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Patient Compass

In this issue: July 2018

Our quarterly magazine contains important updates on policies, topics of interest, as well as a summary of recent disciplinary findings.
Read the latest issue here.

Continuity of Care Matters for You and Your Family

Tell us what you think about our proposed policies

A biopsy report is accidently filed away before the physician reviews it. A man who recently underwent a hip replacement is anxious because he feels he never got a chance to have his questions answered before leaving hospital. A new mother, worried about her baby’s refusal to eat, phones her family physician’s office but is unable to leave a message on the voice mail system.

These are all very different scenarios, but they share one common theme: They are examples of breaks in continuity of care that can happen in our complex, fast-paced health-care system staffed by busy people. And any of the above scenarios could result in serious harm to a patient.

The CPSO has developed several new policies about “continuity of care” to help reduce and minimize breakdowns in care. We recently posted the draft policies for comment and we want your feedback on how to improve them.

What is “Continuity of Care”?
Continuity of care can mean many things, but often focuses on the importance of patient care being connected and coordinated. This means that your care providers are sharing and following-up on information, and working together to make sure that each health interaction you have is informed by your other interactions. It also means that you, as a patient, are taking an active role in your care and treatment. In this way, continuity of care is an essential part of patient-centred care and critical to patient safety

The Story of Greg Price
In 2012 Greg Price, a 31-year-old Alberta man, died unexpectedly three days after surgery to remove a cancerous testicle. Greg experienced delayed treatment and disjointed medical care and his death prompted the province to take a hard look at factors in the health care system that may have contributed to his death. The resultant review concluded that the health care system had utterly failed him. The report said that: “this patient was in the care of two, and then three, primary care physicians, none of whom knew or had access to his whole history. Greg experienced delays in receiving important tests, difficulties contacting the treating physician, confusion regarding how to book appointments and inadequate communications from physicians regarding appointments and test results.”

You can read more details about Greg’s story in Dialogue magazine.

Many patients experience frustration and confusion as a result of things like not being able to reach or leave a phone message for their physician, unclear emergency and after-hours care plans, delays in the review of test results, or even pharmacists having difficulty reaching physicians to clarify prescriptions. While Greg’s story involved several missed opportunities and breaks in communication, even a single break in continuity of care has the potential to negatively impact your overall care.

What’s in the draft policies?
Physicians play an important role in our multi-layered health-care system and your care requires co-ordination within the system. While there are some things your doctor can’t control, there are many continuity of care issues that are within a physician’s control or influence. Our draft policies focus on these issues.

The Continuity of Care draft policy comprises an umbrella policy and four distinct companion policies. The umbrella document outlines general expectations while the four companion policies focus on the following key areas:

  • Availability and coverage: physician availability, after-hours care, and coverage during temporary absences
  • Managing tests: ordering and tracking tests, following up with patients, collaborating with colleagues and patient engagement
  • Transitions in care: transferring care to other physicians and health-care providers, particularly hospital discharges and referrals to specialists
  • Walk-in clinics: physician responsibilities to facilitate continuity of care given the episodic nature of walk-in clinics

Quick reads
You can learn more about each of the areas covered by the policies by clicking on the icons below to read a short ‘primer’ on each draft policy.

You have a role to play too:
Things you do as a patient can complement a physician’s efforts to provide you with the best care and help prevent breakdowns in care. For example, your choices regarding when and how to access care, completing your tests in a timely manner and being available to receive your test results, are some of the ways you can impact continuity of care. The draft policy asks doctors to engage you in your care and help you understand how you can actively help to reduce these breakdowns. In future, we plan to develop a companion document for patients.

There are many more aspects to continuity of care and they are explored in an article in our recent issue of Dialogue magazine.

How to participate in the discussion
Patients bring a unique and valuable perspective to the issues raised in our draft policies, so we want you to lend your voice to the discussion.

Visit our continuity of care consultation webpage. Here you can read the draft policies in full as well of contribute to the discussion in a variety of ways:

You can also send us your comments by regular mail. We hope you take the time to review the draft policies and contribute to the discussion. Your input will help to shape the final products into policies that reflect the needs of Ontario patients and their families.

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New Warning Sticker on Opioid Prescription Bottles

Beginning in October 2018, when you pick up an opioid prescription, you’ll see a sticker on the container that warns patients that opioid medication can cause dependence, addiction and overdose. This is part of a new Health Canada strategy to ensure patients receive consistent, relevant information about the safe use of prescription opioids and their potential risks. Along with the new mandatory stickers, Health Canada will also require that Canadians be given a patient information handout whenever opioids are dispensed to them at pharmacies or in doctor’s offices.

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Safety First: Storing and Disposing of Your Medications

Improperly storing and disposing of your medications at home can lead to medication errors, accidental poisonings, as well as inappropriate drug use and illegal diversion. And, despite the use of child-resistant packaging, reports of children harmed from accidently swallowing medications are often the result of improperly stored or discarded medications. To help doctors and patients create safer home environments, the Institute for Safe Medication Practices (ISMP) Canada has developed useful information and resources about how to safely store and dispose of medications at home. Resources include their “Prevent Medication Accidents” information card and “5 Questions to Ask about Your Medications”, a patient handout about the proper use, storage and disposals of opioids prescribed to treat post-surgery pay. Click on the icons below to download these resources. And read more about ISMP’s advice and guidance in their recent bulletin.

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Do You Use Marijuana?

Now that the federal government will make recreational marijuana legal as of October 2018, physicians know that patients may be more open to sharing information about their marijuana use with health care professionals. So, don’t be surprised if, as part of your routine history taking, your doctor asks whether you use marijuana in the same way they ask about alcohol and smoking.

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Road Safety


When must your physician report medical concerns that affect driving abilities?

Doctors are required by law to report patients they believe to be medically unfit to drive. Recently, the Ontario government took steps to strengthen the requirement by specifying which medical and visual conditions, and functional impairments to report. As of July 1, doctors, nurse practitioners, optometrists and occupational therapists have the discretionary authority to report the following high risk conditions when they believe the condition affects a patient’s attention, judgment and abilities:

  • Cognitive impairment
  • Sudden incapacitation
  • Motor or sensory impairment
  • Visual impairment
  • Substance use disorder
  • Psychiatric illness

You can read more about the updated reporting requirements in the latest issue of the CPSO’s Dialogue magazine or visit the Ministry of Transportation website.

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We want to hear from you!

The College relies on feedback from the public, as well as the profession, to formulate policy. Please take a few moments to comment on our open consultations.
View our active consultations.
Learn more about the College’s consultation process here.
Join our mailing list and receive notification of all future policy consultations.

For general inquiries or to make a complaint, contact our Public Advisory Service:
Toll Free: 1-800-268-7096 Ext. 603
Copyright © 2018 College of Physicians and Surgeons of Ontario, All rights reserved.

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