Dear Colleagues,  

I hope that the summer has been treating you well. I've been grateful for the time I've had to be away to recharge and I hope that you have had this opportunity as well – a break is both important and well deserved to restore and recharge our batteries.

We're aware of and have highlighted the unique role you are all playing in supporting your patients in this "last mile" of the vaccination effort – hard work that is so critical. We have also seen practice patterns shift towards more in-person care. An average of 50 per cent of visits across Ontario in primary care are now in person – reflecting increasing patient demand and greater confidence bringing in these patients, given rising vaccination rates and with good office infection control measures. 

With more in-person care we also know some of you face challenges – small spaces, figuring out what to prioritize with the many competing clinical demands, worries about Delta and how it impacts office practice, and more. We have heard your questions and concerns and are sharing these updates and practical tools to support you in your day to day.

COVID-19 News

• Updated Ministry of Health (MOH) COVID-19 guidancefor primary care. OCFP summary here and a list of what has changed. 
• Highlights:
  • Key consideration of patient preference in determining when to provide in-person care with a shift away from a "virtual-first" approach. We've updated our Considerations for balancing in-person and virtual care to reflect this, including guidance on managing febrile illness/COVID-19 symptoms in office.
  • You can now use standard cleaning processes (i.e., as normally would be done pre-pandemic for IPAC) for patients who screen negative. More info here.
  • Optimize ventilation to maximize airflow – see ways to do so in this FAQ.
  • Fully vaccinated asymptomatic “high-risk” contacts do not need to self-isolate. This flowchart summarizes the steps after a high-risk exposure, and check out this helpful guide from Marathon Family Health Team on how to support your office staff with decisions on working given symptoms, exposure, and vaccination status. New OCFP guidance to help you with balancing the current multiple clinical demands. Key priority: ensuring provision of comprehensive and after-hours care to keep patients in the community and out of hospital and emergency.
• New provincial vaccination policy for higher-risk hospital and community settings and detailed resource guide. This does not apply to community-based family practices, though MOH has encouraged us to consider similar policies in our offices. 
• Medical exemptions to vaccination: Valid medical exemptions are few and include serious allergic reaction to the vaccine or its components, and myocarditis/pericarditis with the first dose. To confirm exemption, these situations should be reviewed by an allergist (possible through eConsult) or other appropriate specialist.  
• For more details, see MOH resource guide on the vaccination policy (pages 5 and 6 ) and this OMA toolkit(login required) which includes sample language that you may use for vaccine exemption notes.
• Third doses now being offered to certain vulnerable populations, such as long-term care residents and transplant patients. Details of the changes are in the MOH announcement.

Vaccination Tools and Resources

• COVID-19 vaccines for use in-office: We know all family doctors are working to encourage patients to be vaccinated. The government is clear on itssupport for opportunistic vaccination in our clinics with mRNA vaccines. Please contact your local PHU if you wish to vaccinate.
• An update: Primary care and all Public Health Units are represented in the new provincial “last mile” vaccine initiative, chaired by Dr. Homer Tien, head of Ontario’s COVID-19 vaccine task force. We will continue to advocate for provincial support to further facilitate in-office vaccination, including reducing administrative barriers.
• We understand there has been recent progress toward providing family doctors with rostered patients access to lists of their unvaccinated patients. This information is expected to be available in early September. We will share more information as it emerges.
• Helpful resources to support your conversations with those who are unvaccinated: this guide from University of Calgary and free learning modules from UofT DFCM and OCFP; for youth specifically, this MOH FAQ on safety and efficacy, and ca from the Children’s COVID-19 Vaccine Advisory Table.
• New resource about myocarditis and pericarditis: a helpful primer on managing symptoms post-vaccine, developed by a group of physicians and pharmacists.

Antigen and Antibody Testing

• Rapid antigen tests are available for free through this MOH program. These tests are not currently recommended for one-off testing of patients or for those with COVID-19 symptoms, but may be useful as part of regular ongoing screening of staff, where repetitive testing may offset low sensitivity. PCR testing is not widely available for in-office use currently – we will keep you updated on developments. 
• MOH testing guidance has just been updated along with additional resources to help guide antigen and molecular point-of-care testing.
• COVID-19 antibody (serological) tests are not conclusive for protective immunity nor to rule out infection.
• Great reference document developed by a group of Ontario physicians and scientists.

Medical/Vision Test Extensions 

• As of July 31, there are no longer automatic extensions from the Ministry of Transportation for drivers requiring medical/vision tests (i.e., commercial drivers, seniors, medical suspension, etc.). These extensions had been in place since the beginning of the pandemic. 

Flu Season/Influenza-like Illness

• We know the fall will be a busy time with kids (including ours) returning to school and the flu and cold season approaching. We are working provincially to advocate for continued testing and assessment "hubs" in the community.
• As noted above, see page 3 of this OCFP document for information on managing febrile illness/COVID-19 symptoms in office.
• This Choosing Wisely Canada’s Cold Standard Toolkit, released in 2020, includes useful information on managing respiratory tract infections in the context of COVID-19 and virtual care.

OCFP Educational Opportunities and Events 

• COVID-19 Community of Practice with UofT DFCM – next session is Friday, Sept. 17, 2021 at 8 a.m. More details available soon.
• Now open: Practising Well – Register as a Peer Learner: Get support from a colleague 1:1 or in a small group about mental health, substance use disorders and/or chronic pain
• Aug. 31, 2021 – 7:00 to 8:00 p.m. Practising Well – Join this Information Session to see how you can share your expertise as a Peer Guide
• Sept. 13 and Sept. 17, 2021 – 1:00 to 5:00 p.m. (both days) Mood Disorders: Comprehensive and Realistic Strategies for Primary Care (registration fee applies)
• Sept. 22, 2021 – 8:00 to 9:00 a.m. Practising Well Community of Practice for a discussion of ways to support young patients with mental health and substance use challenges.
• Sept. 27 and 28, 2021 – 1:00 to 4:30 p.m. (both days) Child and Adolescent Health: Best Evidence for Preventive Care (registration fee applies)
• Oct. 5, 2021 – 9 a.m. to 5 p.m. Practising Wisely: Reducing Unnecessary Testing and Treatment (registration fee applies)
• Save the date for the OCFP’s 2022 Family Medicine Summit, including livestream events on January 28 and 29, 2022
• … and watch for more information coming soon about the OCFP’s upcoming Annual Meeting of Members, to take place Friday Sept. 24, 2021 

*****

I am so mindful of our collective exhaustion and the need to care for ourselves and each other. I welcomed the report from the OMA’s Burnout Task Force which identified five system-level solutions to physician burnout, and other initiatives including the Burnout Toolkit and Burnout Podcast. 

At the OCFP, we will work together with the OMA in advancing these solutions – in particular, the need for addressing the burden of paperwork/administration to free up more of your time for care. 

Signing off with gratitude to you for your hard work, and fierce pride in our profession and the difference you continue to make in your patients’ lives through this pandemic. 

Liz