Dear Colleagues,

While we face a significant surge of respiratory infections in our communities, I would like to acknowledge and thank you for your hard work and dedication.  It is an extremely challenging time in healthcare, and I appreciate your continued efforts to meet the needs of your patients.

In this email:

• Children’s Pain Medications
• Respiratory Infections
• COVID-19 Vaccination | Flu Vaccine
• Tools to support your practice
• From the OCFP
• Other Opportunities
• Advocacy

Children’s Pain Medications

• The shortage of children’s acetaminophen and ibuprofen is expected to continue to ease in coming weeks. Until supply issues are resolved, here is information for families and caregivers on children’s pain and fever medication use from the Canadian Pharmacists Association, and a reference chart from Unity Health to help with dosing.
• The ministry has provided an update on shortages of antibiotics for children, including alternatives to amoxicillin.

Respiratory Infections

Patient Resources

• The OCFP has updated our Family Doctor Tips on Caring for Children with Respiratory Symptoms tip sheet to include a caution to parents and caregivers regarding the use of ASA. This document is now available in French, Traditional Chinese, Simplified Chinese, Hindi, Farsi, Tamil, Portuguese, Arabic, Urdu, Italian and Spanish.
• The Ministry of Health is sharing patient-facing resources for use in family doctors’ clinics. Find a flu fact sheet in English and French and an RSV fact sheet in English and French.

Family Doctor Resources

• The OCFP has developed a tip sheet on common respiratory conditions in children – including diagnoses, signs, management and red flags – to support care of your young patients with symptoms. Our thanks to pediatrician Dr. Tasha Stoltz for her COVID-19 Community of Practice presentation which was the inspiration for this tool.
• To improve access outside of long-term care/retirement homes, the antiviral Tamiflu^® now has a Limited Use (LU) Code in the Ontario Drug Benefit Formulary (pp.8-9) for the 2022-2023 influenza season, for prescribing to patients in community settings who are at high risk of complications from influenza infection. See the CEP’s Managing Fall/Winter Season -- Therapeutics for information based on current guidelines for Tamiflu^® use from Public Health Ontario and Association of Medical Microbiology and Infectious Disease Canada.  
• Choosing Wisely Canada’s (CWC) The Cold Standard toolkit has been updated. CWC also has specific recommendations for Using Antibiotics Wisely to reduce unnecessary use in primary care, with supports including the ‘Viral Prescription Pad’ and ’Delayed Prescription Pad.’
• New guidance for Clinical Assessment Centres (November 28, 2022) confirms their role in assessing and supporting adult and paediatric patients with COVID-19 and/or expanded influenza-like illness symptoms. If your patient does not require emergency attention, and you are unable to assess, conduct needed testing or initiate treatment for COVID-19 and other respiratory illnesses, consider referring your patient to a nearby Clinical Assessment Centre. Patients may also self refer. CACs are looking to expand after-hours coverage and locations as well as assessing patients presenting with cough and cold symptoms.
• For infants at high risk from RSV, the ministry’s RSV Prophylaxis Program covers the full cost of the drug palivizumab.
• Remind patients that Health Connect Ontario (call 811) is an option to speak with a registered nurse, day or night for secure and confidential health advice.

COVID-19 Vaccination | Flu Vaccine

• Vaccination remains critical to protecting our patients from COVID-19 and the flu and supporting capacity in the health system. The OMA has developed this letter template you can use to encourage your patients to get vaccinated and this new Focused COVID-19 Communication patient resource explains boosters.
• Updated Vaccine Guidance (November 7, 2022) adds adults who belong to a “racialized and/or marginalized community disproportionately affected by COVID-19” as a priority group, strongly recommended for a bivalent booster at a three-month interval from previous dose or COVID-19 infection. Patients can use this booster decision aid or this online tool to check eligibility.
• Answers to common questions about the bivalent vaccine are available in this ministry resource (in French and English), including details for health care providers. You can also share these info sheets for patients in English and French.

More Tools for your Practice

• Family physicians can now directly refer frontline health workers to psychologists for MOH-covered treatment. Learn more.
• A new tool to help diagnose and treat heart failure is available from the Centre for Effective Practice. 
• Check out CareCanvas, a new web-based dashboard from U of T DFCM and the POPLAR network that enables you to easily see practice-specific data and act on care gaps.

From the OCFP

• Registration for our 2023 Family Medicine Summit (FMS) is now open! The FMS will include two live-streamed days, January 27 and 28, plus 20 on-demand sessions. This year’s keynote speakers will include: Lieutenant-General (ret) The Honourable Roméo Dallaire, Dr. Alika Lafontaine and Dr. Robert Varnam. Learn more and register now.
• The OCFP is seeking your input on our policy priorities. Your responses are confidential and will be used in aggregate form only. Thank you for participating in our survey – the estimated completion time is no more than five minutes.
• As changes to virtual billing codes came into effect on Dec. 1, we recognize there have been some challenges. The OCFP is currently looking at best practices on using virtual care in this new environment and will share those with you.
• As the OCFP continues to advocate for changes to the systemic contributors of burnout, we know family doctors also need personal and practice-oriented coping strategies to manage during this period of incredible stress. Join the Practising Well Community of Practice on December 14, 2022 from 8:00 to 9:00 a.m. for tips and tools to help address the overwhelm many of us are experiencing. Register.
• Peer Connect is a Mainpro+® certified program to support family doctors to respond to mental health issues, address substance use disorders and chronic pain challenges.

Other Opportunities

• Through Ontario Health’s Understanding Quality Standards in Primary Care Program, you can now earn Mainpro+® credits for the quality standards you read.  Learn more.
• Dr. Danielle Martin, U of T Department of Family and Community Medicine Chair, has extended an invitation to her virtual fireside chat with the Honourable Carolyn Bennett, Minister of Mental Health and Addictions on December 9, 2022. Register.

 Advocacy

• The OCFP continues advocacy efforts focused on the impact of the family doctor shortage and what is needed to help us in our practices. Recent media interviews include:
  • Dr. Mekalai Kumanan, Cambridge – ‘Perfect storm’ causing family physician shortage in Cambridge
  • Dr. Jennifer Bondy, Windsor - Solutions needed as local family physician crisis growing worse
  • Dr. Mike Gagnon, Bolton - Team-based care needed to solve shortages
  • Dr. Jobin Varughese, Brampton – Beyond Frustrating, ‘Peel resident; doctor says family physician shortage is a ‘crisis’
  • Dr. Claudia Hubbes and Dr. Clare Liddy, Ottawa - Only a handful of family doctors in Ottawa accepting new patients
• Are you interested in lending your voice to advocacy efforts in the coming months? If so, please contact [email protected] to discuss how we can support you.

As we all face the ongoing challenges in family medicine, we were pleased to take one evening, on November 22, to celebrate our profession and the contributions we make as a collective at the annual OCFP awards. Congratulations to all of this year’s recipients.

Once again, thank you for all that you continue to do as you care for patients.  You are making a difference.

Mekalai