Over the last 16 months, our team has conducted the largest public engagement ever on the future of
#primarycare
in Canada
Today we release our final report✨
10,000 people
10,000 participant hours
1 vision for primary care
🧵
A close family member, under age 50, lives in a GTA hotspot. They asked me how they could get a vaccine. I suggested their best bet was to follow
@VaxHuntersCan
How is it that the most important vaccination campaign of our lifetime is so reliant on a great group of volunteers?
Like many parents, I'm struggling to understand why the Ontario government is so strongly against using rapid testing to prevent the spread of
#covid
in schools.
THREAD 🧵
How many hundreds of doses of AZ are in our fridges, set to expire in <2 weeks? We need to make a decision about them now.
Let people make an informed choice on second doses or send the doses to a region/country where they will be used.
When in doubt, presume COVID
PCR (+), RAT (-) = COVID
RAT (+), PCR (-) = COVID
RAT (+), no PCR = COVID
symptoms but no test available = COVID
If any of these situations applies to you, please self-isolate for 10 days along with members of your household. Notify your contacts.
The shortage of kids acetaminophen & ibuprofen has been stressful for parents
Thanks to our amazing SMHAFHT pharmacists Brenda Chang, Doret Cheng, and Jon Hunchuck
@UnityHealthTO
@UofTFamilyMed
for this handy resource on how you can split and/or crush adult tabs for kids
“The primary role of public health is to reduce harm to the public, and to protect the most vulnerable in society in particular. It should not be about promoting personal preference for the privileged”
—
@picardonhealth
@globeandmail
In Ontario, we have many, many different queues to get a vaccine
That means a system that is both inefficient and inequitable
-Wasted time navigating
-Potential double-booking & missed appts
-Access easiest for those who are IT savvy, connected, have time, and speak English
Why have so few Ontarians received Paxlovid, a drug that can reduce the risk of hospitalization for those at higher risk of
#covid
?
Here are some of my observations as a family doc 🧵
The most efficient, effective way to get vaccines in arms for those 5-11 years?
School-based clinics, starting with those in communities with higher cases
Do PHUs have a plan? Would love reporters digging into this
Almost a third of students were absent at our local school
@tdsb
this week
Sick kids
Lost learning
Parental time off work
Grandparents at risk
More COVID everywhere
We need to bring back
#MaskMandates
1. I've spent some time reviewing NACI's AZ recommendations today
Here's why I think I will end up recommending AZ to the vast majority of my patients 40+ after an informed discussion
(For context, I live & practice in TO)🧵
Most of the AZ doses set to expire have already been distributed to small pharmacies & primary care clinics. If we don’t want to waste, using them for second doses is probably the only practical option.
Those who had their 1st dose should be able to make an informed decision
I wish
@globeandmail
had published a four-page opinion piece from Dr Allison McGeer on the important role of vaccines in reducing serious illness and death from COVID-19
I’d love to see the Ontario government send an SMS and email to everyone 50+ who received a 2nd dose >6 Mo ago, asking them to get their 3rd dose, explaining why it’s important, how they can book, and where to find more info
This should be possible with data from COVAXON
With sky-high case counts, we decided to get our kids (8 and 11) their 2nd COVID vaccine today, ~4wks from their 1st dose
An 8 wk interval was initially recommended b/c of theoretically lower myocarditis risk & better/longer immunity
We opted for non-theoretical benefit NOW
Everyone in Canada should have a family doctor, NP or primary care team they can see regularly when they need to
Let’s set the goal and enact bold reforms to achieve it
People in Canada are ready
Primary care is the front door of the health care system
But for too many people in Canada, that front door is now closed
In my latest commentary
@CMAJ
, I propose some bold reforms to keep the door wide open 🧵 1/
There seems to be a perception among the public that Pfizer is better than Moderna. Not true!
Both have similar efficacy in trials and similar safety profile. Both use mRNA technology.
Both are excellent choices. Really.
Primary care is the foundation of the healthcare system
Like a good building foundation, we forget about it when it’s working well
It’s unseen, unsexy, and no one really wants to spend extra on it
But, when it starts to crumble, the whole home can give way 🧵
I've been thinking a lot about the patients in my practice who still say no to the COVID vaccine
They are not anti-vaxxers
Most have difficult lives—newcomers, BIPOC, histories of homelessness, trauma, poverty
They (reasonably) mistrust gov't & are victims of misinformation
If someone in your household tests positive for COVID-19 (by RAT or PCR), please self-isolate for 10 days—regardless of your vaccination status
Unfortunately the advice on the
@ONThealth
website is outdated
Instead, use this algorithm 👇🏽
Every day I'm amazed at how many Ontarians step up to get vaccinated—first with one dose and now two—despite a system that is chaotic, confusing, and at times simply unfair
Thanks to you, things are moving in the right direction
In 2002, I graduated from medical school and chose to specialize in family medicine.
Why?
At the core, I loved the idea of nurturing relationships to support people and communities.
21 years later, I still love what I do. ♥️♥️♥️
Happy
#WorldFamilyDoctorDay
!
There is an unfortunate narrative out there that family docs are not seeing patients in person and that this is leading to a rise in ED visits
The *real* story is so much more nuanced
Yes, some patients are struggling with timely access—but there are many factors at play
🧵
At our clinic, we've been hearing a lot of concerns from patients about the AZ vaccine.
Many are reluctant to take it at first but feel confident after a short discussion with their family doctor.
Here is what I review during that conversation 🧵 1/
With a record number of cases and rising ICU admissions, it pains me that there is so much AZ in the freezer
It's time NACI & Ontario opened up AZ use to more age groups. People are capable of making an informed decision, weighing the growing benefits against the minuscule risks
I've heard anecdotally that some family physicians are still taking a virtual-first approach, triaging who comes in-person
It's time to switch to a patient-directed approach—where patients can tell the receptionist what they prefer
(See: via
@CMAJBlogs
)
As a doctor & mom, I'd love a plan that re-introduces in-person learning with strategies that minimize community spread:
-better ventilation
-more outdoor ed
-use of rapid tests
-more effective case/contact management
-higher teacher:student ratio
Is any of this on the table?
Today, our 14 yo got her booster. She walked into our local pharmacy and got it by herself
🙏🏽🙏🏽🙏🏽 to
#LawlorPharmcy
@KyroMaseh
who made it super easy
I feel good knowing she's reduced her risk of getting COVID, missing school & transmitting COVID to others
I want to start by acknowledging the confusion and frustration that the latest NACI statement has caused those who got the AZ vaccine—and the pharmacists and primary care clinicians supporting them
As I write, I know many are on the phone rescheduling appts
A few thoughts 🧵1/
The UK has vaccinated 4x as many people as Canada
A key ingredient in their secret sauce?
#primarycare
GPs have administered roughly 75% of all vaccines in the UK
#trust
#relationships
Last autumn NHS leaders predicted 20% of all Covid jabs would be administered from general practice centres.
We’re nearly half way through the programme and the figure remains around 75%.
Track record, local, trust.
General practice needs to be supported to keep going.
Mental health and addictions are inextricably linked to the social determinants of health
This is borne out by research and also my own clinical experience
Take these examples from my own practice 🧵
Yesterday was
#MatchDay
, when graduating med students are selected into a residency program
Sadly, more than 250 family medicine residency spots went unfilled nationally. 😭😭😭
This does not bode well in a time when >6.5 million people already don't have a family doc or NP.
Are you confused about
#COVID
?
How do you know when you have it?
Who can get a test?
When to use a RAT?
When to call a doctor?
You're not alone.
We
@UofTFamilyMed
@OntarioCollege
have pulled together answers to common COVID Q's
Here's a rundown 🧵
Proud of our team
@UnityHealthTO
@UofTFamilyMed
who have vaccinated 30 shelter programs and 3 congregate living buildings in TO for a total of 1350 first doses to shelter residents and 125 to shelter staff!
👏🏽👏🏽👏🏽
I’ll end though as I started, acknowledging those who stepped up to take AZ—helping us achieve the highest rate of 1st dose coverage in the world—and the pharmacies and primary care offices answering their calls right now. 🙏🏽🙏🏽🙏🏽
Everyone is worried about the new variant, Delta
What can we do about it?
At our session this morning, Peter Juni
@COVIDSciOntario
had two clear messages:
-prioritize 2nd doses where the Delta-variant is spreading (e.g. Brampton, Peel, Toronto)
-reduce inter-regional travel
Hey primary care,
There are new drugs that we can prescribe to (select) adults with COVID in the community
Check out this useful 2-pager developed by our pharmacists Brenda Chang, Doret Cheng, Sharan Lail & Beth Leung at St. Mike's
@UnityHealthTO
@UofTFamilyMed
Please share!
If we want to vaccinate more people quickly, we need to give more vaccine to primary care
Agree with
@BogochIsaac
in this
@CBCNews
article
I’d add that giving more vaccine to primary care would also lead to a more equitable rollout
To start, there has been too little public communication about treatments available, who qualifies & where they can access it
We’ve tried to fill this gap with resources like this one
via
But we need a big multi-channel campaign
I know some parents are reasonably worried about the risk of myocarditis following COVID-19 vaccination for children 5 to 11
Here's what we know about the risk and why experts think it will be much LOWER in this age group than with teens/adults 🧵
Thanks to colleagues
@cdavidnaylor
@DrFahadRazak
and Art Slutsky for countering the misinformation published in last weekend’s
@globeandmail
Vaccines have reduced serious illness and death from COVID-19. Period.
Public education is crucial b/c the meds are only effective if given within 5 days of symptoms. And most people have received the message to not bother the healthcare system if they have symptoms and can manage at home. Now we want *some* people to call us ASAP
You just found out your child has COVID. What should you do?
How can you best care for your child? When should you call the doctor or take them to the ED?
Our latest resource provides the answers 🧵
How is that >98% of Danes have a GP? Part of the answer lies in their approach to training physicians.
Here's a summary of some of what I've learned on my trip to Denmark 🇩🇰 🧵
(the photo here is a wall of some of the 170+ residents trained at the practice I visited)
We know that a recommendation from a trusted healthcare provider goes a long way towards building vaccine confidence
That's why
@NoahIvers
and I drafted this letter to send to our patients, encouraging parents to say YES to the
#covidvaccine
for their kids age 5 to 11
Special day at our community vaccine clinic run by Regent Park CHC
@FredVictorTO
@UnityHealthTO
We hit 10,000 doses—and I got to end my shift vaccinating an extra special someone (dose 2!)
Is it because community case counts aren't high enough for the tests to pick up enough cases to make it worthwhile?
Well, if that's the argument then it makes even less sense to support rapid testing of vaccinated adults in workplaces
Is it because we have done everything we can to keep schools safe?
No. We have masks, some distancing, some improvements in ventilation but still large class sizes and plenty of covid circulating in the community
(figure via
@dgurdasani1
)
I worry that we will once again have too many vaccines in freezers instead of arms - when we know speed saves lives.
Why do we need to wait for an online booking system when our central database is ready & we have other ways to book. And why the delay?
Is it because the tests are in low supply or too expensive to purchase?
No. My understanding is the feds are purchasing and distributing the rapid tests to provinces
Most people who become infected with COVID can recover at home without any treatment
But there are now medications doctors can prescribe to keep high-risk folks from getting seriously ill
Which meds? Who can get them? We break it down in our latest @
If you have any symptoms--even if they are mild and even if you are doubly vaccinated--please self-isolate
Get a PCR test if available
If no PCR test is available, continue to isolate while you have symptoms (even if a RAT is negative)
Current ED woes relate to:
-a surge in respiratory viruses (eg RSV)
-understaffing in ED and hospitals
-understaffing in LTC and home care (leading to high ALC rates)
-limited hospital capacity to start
Let’s stop blaming family doctors
5 million Canadians don't have a primary care home and that's a huge problem
But arguing about whether we need more family docs OR more NPs in primary care to "fix" the problem is the wrong debate and a false choice
We need BOTH—and a whole lot more 🧵
Humbled to be named alongside so many people I respect and grateful to the 1000’s who have been part of the vaccination effort—scientists, healthcare workers, administrators, community leaders, advocates, volunteers & all who rolled up their sleeve 🙏🏽🙏🏽🙏🏽
Fri, 815am - 8yo says he has a sore throat and runny nose
These symptoms are NOT on the school screener but we knew he should still stay home
845am - we notified the school and asked for a take-home test kit
9am - picked up this kit from the school office (thx
@MGHToronto
)
*NEW* Our latest study
@AnnFamMed
@RickGlazier1
shows that team-based primary care, coupled with payment reform, can improve patient outcomes & reduce ED use
We desperately need to expand team-based primary care in Canada
(a mega 🧵)
Is it because we don't have the person-power to package/distribute the kits and interpret/action the results?
No. Even if PHUs are stretched, it seems like there are many eager community volunteers
Cuts to med school enrolment in the 90’s resulted in Canada losing part of a generation of doctors
Now nearly 1 in 6 family docs are 65+ and nearing retirement—with too few docs in the pipeline to take over
More great reporting
@kahowlett
@globeandmail
Is it because experts disagree on how rapid antigen tests should be used to keep schools safe?
No. The federal testing and screening panel issued recommendations about rapid testing in schools in March 2021 (!)
Is it because what we've done in schools has worked to keep out covid and related outbreaks
No. There have already been plenty of cases and outbreaks in school with classes sent home and education disrupted
In the last two weeks alone, more than 1,500 cases have been reported in over 800 elementary, middle and high schools, including some 1,400 in students and 160 in staff.
The latest policy
@fordnation
is not so much a failure to listen to science but a failure of common sense
3 days of paid sick leave isn’t going to help much when a typical isolation/quarantine is 10/14 days
Without paid time off, many will go to work and so the virus spreads...
A marginalized patient living in a hotspot didn’t know they were in a hotspot or that they were eligible to book a vaccine
“I don’t want to wait in any lines. I just wanna come and get it from you when you have it”
I didn't have vaccine but he left with an appt to get one
10. So if you're in the GTA or another region with medium or high covid transmission and are over 40 years of age and aren't shut-in at home all the time, the best vaccine is still the one that's first available to you
Winter dressing is all about layering
So is COVID protection
Layer 1: Get your 1st/2nd/3rd doses of vaccine
Layer 2: Wear good quality mask indoors
Layer 3: Breathe fresh/filtered air
Layer 4: Postpone or keep gatherings small
@COVIDSciOntario
Parents: this website is a great resource from
@SickKidsNews
that provides trustworthy advice on what to do when your child is sick
They've just posted a new resource on using adult anti-fever tablets for kids
h/t
@allan_k_grillMD
Primary care should be a legislated right.
That >6.5 million people in Canada go without it is antithetical to the values people hold dear and the promise of Medicare
Thanks
@janephilpott
for this terrific op-ed. I can’t wait to read your book!
Things are changing fast. It's hard to keep up.
Fear not.
We have updated our resources based on new guidance issued by the province last week and the many questions we've received
Here's a short summary 🧵
@OntarioCollege
@UofTFamilyMed
Total health spending in Denmark 🇩🇰 is similar to Canada 🇨🇦, yet almost everyone in Denmark has access to primary care
I'm here on a 9-day tour to learn how they make it work
Today I met with Morten Petersen, CEO of , the Danish e-health platform 🧵
With new variants on the rise and a possible 3rd wave on the horizon, speed matters
The faster we vaccinate, the more lives we save
That's why we need to use all available resources—including family doctors
My latest
@TorontoStar
85% of eligible Canadians fully vaccinated
A kids vaccine approved in the US
Low/declining cases in most regions
Truly light over darkness
Happy Diwali 🪔
I've been overcome with emotion these last few days
immense sadness - for the lives lost
anger - at our policy failures and their unequal impact
frustration - still no
#PaidSickDays
guilt - could I have done more?
hope - seeing so many colleagues working hard for better
Not sure if you qualify for a booster vaccine dose in Ontario or what meds are considered immunosuppressants?
@ONThealth
has just released more specific guidance including a med list here:
So how can we do better?
There are the basic things—a public education campaign, a clearer website, easier-to-access centres
But we also need to ramp up distribution channels
Primary care professionals should be empowered to prescribe
This headline is disappointing.
Our research has shown repeatedly that the vast majority of family doc offices have been open to in-person visits through the pandemic
Our team has been seeing +++ people with respiratory illness these last few weeks.
Fun fact: nearly every person in Denmark 🇩🇰 has the name of their GP (or group of GPs) on their healthcard
It's an organized system where 98+% have access to primary care.
How do they do it? One key lies in how GPs are organized. 🧵
(photos of Christian Folsach's practice)
Thanks
@globeandmail
for sharing the stories of some of the >5000 Canadians who lost their life in 2020 due to an opioid overdose — too many of them in the prime of their lives.
Wouldn’t it be great if every Canadian could get a family doctor with the same ease with which you register kids for public school?
Think it’s a dream? It doesn’t have to be
My latest oped
@TorontoStar
w/
@docdanielle
In Ontario, access to Paxlovid is via select COVID clinical assessment centres
People self refer or they can be referred by their family doc
But the MoH website doesn’t make it easy to know where to go
Lots of discussion about burnout in healthcare
What is one thing we can all do to help?
Be extra kind
Especially to nurses, clerical, and other support staff who often bear the brunt of patient frustration
There are big system problems. It's not their fault.
I have huge respect for the individuals working with NACI. Now, >15 mo into the pandemic, they really need to be supported by savvier comms. They would also benefit from welcoming more members of the public, pharmacists & primary care clinicians to their deliberations 10/
Nearly 70% of parents are keen to have their children age 5-11 get the Covid vaccine 👏🏽
Top reasons
✅protect their kids from COVID
✅protect others in their family
✅prevent missing in-person school
✅more comfort taking their kids to public places
When you look up COVID clinical assessment centres you get a list of “COVID assessment centres” together with “COVID clinical assessment centres”
Both types offer testing but it’s only the “clinical” centres that can provide COVID treatments
What are the medical exemptions to
#COVID
vaccination?
In short:
-anaphylaxis or serious allergic rxn to COVID vaccine or its components AND review by allergist
-myocarditis/pericarditis with 1st dose
Some helpful guidance for providers on pg 5-6 here:
Family medicine is often seen as a "lesser than" specialty.
In truth, generalism is more and more needed yet harder and harder to practice.
Family medicine needs respect, pay and support commensurate with its value
via
@thewalrus
cc
@UofTFamilyMed
What's a typical day in a GP practice in Denmark 🇩🇰 where 98%+ of people have access to primary care?
Here's some of what I learned spending the day at a practice in Aarhus last month 🧵
(and yes, the space really is as beautiful as it looks in these photos!)
Our journey illustrates how important it is to give parents clear guidance on what to do if their kid has sx and provide easy access to PCR testing
Felt super lucky to live in east TO where every school has school has take home tests thx to
@MGHToronto
@janinemccready
+ others
Mother’s Day morning at the Scarborough Bluffs, one of my favourite places in TO. Thanks to this crew for their support, resilience, and love, especially this year 💙