Special delivery: maternity care fieldtrip to Princeton Just what is it like for expectant

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1 Special delivery: maternity care fieldtrip to Princeton Just what is it like for expectant mothers and their physicians in Princeton? Penticton maternity care providers went on a fieldtrip to find out. From that visit came an appreciation of how little resources currently exist in Princeton, and what more needs to be done to assist rural maternity patients. Currently, expectant mothers with low risk pregnancies receive care from Princeton doctors and nurse practitioners until they are weeks into their pregnancy. Care is then transferred to a Penticton-based maternity care provider, which results in monthly, then bi-weekly and eventually weekly visits to Penticton. Princeton General Hospital stopped providing labour and delivery care in the early 2000s. Once this service was discontinued, the skills of nursing staff and the equipment, such as an incubator currently stored in the library closet, stopped being maintained. This results in an unease among Without a practicing dermatologist in the South Okanagan, family physicians are turning to teledermatology as a way to set up referrals and provide dermatology care. Oliver physician, Dr. Rob Swan, has visited every doctor s office in Oliver and Osoyoos to spread the word about ConsultDerm, a program that gives online access to dermatology assistance. He also lets physicians know who is already using this program, such as Dr. Carmel Anderson, a Kelowna dermatologist. She gives an excellent PROJECT UPDATES Spring 2016 From left: Dr. Kevin Renaud (OBGYN), Dr. Jose Goncalves (OBGYN), Dr. Greg Selinger (Family Physician/Obstetrics), Alyson Jones (Willow Midwives), and Dr. Ella Monro (Princeton physician) tour Princeton General Hospital to assess maternity care needs. the physician and nursing staff about being able to manage a labour and delivery in our hospital together as a team, explains Princeton physician, Dr. Ella Monro. One nurse said to me, I d way rather deal with a patient walking through the door with a cardiac arrest than a healthy woman going into labour. This fieldtrip highlighted opportunities to better co-manage and transition women smoothly from Family physician championing teledermatology in Oliver/Osoyoos Oliver physician, Dr. Rob Swan, is spreading the word about the benefits of ConsultDerm online consultation, says Swan. Swan has also started to engage Penticton and Princeton physicians, letting them know how to involve MOAs in consultation requests, and how to get complete consultation care in Princeton to care in Penticton so that all three partners, the Princeton physicians, the Penticton physician and the patient all feel supported and connected in the care that is being provided. A patient-centred model of care will ideally include obstetric emergency training for Princeton physicians and nurses, telematernity and earlier involvement of Penticton maternity care providers. records on EMRs. Swan also will present at PRH Tuesday Rounds in June. Once doctors get using the program, I think they will find it a useful tool and be valuable in the care of some of our patients with skin problems. Last fall, 37 physicians attended a Shared Care dermatology/ teledermatology CME, featuring retiring Penticton dermatologist Dr. Rusty Harris, and Salt Spring family physician Dr. Paula Ryan. If you missed this CME and/or would like more information, please contact: tracy.stclaire@sosdivision.ca. South Okanagan Similkameen Shared Care initiatives enable family and specialist physicians to work together within their communities to improve patient care

2 Shared Care in our Community PROJECTS ON THE GO... Telemedicine Using technology to connect rural patients to Penticton specialists Project Contact: Tracy St. Claire WHO IS INVOLVED Drs. Jose Goncalves, Marina Louw, Ella Monro, Kevin Renaud, Robert Swan, Michelle Teo, Shannon Walker, Lloyd Westby; (IH) Susan Brown, Viola Brown, Chris Danby, Lori Motluk, Cherie Whittaker; (Shared Care staff) Primary Maternity Care Bringing together primary maternity care providers to co-design a sustainable model of maternity care Emergency Connecting patients presenting to emergency with the right care, the right provider at the right time Child and Youth Mental Health And Substance Use Increasing the number of children, youth and their families receiving timely access to integrated and appropriate mental health and substance use services and supports, while involving children, youth and families in that care Documenting barriers and gaps in care for resolution at a higher systems level Project Contact: Tracy St. Claire tracy.stclaire@sosdivision.ca Drs. Armelie dela Cruz, Steve Evans, Alicja Frasinski, Lisa Friesen, Jose Goncalves, Manoj Parameshwar, Kevin Renaud, Julie Ryckman, Greg Selinger, Sue Severide, Marius Snyman, Cara Wall, Danielle Weisgarber, Murali Venkataraman; (midwives) Alyson Jones, Suzanne Lobb, Jennica Rawston, Christy Raynolds, (IH) Lori Motluk, Patricia Park, Kerry Rollison, Maureen Spinks, Elaine Stetsko; (Shared Care Staff) Project Contact: Tracy St. Claire tracy.stclaire@sosdivision.ca Drs. Zoe Ayling, Brent Harrold, Heidi Ingram, Jeff Plant, Shannon Walker; (IH) Susan Brown, Anne Morgenstern, Lori Motluk, Deborah Runge; (Shared Care staff) Seeking interested physicians for involvement in this new project: Project Contact: Tracy St. Claire tracy.stclaire@sosdivision.ca SOUTH OKANAGAN LOCAL ACTION TEAM: Drs. Vijender Balain, Barb Main, Manoj Parameshwar, Elmine Statham, Kyle Stevens; (IH) Ginger Challenger, Debra Forcier-Salverda, Denise Kayto, Jamie Marshall, Anne Morgenstern, Joseph Savage; (SD #67) Louise Ganton, Michelle Glibbery, Adelle Jones, Todd Manuel, Brad Russill, Tracey Sorensen; (MCFD) Deb Hardman, Lars Larsen, Jason MacKenzie, Deneen Ollis, Cindy Whitford; (PDCRS) Tanya Behardien; (CMHA) Jessica Lutz, Dennis Totteham; (FORCE)Traci Cooke, Tricia Highley, Harry Holman, Rylee McKinlay, Terri McKinlay, Jim Pearmain; (PIB) Ted Cutbill, Lynn Kruger; (Rotary) Brian Hughes, Milton Orris; (RCMP) Mark Provencal; (Boys & Girls Club) Jen Anderson; (MLA office) Dan Ashton, Dick Knorr; (PSP Coordinator) Wendy Boyer; (Penticton Mental Wellness Centre) Jim Cleghorn; (City of Penticton) Helena Konanz; (Community Foundation) Aaron McRann; (Pathways) Daryl Meyers; (YES) Amberlee Erdmann, Melissa Redfern; (Shared Care Staff) OSOYOOS OLIVER OKANAGAN FALLS LOCAL ACTION TEAM: Drs. Peter Entwistle, Steve Evans, Elmine Statham, Garnett Tarr, Jan Venter; (IH) Dayle Drury, Stuart Johnston, Tanya Potts, Joseph Savage, Barbara Taggart; (SD #53) Shendah Benoit, Terry Collis, Tammy Gendron, Sara Illingworth, Tina Lovett, Karin Maertins, Adrienne Mailey, Margaret Nazaroff, Tuson Pearle, Ron Rachinski, Mike Safek, Karen Sinclair, Marieze Tarr, Bev Young; (RCMP) Randall Bosch, Blaine Gervais, Susan Harper, Kurt Lozinski, Kirsten Marshall, Mark Provencal, Tina Wallner; (MCFD) Staci Friesen, Jason McKenzie, Chad Teigen; (OIB) Lindsay Anderson, Matthew Baran, Sandra Shaw; (Desert Sun) Tamara Adspell, Norma Jean Schmidt; (Boys & Girls Club) Jen Anderson; (Community Advocate Acess Centre) Donna Ashcroft; (PDCRS) Tanya Behardien; (PSP Coordinator) Wendy Boyer; (SOK Immigrant & Community Services) Corrine Janow; (SOICS) Gurtej Kang; (MOA) Jacinda Pownall; (BCSS) Robbie Shea; (Oliver recreation) Carol Sheridan; (OK Boys & Girls Club, Oliver) Laurene Sloboda; (Shared Care Staff) CME event coming soon... Thank Yous, Welcomes, Best Wishes! Ask a Specialist/Tell a Specialist Thursday, June 2nd Linden Gardens, Kaleden BC Shared Care Steering Committee: Drs. Glen Burgoyne, Marius Snyman, Michelle Teo, Bryan Tighe, Shannon Walker and Elizabeth Watters; Susan Brown, Donna Jansons, Lori Motluk, Robin Watt; Terrie Crawford, Ida Keller, Tracy St. Claire World cafe style event featuring local specialists including Drs. Zoe Ayling, Ingrid Douziech, Ali Moshaver, Troy Pinsonneault, Siva Raghavan and Kevin Renaud For more info or to register: idakeller@sosdivision.ca Tracy St. Claire Shared Care Project Manager tracy.stclaire@sosdivision.ca Riley Gettens Shared Care Project Coordinator riley.gettens@sosdivision.ca Thank you, Dr. Brian Forzley for 6 years on the Shared Care Steering Committee, and for being an original co-founder with Dr. Elizabeth Watters Welcome, Dr. Bryan Tighe to the Shared Care Steering Committee Welcome, Riley Gettens as the Shared Care Project Coordinator, focusing on CYMHSU Best Wishes, Lisa Needoba Lisa and husband, Mike Watson, are recovering from surgery in Hong Kong, and are set to arrive home in the Okanagan soon. Thanks to everyone who reached out to help Ida Keller Shared Care Project Assistant ida.keller@sosdivison.ca Kate Harris Evaluation and QI Coordinator kate.harris@sosdivision.ca

3 South Okanagan Similkameen Inside this issue INITIATIVE UPDATES Spring 2016 Locum Recruitment Website Physicians have probably noticed a change at Penticton Regional Hospital Tuesday Rounds. That s all due to a new approach. Up and running since January 2016, the new Tuesday Rounds format features local physicians presenting topics requested by their peers. It s so great to make use of wonderful local expertise that we have right in our midst, as well as avoiding the bias inherent with pharma-sponsored events, says Dr. Chris Toneff of the newly created CME planning committee. The CME planning committee, a partnership of the SOS Division of Family Practice and the Penticton Medical Society, working with the SOGH Medical Society and PRH administration, is devoted to delivering physician-driven, needs-based education for family physicians and specialists. Recent topics presented at the CYMH Patient Care Resources request of physicians were: Dr. Jose Goncalves (genitourinary syndrome of menopause), Dr. Karen Papay (obscure GI bleeding), Dr. Majid Zolein (plasma cell neoplasms & multiple myeloma), Dr. Brian Forzley (end of life planning), Dr. Mark Sawatzky (benign upper GI disease), Dr. Sarah Broder (DVT & PE), Dr. Alexander McIntyre (DSM V bipolar depression in primary care settings), and Dr. Elmine Statham (cow s milk protein allergy in infants). Suggestions for possible topics have come from different sources. Some Polypharmacy Risk Reduction Physicians welcome change to Tuesday Rounds Tuesday Rounds PRH are taken from surveys of physicians learning needs, while others were ideas noted at previous CME events. Topics to be presented in the coming months include: Dr. Alan Hooper (lateral elbow pain), Dr. Tim Bell (ACL injuries), Dr. Alan Nixon (the rational use of opioids in palliative care), Dr. Brian Forzley (care of the transplant patient in family practice), and Boyle & Co. (medical legal forms). Turnout has been excellent to all the rounds presented this year, adds Toneff. In future, it is planned to include SOGH physicians in this new Tuesday Rounds format. If you would like to make a suggestion for future presentation topics or for speakers, please send them to Julie Young or member.services@sosdivision.ca. CME Planning Committee Members Dr. Jack Kooy Dr. Perold Louw Dr. David Paisley Dr. Cathy Rooke Dr. Jacqueline Stewart Dr. Chris Toneff Dr. Elizabeth Watters Tracy St. Claire and Julie Young Special thanks to the committee for their continued enthusiasm. Thanks also to Jolene Coburn and the PRH medical administration South Okanagan Similkameen

4 Project helps physicians reduce medications for frail elderly Frail elderly patients often end up taking too many medications. Prescribing excessive or conflicting medications can lead to side effects such as delerium and confusion. This in turn can make the elderly much more prone to falls, and otherwise reduce their quality of life. The reasons behind overmedication vary sometimes it is a result of trying to mitigate side effects of current medications, or is a result of a visit to Acute Care where medications are often required to give care in that environment. Of course, the frail elderly need medications, but until recently how to de-medicate patients hasn t been equally considered. A new polypharmacy risk reduction initiative, locally spearheaded by Dr. Mark Lawrie, aims to combine education and resources to safely and successfully reduce the amount of medications taken by residential care patients, and at the same time, make sure that necessary medications are used appropriately. Lawrie, who recently completed mentorship training with Shared Care BC has started mentoring family physicians on polypharmacy reduction at residential care facilities. Do you need to advertise for a locum, or fill a permanent vacancy? The SOS DoFP has a new recruitment website, which will help attract and retain physicians in the South Okanagan Similkameen. The site contains: Permanent vacancy postings Locum vacancy postings Clinic profiles Community profiles Physician resources The site now gives physicians an opportunity to advertise to Mentoring began at Haven Hill Retirement Centre with a group of six physicians who met to discuss general issues around polypharmacy. These group sessions were followed by hour-long meetings with individual physicians, a pharmacist and care staff member to develop new care strategies and to look at patient chart examples. Physicians need to have more knowledge of the effects of medication on the elderly, says Lawrie. We need to remember to look at a patient with fresh eyes and personalize care. Everytime we see a patient, we must remember to ask: Is this a medication issue? That way we can medicate more appropriately. Family physician, Dr. David Paisley took part in the project at Haven Hill. This was a helpful session and underscored the importance of speaking with patients and family Family physicians such as Dr. David Paisley (left) are mentored by Dr. Mark Lawrie on polypharmacy risk reduction for residential care patients Advertise to find locums on the new SOS DoFP recruitment website Video clips (pictured above) are just one of many marketing tools on the SOS Division recruitment website, which can be used to fill locum and permanent vacancies: about any changes in medications. It s important to know the evidence about different medications. This polypharmacy risk reduction initiative is being rolled out in stages. Mentoring will soon begin at the Hamlets, which will be followed by a third residential care facility. It is hoped that the polypharmacy reduction strategy will also be introduced across the healthcare continuum. In the South Okanagan Similkameen, a polypharmacy reduction initiative is also beginning in Acute Care. We started with the frail elderly because they are the population on the most medications, and there are the most gains to be made, says Lawrie. There s an awareness that the care of the frail elderly is taking a lot of time and resources. This is an initiative where we can figure how to help them more effectively. previously unknown locums outside the valley, says Aarin Frigon, Project Manager. Right now it s all word of mouth, and everybody is chasing the same pool of locums. The site also links to Health Match BC, which provides a variety of additional information about clinics. The use of pictures and videos on the new website offers more marketing tools to attract new physicians, adds Frigon. To post a vacancy on the website, please contact Julie Young or (member.services@sosdivision.ca). 2

5 Patient Care Resources Information on how to refer to Kelowna's new child and youth psychiatrist, Dr. Ingrid Douziech (right), as well as the following Child and Youth Mental Health resources, can be found on our newly updated website: 1 Direct access to child and youth psychiatry services New child and youth psychiatrist, Dr. Douziech, is working in the adolescent psychiatry unit in Kelowna 5 days a week. She will be holding two ½ days clinics out of her office one focused on eating disorders and the other ½ day for CYMHSU consults. She welcomes referrals from South Okanagan Similkameen physicians for patients able to travel to Kelowna. Douziech s contact information can be found under Patient Care Resources in the Member Portal of the Division website. Physicians will also have a chance meet Dr. Douziech at a the Ask a Specialist/Tell a Specialist CME in June. The SOS Local Action Team continues to try to recruit child and youth psychiatry services to the area. 2 New Ministry screening changes All child protection reports are now being made through Ministry of Children and Family Development (MCFD) Centralized Screening. The change is meant to improve consistency and efficiency of screening and to free up time for social workers. To access Centralized Screening, call the local office at and press zero or call Centralized Screening directly at Connect directly with MCFD social workers Physicians are encouraged to connect directly with MCFD social workers around mutually-shared care of children and youth. MCFD welcomes physicians to ask for cell phone and direct office numbers for social workers of mutually-shared clients to enhance collaborative care. 4 Connect directly with school counselors Thirteen local physicians and 11 school counselors met on the evening of Feb. 29th. They shared challenges and successes in working with children and youth with MH and SU issues. All agreed that more connection between physicians and counselors would benefit care. To facilitate that connection, a list of counselors private s and direct phone numbers are now available. Access them under Patient Care Resources in the Member Portal of the Division website or contact ida.keller@sosdivision.ca. 5 Living Life to the Full: Eight free youth sessions The Canadian Mental Health Association is offering 8 free sessions for youth (ages 13-18) struggling with anxiety or depression. The course runs Wednesdays from 4:30-6:30pm April 13 to June 1. Youth can register by calling or ing vm.chma@shaw.ca. More program information is available: Patient Care Resources in the Member Portal of the Division website. 6 SOS Let s Talk.ca Local CYMHSU resources are available on the SOS Let s Talk.ca website. In addition, this page links to resources outside the region. COMING EVENTS... Physician Lead Appreciation Event at the Vanilla Pod Restaurant Wednesday, April 27th 5:30pm -9pm Ask a Specialist/Tell a Specialist Following the success of the SOS physician lead appreciation event at the Vanilla Pod in November, a second event will be held this April 27th. The SOS Division of Family Practice has invited physican leads to this event in order to thank them for getting involved. It s also an opportunity for these physicians to connect in a fun, informal setting, and to learn about each other s work in the Division. For more info about Division projects: Julie Young (member.services@sosdivision.ca). World cafe style event featuring local specialists including Drs. Zoe Ayling, Ingrid Douziech, Ali Moshaver, Troy Pinsonneault, Siva Raghavan and Kevin Renaud Thursday, June 2nd Linden Gardens For more info or RSVP: idakeller@sosdivision.ca/

6 SOS Division in our Community PROJECTS ON THE GO what is it?... and who s involved In-patient Care Program Physicians care for their own patients in-hospital and care for patients admitted without an FP, cover call collaboratively, provide Doctor of the Day support at residential care facilities Drs. Ron Gans, Ella Monro, Jan Venter Julie Young member.services@sosdivision.ca Residential Care Developing Sustainable Rural Practice Communities (JSC) A GP for Me (Extended) Impact Funding Shared Care Shared Care initiatives enable family and specialist physicians to work together within their communities to improve patient care Providing proactive care, polypharmacy risk reduction, reducing barriers to good residential care, and decreasing avoidable visits to the ER at residential care facilities Facilitating innovative and service delivery arrangements to resolve issues of recruitment, retention, and/ or service delivery in Oliver/Osoyoos, Keremeos and Princeton Community Worker Project: Princeton Recruitment and Retention Mental Health and Substance Use Stabilization Clinic (Martin St. Outreach Centre, Penticton) Telemedicine Primary Maternity Care Emergency Child and Youth Mental Health and Substance Use: SOS Local Action Team OOO Local Action Team Drs. Colleen Black, Robert Calder, Mark Lawrie, Marina Louw, Bob Mack, Margaret Myslek, Richard Tatham, Elizabeth Watters, Lloyd Westby; (IH) Cindy Regier Arlene Herman Project Manager tel: arlene.herman@sosdivision.ca Drs. Peter Entwistle, Marina Louw, Tim Van Der Heide; Interior Health, BC Ambulance, Osoyoos Indian Band, Upper Similkameen Indian Band, Okanagan Nation Alliance, RDOS, Village of Keremeos, Towns of Oliver, Osoyoos, and Princeton Aarin Frigon Project Manager tel: aarin.frigon@sosdivision.ca Drs. Peter Entwistle, Ella Monro; (PDCRS) Princeton Family Services Aarin Frigon Project Manager tel: /aarin.frigon@sosdivision.ca Drs. Lisa Friesen, Leslie Lappalainen, Kyle Stevens, David Stoll; (IH) Joseph Savage, (MOA) Kelly Hawes Aarin Frigon Project Manager tel: aarin.frigon@sosdivision.ca Steering Committee: Drs. Glen Burgoyne, Marius Snyman, Michelle Teo, Bryan Tighe, Shannon Walker and Elizabeth Watters; Susan Brown, Donna Jansons, Lori Motluk, Robin Watt; Terrie Crawford, Ida Keller, Tracy St. Claire Shared Care projects contact: Tracy St. Claire Shared Care Project Manager tel: tracy.stclaire@sosdivision.ca SOS Division of Family Practice: New and Retiring Physicians Spring 2016 Thank you, Retiring Physicians Dr. Khati Hendry Welcome, New Physicians Drs. Catherine Botting (Fairview Medical Clinic, Penticton), Miranda Clark (locum, Penticton area), Alan Gow (Okanagan delegate to Doctors of BC board, Osoyoos), Claire Kuzmochka (covering for Oliver s Dr. Alan Ruddiman during his year presidency of Doctors of BC), Mahrous Mousa (Cascade Medical Clinic, Princeton), Danielle Weisgarber (Rosedale Medical Clinic, Summerland) 4