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Tackling opioid use disorder on the frontlines

Evidence-based treatment can improve the lives of those living with an opioid use disorder

…so begins a report prepared by the Canadian Centre on Substance Use and Addiction (CCSA) last year documenting the many best practices in use across the country to manage a condition inexorably linked to the explosion of opioid-related deaths.

The Public Health Agency of Canada estimated 10,300 Canadians died from opioid-related causes between January 2016 and September 2018. More than 100 Ontarians are dying of an opioid overdose each month, and the crisis is not yet slowing. It is clear that we have an evidence-based consensus that more can and should be done to support those working on the front-lines of our health care system—family physician offices, nurse practitioner led clinics, and emergency departments, for example.

Elevating primary care reporting in Ontario

Over the last five years, several organizations in Ontario have developed and shared reports to support primary care clinicians in their efforts to improve patient care. Until now, these reports were produced independently and in a largely uncoordinated fashion.

Each of these initiatives were intended to fill an important gap in access to information. It wasn’t too long ago that there was no mechanism for family physicians practicing in Ontario to see comparative data on their own practice. As recently as 2015, less than a third of family physicians in Ontario reported routinely receiving information on how the clinical performance of their practice compared with that of peers. In contrast, 70% of family physicians practicing in the UK reported receiving this type of information.

Though well-intended, the number of reports in Ontario then became overwhelming. Many family physicians indicated they did not access or read the reports they were receiving due to time pressures, little relevance or concerns about validity. This was expressed by physician leaders at a roundtable called to address the issue. Not suprisingly, there was clear and shared understanding across providers of the reports that these multiple uncoordinated reporting efforts could lead to disengagement and accelerate burnout.

Quality at the coalface: How front-line providers are upping their game

Dr. David Kaplan

Providing quality care should be the aim of all who work in the Ontario health care system.

However, in today’s high-pressure environment, physicians and other health care professionals practising primary care in the community or in hospitals are often challenged to find time to engage in quality improvement initiatives on top of providing the necessary care for their patients.

As Dr. Jeremy Grimshaw, Professor of Medicine at the University of Ottawa said in a recent commentary for physicians: “You want to provide the best care for your patients but often don’t have the time or energy to scan a dense and convoluted report that tells you how to do this, even if it is based on data from your own practice.”

Osteoarthritis: Be aware of a better care option

by Dr. Joshua Tepper

Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability.

With an estimated 5.6 million Canadians suffering from osteoarthritis and that number expected to increase significantly as the population ages, the condition still has no cure and can be difficult to manage effectively. In Ontario, people with osteoarthritis report a quality of life 10% to 25% lower than those without osteoarthritis, and they incur health care costs two to three times higher. Despite the seriousness of this situation, osteoarthritis is often underdiagnosed and undertreated.

Osteoarthritis is just one of several musculoskeletal conditions that affects one in three Ontario adults. Recently released wait-time data that can be found on the Health Quality Ontario website shows that patients with these conditions spend the most time waiting to access health-care services, like magnetic resonance imaging (MRI) even though that may not be the best treatment option. In addition, uncontrolled knee, hip and back pain has been associated with inappropriate use of opioids.

To address this, an approach to redesign and innovate the current model of care in Ontario will help people access the right treatment faster, starting with osteoarthritis and other conditions causing hip, knee and low-back pain.

MyPractice: My Primary Care

Dr. David Kaplan

According to a recent report from Health Quality Ontario, 9 Million Prescriptions, one in seven Ontarians fills a prescription for opioids every year. More than 9 million prescriptions for opioids were filled in the province in 2015/16. Canada remains the second-largest consumer of prescription opioids in the world, after the US.

Unfortunately, many patients are receiving these highly addictive drugs, from both legitimate and illicit sources, with only questionable benefit. This is a complex problem involving many health care providers and many interwoven factors compounding the situation.

While physicians are faced with the challenges of treating patients with often complex disorders and few resources, more appropriate prescribing by all physicians is part of the solution.

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