April 29, 2022

Dear Colleagues, 

I’ll start by acknowledging how you, as family doctors across the province, have stepped up to support timely and appropriate Paxlovid prescribing, and in so doing have widened access to treatment for patients and helped prevent hospitalizations and mortality. Thank you! 

This President’s message includes the latest updates and tools to support Paxlovid prescribing, building on what I shared previously, along with information on IPAC/PPE and other key areas currently.

*****

PAXLOVID 

How to access and who’s eligible

• Ontario Health has published primary care pathways for accessing Paxlovid and this week a memo on tools for Paxlovid prescribing, including: use of COVaxON and EMR searches to help identify high-risk patients, an adaptable OCFP-developed script to communicate with patients, and a Paxlovid prescription form for PS Suite, Oscar and Accuro, and in PDF. 
• Ontario Renal Network has published guidance on prescribing for patients with chronic kidney disease and patients on dialysis. Approach to creatinine is discretionary based on case-specific risk assessment. An eGFR is recommended – if no benchmark for patient within past 6 months – where there is clinical judgment that the patient is high risk for/has a history of renal dysfunction. Renal function can be ordered ASAP from community lab, noting on the requisition that the patient is Covid-positive.
• The partnership between community pharmacists and family doctors is crucial in the effort to widen access to Paxlovid. We’re hearing from pharmacists that the use of the Paxlovid prescription form and the provision of a contact number to reach you are very helpful in this shared effort.
• Pharmacy locations dispensing Paxlovid, updated regularly: downloadable Excel list | interactive map (Google)
• List of Clinical Assessment Centres distributing Paxlovid. Note: IV Remdesivir may be an option for those unable to receive Paxlovid. Contact your local CAC to find out where/how to access.
• Use MOH testing guidance (April 11) to identify who should be considered for testing and then apply the Ontario Science Advisory Table (SAT) recommendations, which establish a threshold of 5 per cent risk of hospitalization to determine who would benefit from treatment.
• Reminders: treatment must be started within 5 days of symptom onset; a positive test is required (PCR, rapid molecular, or rapid antigen test [including self-administered]); Paxlovid is free to any eligible Ontarian and does not require a Health Card.
• Please see my previous President’s Message for more details on resources for prescribing and patients. 

Other Paxlovid resources

• CEP continues to update its resource centre for Paxlovid prescribing.
• If you missed it, check out the resources and recording from last Friday’s incredibly informative COVID-19 CoP session, All About Paxlovid, with infectious disease specialist Dr. Andrew Morris, pharmacist Dr. Kelly Grindrod and family physician Dr. Sohal Goyal.
• Our next COVID-19 Community of Practice session is May 13, at 7:55 a.m. We will continue with a focus on Paxlovid and treatments as well as other timely COVID updates. Panelists are Orillia family physician, Dr. Kim McIntosh, infectious disease doctor Dr. Zain Chagla, and others. Registration opening soon. 

IPAC/PPE 

IPAC/PPE remains key to providing in-person care and keeping yourself and your clinic staff safe. We’re pleased that the requirement for masks now remains in place through to June 11 for healthcare settings, including our practices, to be followed by issuance of new Ministry guidance.

• The OCFP has developed a suite of IPAC/PPE tools for your practice, including a screening tool, a summary of IPAC/PPE guidelines, and updated tips for your clinic and information on N95s. Thanks to partners at PHO, OMA, CEP, and others who helped inform these resources.
• For an excellent overview of IPAC in your practice, see this recording of the April 14 PHO webinar, IPAC Practices in Clinical Office Settings, with Dr. Jeya Nadarajah and others. 

Other treatments | vaccines

• Update on Novavax – for patients age 18+ who won’t/can’t receive an mRNA vaccine. Contact your PHU to learn how to access for your patient in your region as this may vary. For example, Toronto has begun offering the Novavax vaccine on specified days at its Metro Convention Centre clinic.
• Update on Evusheld – expected to be available in Ontario this week. The province has said the drug will be available to individuals at highest risk of severe outcomes from COVID-19 and who are not yet currently infected.
• Second boosters as “5th doses”: Ontarians age 60+ who are also immunocompromised and at least five months from their previous dose are eligible for a second booster (a 5th dose based on a three-dose primary series). A clear and complete summary of vaccines/boosters in “Confused About COVID” from UofT DFCM/OCFP.
• Please continue to encourage patients to get their booster doses – currently, just 61 per cent of Ontarians aged 18+ have received three doses.
• Children 5-11 remain a vastly under-vaccinated group, with roughly 35 per cent with two doses at this time. Take opportunities to answer questions your patients may have about vaccinating their young children. 

More from the OCFP 

• Happening next week! The first in the Choosing Wisely in Primary Care series, from OCFP and partners: May 4, 8 a.m., Antibiotic Prescribing and your CPSO QI Requirements, with Drs. Jane Charters, Abhishek Raut and Anthony Train, moderated by Dr. Darren Larsen. REGISTER
• Upcoming Practising Well CoP session, with UofT DFCM – Letting Go or Living with Anxiety, May 25, 8 a.m., with guests Dr. Jon Davine and Dr. Karen Trollope-Kumar. REGISTER
• Webinar, with Ontario Osteoporosis Strategy: Clinical Application of the LTC Fracture Prevention Recommendations for Frail Older Adults, June 10, 12:30 – 1:30 p.m. REGISTER
• OCFP FMS 2023 Call for Abstracts is now open – learn more about this opportunity to present at our flagship educational event and submit your abstract by June 12.

Other updates

• CMOH has issued a memo alert about cases of acute hepatitis occurring in children up to 16 years of age and is urging vigilance in watching for signs and symptoms.
• CFPC has published a family physician guide with Best Advice: Caring for Veterans, aligned with the principles of a Patient’s Medical Home.
• Cancer Care Ontario has revised recommendations for follow up of abnormal cytology.
• CAMH’s STOP on the Net online smoking cessation program is available in English and French and includes resources for you and your patients.

The growing provincial efforts to “Axe the Fax”, driven by primary care leaders, is a step toward reducing the heavy load of administration we face and freeing up more time for care. The Ministry’s survey, available until May 4, is gathering input to inform next steps to fax phase-out.

Solutions like this form the pillars of the OCFP’s Life Without A Doctor advocacy campaign where we are highlighting the urgent need for greater investment in family doctors and policy solutions. See our statement on the Spring 2022 budget. To learn more about our advocacy impact to date, REGISTER for our member advocacy Town Hall on May 4, 2022, 7 p.m., being held together with the SGFP.

Take care and, as always, thank you for your continued work and dedication to your patients.

Liz