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Clinical prevention prerequisites A framework for health authorities

Clinical prevention prerequisites A framework for health authorities. Ak’ingabe Guyon MSc MD CCFP FRCPC Public health and preventive medicine specialist Montreal Public Health Unit Framework developped in collaboration with David Kaiser, Valérie Lemieux and Robert Perreault.

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Clinical prevention prerequisites A framework for health authorities

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  1. ClinicalpreventionprerequisitesA framework for healthauthorities Ak’ingabeGuyon MSc MD CCFP FRCPC Public health and preventivemedicinespecialist Montreal Public Health Unit Framework developped in collaboration withDavid Kaiser, Valérie Lemieux and Robert Perreault Thursday, May 29th 2014 CPHA conference, Toronto

  2. Plan • Background and objectives • Clinicalpreventionprerequisites • Regional and provincial applications Clinical prevention prerequisites A. Guyon, May 2014

  3. Prevention: an essential public healthfunction 1. Background and objectives Public health Health promotion • PreventionLast 2006, Starfield 2008, BC Clinicalpreventionpolicyreviewcommittee 2009, • It includesat least : • Immunisation • Counseling • Screening and earlydetection • Preventivetreatments Surveillance Protection Clinical prevention prerequisites A. Guyon, May 2014

  4. 1. Background and objectives Initial project • Montreal Public health unit withinregionalhealthauthority • Strategic planning exercise • Clinicalprevention services Clinical prevention prerequisites A. Guyon, May 2014

  5. 1. Background and objectives Driftingproject • …define public health’srole (regional and provincial) in clinicalprevention Clinical prevention prerequisites A. Guyon, May 2014

  6. 1. Background and objectives Clinicalpreventive services USTFPHS, CTFPHC, Thivierge et al. 2014 Clinicalpreventionprerequisites Walsh & McPhee 1992 Barr et al. 2003 Groulx 2007, CSBE 2010 BC Lifetime of prevention 2009, BCMA 2010 US National preventionstrategy 2011 UK Department of health 2014 Clinical prevention prerequisites A. Guyon, May 2014

  7. Objectives 1. Background and objectives • Propose a framework of clinicalpreventionprerequisitesAs a tool to rapidlyidentifywho supports clinicalprevention and how at a regional and provincial level • Apply the framework • at a regionallevel (Montreal Public health unit) • at a provincial level (clinicalprevention services taskforce amongQuebec’s public healthunits) • Redefine public health’sclinicalprevention mandatesAssist the regionalclinicalprevention team as itreassessesitsresponsabilities over clinicalprevention Clinical prevention prerequisites A. Guyon, May 2014

  8. 2. Clinicalpreventionprerequisites • Transversal functionsnecessary for clinicalprevention • Orchestration • Scientific leadership • Direct support to clinicians • Monitoring and surveillance • Patient empowerment Clinical prevention prerequisites A. Guyon, May 2014

  9. 2. Clinicalpreventionprerequisitesframework Orchestration Monitoring and surveillance Scientificleadership Patient empowerment Direct support to clinicians Clinical prevention prerequisites A. Guyon, May 2014

  10. 2. Examples of clinicalpreventionprerequisites Orchestration • Overall leadership and planning • Responsibility for vision and planning • Balancingpreventionwithother public healthfunctions • Ensuring a healthequity focus • Stakeholdersroles and engagement • Role and boundarynegotiationamong institutions, multiple clinicians, NGOs, industry • Workforce planning • Health care services thatstrenghtenprevention • Access, comprehensiveness, continuity, coordination • Funding and incentives • Publiclyfundedcoveragedecisions on clinicalpreventive services • Incentives to clinicians for quality and access to preventive services • Logistics for clinicalprevention • Patient recall and clinicianreminder– Electronichealth records • Populationalprevention programs • For example: cancer screening, immunisation, smoking cessation, etc. References on slide 6, Valaitis et al. 2009, Parks et al. 2012, Bodenheimer et al 2014. Clinical prevention prerequisites A. Guyon, May 2014

  11. 2. Examples of clinicalpreventionprerequisites Scientific leadership • Evidence basedclinicalprevention • Assess new trends, evidence • Priority setting of clinicalpreventive services and schedule • Evidence based practice guidelines • Training and knowledgetransfer • Initial training of clinicians in clinicalprevention • Continuingprofessionaleducation • Research on clinicalprevention • Clinicalpreventive services research • Public healthand health services systemsconducive to prevention BC Lifetime of prevention 2009 Maciosek et al. 2009 Clinical prevention prerequisites A. Guyon, May 2014

  12. 2. Examples of clinicalpreventionprerequisites Direct support to clinicians • Practice support • Qualityimprovement teams • Facilitation • Communities of practice • Support of motivationalinterviewing techniques • Clinicaldecision support at point of care (web, apps, consultations to expert clinicians…) AHRQ, Put preventioninto practice, 2005 Provost et al. 2007; Martel & Leaune, 2009; NICE 2014 Clinical prevention prerequisites A. Guyon, May 2014

  13. 2. Examples of clinicalpreventionprerequisites Monitoring and surveillance • Monitoring • Clinicalprevention services access, uptake • Qualityimprovement of clinicalpreventive services • Evaluation • Of clinicialprevention services effectiveness and efficacy • Of clinicalpreventionsystem’simplementation, relevance, efficacy, efficiency • Surveillance • Preventabledisease and injury trends References on slide 6 and Bodenheimer et al 2014 Clinical prevention prerequisites A. Guyon, May 2014

  14. 2. Examples of clinicalpreventionprerequisites Patient empowerment • Vision of patients as partners • Supporting population demand for clinicalprevention • Media campaigns • Literacyfriendly patient educationmaterial • Unbiased and public preventionfocusedwebsite(s) • Self management support • Web-basedpersonalhealth plans • Self care guidelines for prevention References on slide 6 and Bodenheimer et al 2014 Clinical prevention prerequisites A. Guyon, May 2014

  15. 3. Regional and provincial applications Usefulness of the clinicalprerequisitesframework Montreal public health unit • Identification and analysis of all clinicalpreventive mandates • Sharedunderstanding of clinicalpreventionprerequisitesacross the public healthunit’s divisions • Strategic support for the upcomingregional public health plan Provincial taskforce on clinicalpreventionamongQc public healthunits (Groupe de travail de la Table nationale de concertation en prévention clinique) • Identification of local, regional and provincial stakeholders • Diagnosis of currentstakeholders’ involvement • Systematic identification of gaps and overlaps • Strategic support for the upcoming provincial public health program Clinical prevention prerequisites A. Guyon, May 2014

  16. 3. Regional and provincial applications Towards a clinicalprevention system Stakeholdersweaklycoordinated and involved • Clinicalprevention system • Clinical and public health expertise centres (INSPQ, INESS) • Ministry of health(public health, primary care, hospital services, RAMQ insurance plan, …) • Regionalhealthauthorities and local centres (ASSS, CSSS) • Public health(local, regional, provincial) • Health care services (CLSC, clinics, hospitals pharmacies, etc.) • Professional organisations (MD, nurses, pharmacists, etc.) • Patients, NGOs, etc. Clinical prevention prerequisites A. Guyon, May 2014

  17. Questions ?Comments ?Regional or provincial experiences in planning a comprehensiveclinicalprevention system? Ak’ingabe Guyon aguyon@santepub-mtl.qc.ca Clinical prevention prerequisites A. Guyon, May 2014

  18. References • Agency for healthcareresearch and quality (AHRQ). Put preventioninto practice – websitecurrent as of November 2005 • Barr V et al. 2003. The expandedchronic care model: an integration of concepts and strategiesfrom population health promotion and the chronic care model. HealthcareQuaterly, 7(1) 73-82. • Bodenheimer T et al. 2014. The 10 building blocks of high-performingprimary care. Annals of familymedicine 12(2) 166-171. • British Columbia (BC) Clinicalpreventionpolicyreviewcommittee. 2009. A Lifetime of prevention. Ministry of health, Governement of British Columbia, Vancouver. BC. • British Columbia Medical Association(BCMA). 2010. Partners in prevention. Implementing a lifetime of prevention plan. BCMA, Vancouver. • Canadian task force on preventivehealth care (CTFPHC). Websiteconsulted on may 19th 2014. http://canadiantaskforce.ca/ • Thiverge et al. 2014. Évaluation Médicale Périodique. Direction de santé publique - Agence de la santé et des services sociaux de Montréal et Collège des médecins du Québec, Montréal, Québec. • Commissaire à la santé et au bien-être du Québec (CSBE). 2010. Rapport d’appréciation du système de santé et de services sociaux. Adopte une approche intégrée de prévention et gestion des maladies chroniques: recommandations, enjeux et implications. Québec, Québec. • Groulx S. 2007. L’intégration des pratiques cliniques préventives. Guide pour la promotion et le soutien des pratiques cliniques préventives. MSSS. Québec. • Last J. 2006. A dictionary of epidemiology. New York: Oxford Universitypress. • Maciosek, M. V., Coffield, A. B., Edwards, N. M., Flottemesch, T. J., & Solberg, L. I. (2009). Prioritizing clinical preventive services: a review and framework with implications for community preventive services.Annu Rev Public Health, 30, 341-355. Clinical prevention prerequisites A. Guyon, May 2014

  19. References • Martel D., Leaune V. 2009. L’amélioration des pratiquescliniquespréventivesà l’égard des habitudes de vie. Recension des écrits. Direction de santé publique, ASSS de Montréal. • National institute for health and care excellence (NICE). 2014. Behaviour change: individual approches. NICE public health guidance 49, • National prevention council. National prevention strategy. America’s plan for better health and wellness. US Dept of health and human services. Office of the surgeon general, Washington, DC. • Parks AV et al. 2012. Opporunity knocks for public health departments: increasing the use of clinical preventive services by older adults. Policy note. UCLA center for health policy research. LA, California. • Provost, M.-H. (2007). Description, impact et conditions d'efficacité des stratégies visant l'intégration de la prévention dans les pratiques cliniques : revue de la littérature. Québec, QC: Ministère de la Santé et des Services Sociaux. • StarfieldB, Hyde J, Gervas J, Heath I. 2008. The concept of prevention: a good idea gone astray? J EpidemiolCommunityhealth 2008 (62) 580-583. • Walsh JME, McPhee SJ. 1992. A systems model of clinicalpreventive care: an analysis of facotrsinfluencing patient and physician. Health Education Quarterly 19, 157-75. • United Kingdom’sDepartment of health. 2014. Living well for longer. National support for local actions to reduceprematureavoidablemortality. April 2014. London, UK. • U.S. Preventive services task force (USPST). Websiteconsulted on may 19th 2014. http://www.uspreventiveservicestaskforce.org/ • Valaitis R et al. 2009. A scopingliteraturereview of collaboration betweenprimary care and public health. Report to the Canadian health services foundation. Clinical prevention prerequisites A. Guyon, May 2014

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