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5 COVID-19 Messages for the Public: Infographic

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COVID-19: Tips for Family Doctors

Screen by Phone. Virtual Visits. Guides for Referral and Testing. In-person Considerations.

Updated: March 31, 2020

Bookmark the Ministry of Health website for their most up-to-date documents. At the time of this writing, there is a discrepancy between the ministry's Quick Reference document on Testing and Clearance (March 27, 2020) and the Guidance for Primary Care document (March 20, 2020) - the former suggests testing decisions be guided by clinical judgment, while the latter uses the language of the Case Definition for testing. The OCFP is advocating for these documents to be aligned and clarified for family physicians.

Note that the OMA Patient Assessment Tool also recommends using clinical judgment in determining who to test. The Quick Reference document and the OMA document both reference high-risk groups who should be prioritized for swabs.

If you work in a long-term care and/or hospital setting, please see the ministry's Guidance for the Health Sector webpage for sector-specific information. 

**We know that you are working very hard to keep up with COVID-19 information as it evolves and that you are concerned about insufficient PPE for needed in-office assessment/care. Many stakeholders - including the OCFP - have been advocating for PPE for family doctors. The Ministry of Health's order on PPE and PPE Update on March 28 acknowledges that more needs to be done to ensure supplies are where they are needed. The OCFP is seeking specific answers for primary care. In the meantime, see some considerations in the box below related to in-person visits, recognizing that as family doctors you are ultimately in the best position to determine when an in-person visit with a patient is warranted and safe to do so.

We are also advocating for better access to testing in order to understand community prevalence and to allow family physicians and healthcare workers to get back to work.

We are grateful for the difficult work that you are doing, and we are proud of the vital role of family physicians in the health care system**.
 

Screen and Book Virtual Appointments

  • Consider posting signage/messages on your website, having a message on your voicemail and/or sending an email blast to encourage patients to self-identify or use the self-assessment tool.
  • A sample message to patients may be as follows:
    • "With the outbreak of the coronavirus, when booking an appointment, we ask that you PLEASE let the staff know if you have a fever or new/worsening cough. To avoid the potential spread of infection, DO NOT go to the clinic without first calling. This will help our staff to do the right things to care for you and for the other people in the clinic at that time. We can provide phone or video call to assess your situation and provide further instructions.
    • If you have travelled outside Canada in the past 14 days, follow the guidance of Public Health on the need for self-isolation, such as staying at home, avoiding close contact with others, and washing your hands vigilantly. We appreciate your help in this matter and look forward to keeping our clinic a safe place for all."

  • At this time it may be prudent to offer all patients with symptom concerns a virtual visit to be assessed by a physician or clinical delegate so that a determination about the need for swabbing can be made based on clinical judgment (see Quick Reference document and OMA Assessment Tool):
    • Patients should follow the instructions for self-isolation, such as staying at home, avoiding close contact with others, and washing hands vigilantly until contacted by the clinician
    • Family members and caregivers may seek guidance for caring for loved ones, which can be found here
    • They should be self-monitoring for fever, new/worsening cough or shortness of breath; if this occurs, they should contact your office or Telehealth (1-866-797-0000) or their local public health unit.

  • Patients with Respiratory Symptoms - As there is increasing community spread of COVID-19, many clinical groups are moving to a model where ALL patients with ANY respiratory symptoms are seen by one physician in the group in a designated 'respiratory clinic' (one physician, one clinic block of rooms, etc.). This can help conserve PPE for the day if other clinicians are doing phone and video assessments, and the staff and cleaning efficiency can also be optimized. We encourage you to work with colleagues locally to align your work and support one another where possible. 

  • Hydroxychloroquine is not appropriate for patients with COVID-19 in primary care, as outlined in this Tools for Practice rapid review.

Virtual Visits 

  • Many family physicians have moved their clinics to phone and video appointments for things like getting a sense of disease severity, having a look at rashes, possible skin infections, sprains, mental health concerns, etc. Below are some helpful guides on conducting remote consultations: 
    • COVID-19 virtual visit: visual summary, adapted for Ontario from a recent BMJ article on assessing respiratory patients by video or voice call 
    • A virtual care guide from OntarioMD/OMA, with virtual platform and billing information.  

Guides for Referral and Testing 

See this Quick Reference Guidance from the Ministry of Health to help inform your decision making on testing and clearance of individuals suspected or confirmed to have COVID-19. Note that testing is based on clinical assessment and not solely on the case definition. Priority groups should be considered as noted in the Quick Reference Guide.
  • Update yourself regularly with your local testing locations and their specific protocols. In some areas, there are testing centres outside of the Emergency Departments. Different locations have differing procedures for patients to follow - detail on each testing location is available on the OMA's COVID-19 webpage, under the "Assessment" section
  • Testing ability is strained in many locations so please be aware of your local circumstances
  • If patients have NO SYMPTOMS - NO TESTING

In-Person Considerations

While virtual care is already being provided by our fellow family physicians for the majority of our patients' needs, there may be times when you feel an in-office assessment/care is clinically necessary. 

Click here for some helpful considerations related to in-person visits, recognizing that as family doctors you are ultimately in the best position to determine when an in-person visit with a patient is warranted and safe to do so. 



 

  • Most medical offices/clinics in Ontario do not have the capacity to conduct clinical examinations and testing for COVID-19. You should only conduct a clinical assessment and collect specimens if:
  • If a patient shows up and you are not equipped for COVID-19 testing onsite, ensure the patient has a mask, isolate the patient in a room, assess from a distance of two (2) metres and refer for testing to either a testing site or Emergency Department, depending on clinical severity and your local circumstance. Patients should travel in their private vehicles if they are clinically stable. Double disinfect all of the touchable surfaces (including computer keyboards) of the examination room after the patient's departure. 

  • If you are equipped to conduct in-office assessments and specimen collection, follow Public Health Ontario's testing procedures to safely collect and send appropriate specimens for COVID-19 to PHO.

*For more information on Routine Practices and Additional Precautions, health care workers should refer to (PIDAC's) Routine Practices and Additional Precautions in All Health Care Settings and Annex B: Prevention of Transmission of Acute Respiratory Infection in all Health Care Settings)

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Check our website regularly and follow us on Twitter (@OntarioCollege) for up-to-date information and resources. In this rapidly evolving situation, we will continue to seek guidance on your behalf, as well as provide you with updates on any new developments that impact your practice. 

Questions or concerns? Please contact us at: [email protected]