Report No. 007-12

Physician Outreach Initiative 

Recommendation

It is recommended that Report No. 007-12 re Physician Outreach Initiative be received for information.

Background

Patients acknowledge their physicians as a reliable source of health information and will often make recommended behavior changes as a result of their advice. Recognizing the importance of this, Health Unit staff support local physicians by providing evidence-based, current information about public health programs and resources.  

In 2010, the Young Families Team committed staff and program resources to plan and implement an initiative intended to increase knowledge and foster ongoing relationships between primary health care providers and the Public Health Nurses (PHNs) who provide services in the Well Baby/Child and Breastfeeding Clinics. Physician offices in London and Middlesex County were demographically aligned with the location of the clinics and designated to the appropriate PHNs.  PHNs conducted a personal visit to physicians, providing the office with the Health Unit’s Physician Resource Binder.  A significant portion of the visit included discussion about the Enhanced 18 Month Well Baby Visit, the new Billing Code related to this issue, identification of developmental concerns and referral processes to local specialized children’s services support agencies.  Physicians were asked to complete a survey to gain information regarding their knowledge level about the Enhanced 18 Month Well Baby Visit, local community resources, services provided by the Health Unit and their current practice.  A project lead was assigned to the initiative in order to ensure coordination, achievement of timelines, consistency for future correspondence, and an efficient process regarding requests for resources. 

Results

Over 80% of primary care offices on the list of physicians were visited by a PHN.  Fifty per cent of physicians on the list participated in an office visit. In total, 343 individuals participated in the visits. Close to half (44%) of the individuals attending the visits were physicians.  In addition, there were nurses (29%), medical residents or nursing students (12.5%) and receptionists (7%).  The remaining individuals in attendance included allied health professionals such as dental staff, social workers and administrators. Based on the qualitative feedback following the visits, it was noted that some respondents appreciated the resources, while others appreciated the information and discussion about the Enhanced 18 Month Well Baby Visit and identification of developmental concerns. This engagement of physicians and office staff resulted in numerous opportunities to provide information sessions, presentations and networking meetings with primary health care providers.

Related Outcomes

• Presentations were delivered to Hospital Grand Rounds on 2 occasions reaching 87 physicians and medical residents; Family Health Team nurses; medical residents; and local nurse practitioners.
• Information sessions and networking opportunities at the Annual Physician Clinical Day in 2010 and 2011 resulting in a total of 250 physicians receiving information and resources.
• An article was written and published in the St. Joseph’s Health Care Centre Partnership Newsletter outlining the services of the Health Unit and the Enhanced 18 Month Well Baby Visit Initiative. 
• An information session at the Children’s Aid Society (CAS) resulting in 5 subsequent presentations to CAS case managers, staff members and foster parents regarding the importance of developmental screening and available support services to all social workers within the agency thereby enhancing the working relationship.
• A presentation to The Southwest Ontario Aboriginal Health Access Centre leading to additional inservices to the medical staff on the Chippewa on the Thames Reserve.  Concerns were expressed about young aboriginal women refusing recommended vaccine in a school setting and resulting in consultation with the health unit regarding the provision of service in a more culturally appropriate setting.  The medical staff was provided with a list of Health Unit contact people for the Healthy Babies Healthy Children program, prenatal programs, developmental screening tools and nutrition resources thereby increasing the partnership and linkages to services to the rural aboriginal population in Middlesex County. 
• Information sessions with physicians and primary health care providers led to the identification of gaps in the referral process for children at risk for developmental delays resulting in the formation of a Specialized Children Services and Supports Committee to explore how intervention and support organizations could work more closely together.
• A Physician Champion Committee was established to develop strategies to enhance connections, networking and educational opportunities with physicians and primary care providers.
• In the spring of 2011, the Young Families Team began to coordinate physician mail-outs every 4-6 weeks which include new resources on identified priority topics and resource requests. A sample of the newsletter is attached as Appendix A.
• In October 2011, the Health Unit in collaboration with the Physician Champion Committee and the specialized children’s services and support agencies, hosted a workshop for 50 physicians. 
• The initiative has been presented at the Ontario Public Health Association/Association of Local Public Health Agencies Conference in Toronto and the National Community Health Nursing Conference in Halifax.

Conclusion and Next Steps

These highlights exemplify the benefits of relationship building with primary care practitioners and the importance of the physician outreach initiative. Family Health Services staff members are committed to building on the accomplishments of the Physician Outreach Initiative. Plans include making the Physician Resource Binder available electronically on the Health Unit website, continuing to provide resources through the physician mail-out, identifying and responding to education and networking opportunities, and engaging in an evaluation strategy.  Areas of focus will include the integration of the issues related to the social determinants of health and greater emphasis on supporting physicians as they work with pregnant women, including teens.

This report was prepared by Ms. Joanne Simpson, Public Health Nurse, Young Families Team; Ms. Ruby Brewer, Manager, Young Families Team; and Ms. Diane Bewick, Director, Family Health Services.

Graham L. Pollett, MD, FRCPC
Medical Officer of Health

This report addresses the following requirement(s) of the Ontario Public Health Standards: Child Health: To enable all children to attain and sustain optimal health and developmental potential #6, #7, #8 

Appendices available upon request.