamilton DS Annual Physical Forms
• 5 (n=9) organizations submitted Annual
Physical forms
• 95 Items on Preventative Checklist (adapted).
Organization Forms: 31, 12, 6, 30, & 14 items
• 2 organizations eager to pilot adapted
Canadian Preventative Care Checklist
Hamilton DS Other Forms
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•
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•
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Medical Appointment Records: 8
PRN Forms (behaviour & Physical Health): 4
Hospital Passports: 2
Seizure Protocol: 1
Medication Change: 1
Ability to self administer: 1
OTC Standing Orders: 1
Approval for Intrusive Physical Techniques: 1
Annual Physicals:
Barriers & Solutions
Other Health & Dental Issues:
Barriers & Solutions
Next Steps?
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•
•
•
•
•
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Form a Sub-Group to oversee implementation
Form a sub-Group to develop evaluation
Adopt a common Annual Physical Checklist
Include Checklist in OSCAR system
Identify HFHT Primary Care Physicians
Train HFHT staff
Communicate with other Primary Care Physicians
(FHT’s, CHC’s, …)
• Train DS Staff
• Communicate with Individuals & Family members
• Identify & overcome barriers to implementation