#1! Le GMF Santé Kildare a le meilleur taux d'assiduité sur le territoire du CIUSSS Centre-Ouest-de-l'Île-de-Montréal depuis 2015 / #1! GMF Sante Kildare has the highest patient fidelity rate (taux d'assiduité) in the CIUSSS Centre-Ouest-de-l’Île-de-Montréal territory since 2015.

Let’s be clear: Kids should NOT smoke marijuana

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This week, the federal government’s tabled Bill C-45 would allow adults to legally possess and use small amounts of recreational marijuana. The bill would make it a criminal offence to sell pot to minors but it would not be crime for youth to possess small amounts of it.
The introduction of the Bill was met with a strongly worded editorial in the Canadian Medical Association Journal:

“Simply put, cannabis should not be used by young people. It is toxic to their cortical neuronal networks, with both functional and structural changes seen in the brains of youth who use cannabis regularly.”
The CMAJ references the Position Statement of the Canadian Pediatric Society. Scientific evidence strongly links marijuana use in youth to:

1. cannabis dependence and other substance use disorders
2. the initiation and maintenance of tobacco smoking
3. an increased presence of mental illness, including depression, anxiety and psychosis
4. impaired neurological development and cognitive decline
5. diminished school performance and lifetime achievement

 
The Canadian Medical Association recommends that the minimum age to buy and use marijuana be set at 21 instead of 18 years.  Furthermore, the CMA stresses that restrictions be imposed on the quantity and potency of marijuana that young people can purchase and use until the age of 25.

 
Dr. Brian Goldman, in his blog “White Coat, Black Art” writes, “I agree that high potency marijuana use in young people is risky.  But I don’t think that legislation is the solution.  Canada has one of the highest rates in the world of young people using marijuana.  As many as 60 per cent of 18 year olds have tried it at least once.  The absence of legislation hasn’t made it that difficult for youth to obtain it. Researchers doubt that bill C-45 or any law for that matter will curb the use of cannabis by young people.  Colorado has had legal marijuana for some time now, and that state has seen no increase or decrease in young people using the drug.”

 
He correctly concludes, “The federal government should stop suggesting that the law is intended to prevent kids from using marijuana, since that kind of message is likely to make the drug more attractive to teens.”

 
As debate Bill C-45 is debated and inches towards legislation, let’s make sure that we put our children’s health first.

 

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Screen Time: We Need a Plan

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” No child should have a phone in their bedroom unsupervised.”
Dr. Leonard Sax, Pediatrician

 

It is always interesting to see which Facebook posts attract the most attention. An interview with Dr. Leonard Sax in the Wichita Eagle, “Why kids today are out of shape, disrespectful – and in charge,” drew considerable interest – even Facebook commented  “This post is performing better than 90% of other posts on your Page.”
The article, http://www.kansas.com/news/nationworld/national/article56473378.html, describes the “reordering of families.” Dr. Sax argues that families are facing a “crisis of authority” where kids are given too much control and are effectively put in charge. “The parent makes a recommendation, but the child makes the final decision. I know of cases where the kid was clearly making the wrong decision and the parents knew it but nevertheless felt completely powerless to overrule their child. The child is the one who suffers.”
He continues, “The same is true with regard to a cellphone in the bedroom. You now find kids at 10, 12, 14, 16 years of age who have their phone in their bedroom at two (o’clock) in the morning. You take the device at night and you put it in the charger, which stays in the parents’ bedroom. No child should have a phone in their bedroom unsupervised.
That’s not just my opinion. That is the official teaching of the American Academy of Pediatrics (AAP) in guidelines published (in) October 2013. But you would be astonished, or maybe you wouldn’t be, how many parents find that an impossible recommendation. They feel that they have no authority over their child in many domains.”

So, what does the AAP actually say and recommend:

According to a recent study, the average 8- to 10-year-old spends nearly 8 hours a day with a variety of different media, and older children and teenagers spend >11 hours per day.1
Presence of a TV set in a child’s bedroom increases these figures even more, and 71% of children and teenagers report having a TV in their bedroom.1 Young people now spend more time with media than they do in school—it is the leading activity for children and teenagers other than sleeping.1,2
Nearly all children and teenagers have Internet access (84%), often high-speed, and one-third have access in their own bedroom.
In a recent study, two-thirds of children and teenagers report that their parents have “no rules” about time spent with media.1 Many young children see PG-13 and R-rated movies—either online, on TV, or in movie theaters—that contain problematic content and are clearly inappropriate for them. Few parents have rules about cell phone use for their children or adolescents. There is considerable evidence that a bedroom TV increases the risk for obesity, substance use, and exposure to sexual content.1,2-8.
Give, these concerns, the American Academy of Pediatrics recommends:

  • Limit the amount of total entertainment screen time to Discourage screen media exposure for children.
  • Keep the TV set and Internet-connected electronic devices out of the child’s bedroom.
  • Monitor what media their children are using and accessing, including any Web sites they are visiting and social media sites they may be using.
  • Co-view TV, movies, and videos with children and teenagers, and use this as a way of discussing important family values.
  • Model active parenting by establishing a family home use plan for all media. As part of the plan, enforce a mealtime and bedtime “curfew” for media devices, including cell phones. Establish reasonable but firm rules about cell phones, texting, Internet, and social media use.

 

1. Rideout V. Generation M2: Media in the Lives of 8- to 18-Year-Olds. Menlo Park, CA: Kaiser Family Foundation; 2010
2. Strasburger VC. Health effects of media on children and adolescents.Pediatrics. 2010;125(4):756–767pmid:20194281
3. Staiano AE. Television, adiposity, and cardiometabolic risk in children and adolescents. Am J Prev Med. 2013;44(1):40–47pmid:23253648
4. Hanewinkel R. Longitudinal study of exposure to entertainment media and alcohol use among German adolescents. Pediatrics. 2009;123(3):989–995pmid:19255030
5. Jackson C. A TV in the bedroom: implications for viewing habits and risk behaviors during early adolescence. J Broadcast Electron Media. 2008;52(3):349–367
6. Adachi-Mejia AM. Children with a TV in their bedroom at higher risk for being overweight. Int J Obes (Lond).2007;31(4):644–651pmid:16969360
7. Kim JL. Sexual readiness, household policies, and other predictors of adolescents’ exposure to sexual content in mainstream entertainment television. Media Psychol.2006;8(4):449–471
8. Gruber EL.. Private television viewing, parental supervision, and sexual and substance use risk behaviors in adolescents [abstract]. J Adolesc Health.2005;36(2):107

https://www.healthychildren.org/English/news/Pages/Managing-Media-We-Need-a-Plan.aspx
http://pediatrics.aappublications.org/content/132/5/958

Nurse Practitioners: What’s the deal?

Many of you may have noticed nurse practitioners popping up in your family medicine clinics lately. If you haven’t noticed them yet, you are very likely going to notice more of them soon. The Quebec government has invested $25 million dollars to help train new nurse practitioners in Quebec. Their goal is to have at least 2,000 primary care nurse practitioners trained in Quebec by 2025. We still have a long way to go to meet this goal; there are only 428 nurse practitioners in Quebec.

So what is a nurse practitioner? Simply, they are a family doctor for healthier people. Nurse practitioners are nurses who have gone back to school and received a Master’s degree and extra medical training. They are qualified to write prescriptions for certain medications, they can send you for blood tests, x-rays, ultrasounds, and other tests, and they can do procedures like stitches.

A nurse practitioner can follow healthy people from babies to older adults for their regular check ups. They can also follow healthy pregnant women until they are 32 weeks pregnant. You will also see them in walk-in clinics because they are able to manage most of the acute issues that bring people to a walk-in clinic.  If you are followed by a nurse practitioner all of your health needs are managed by the nurse practitioner much like if you had a family doctor.

Nurse practitioners are not completely alone. They work in partnership with family doctors who are there to act as the nurse practitioner’s specialist. Much like your doctor may send you to see a specialist, like a cardiologist, a nurse practitioner can “refer” to their partner physician. The nurse practitioner may discuss your case with their partner physician or, if needed, the doctor may see you for a visit.

The goal of the nurse practitioner is to help improve access to primary care. Nurse practitioners are able to help relieve the burden of the family doctors by following their own caseload. This increases the number of Quebecers who have a family doctor and it also allows family doctors to follow more complex cases.

 

https://www.oiiq.org/sites/default/files/rapport-statistique-2014-2015.pdf

http://www.cbc.ca/news/canada/montreal/quebec-super-nurses-1.4041873

Jennifer Reoch

Santé Kildare Nurse Practitioner Candidate

Santé Kildare à l’épicerie!

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Notre première édition de la visite santé au supermarché IGA Lipari fut un grand succès, nous remercions tous les participants qui se sont joint à nous!

Notre nutritionniste du GMF Sante Kildare Caryn a su nous  guider à choisir sainement et à comprendre le fonctionnement des coulisses alimentaires.

La lecture des emballages et les choix à privilégier n’ont plus de secrets suite à cette visite interactive et dynamique.

Nous planifions offrir plusieurs présentations sur la promotion de la santé dans les prochain mois, restez aux aguets! Au programme : nutrition chez les personnes âgées, diabète, soutien aux aidants naturels et plus encore!

Au plaisir de vous rencontrer bientôt!

No need to worry…Casino Montreal still has unlimited free parking!

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The running meter is a distraction that interferes with medical appointments.”
Dr. Rajendra Kale, former editor CMAJ

Our Facebook post last week on plans to reduce parking fees at Quebec hospitals was our most popular yet. Parking fees can be excessive and their appropriateness has been extensively debated.

In the March 6, 2012 issue of the Canadian Medical Journal (CMAJ), doctors debated the merit and necessity of charging patients for parking. Dr. Tom Closson, President and CEO of the Ontario Hospital Association, argued that parking fees are one of the most common ways of making up the deficit of hospital operating budgets. He stresses that provincial government cutbacks to hospitals eliminate “crucial revenues that hospitals use to fund clinical research and front-line patient care.” He admonishes the Journal’s editorial board, “surely CMAJ has something to say about these and other more relevant issues, instead of banging away on the populist drum about parking fees.

Dr. Tim Meagher of the MUHC takes the opposing position, “I support free hospital parking for patients. I would probably also support free transport to and from hospital visits, reimbursement for time lost from work due to hospital visits, and reimbursement for myriad of ancillary costs that hospital visits generate.”

Dr. Rajendra Kale, editor in chief of the CMAJ, writes “”Parking fees amount to a user fee in disguise.” He urges Canadian hospitals to follow the example set in Scotland and Wales where hospital parking fees are abolished “because they burden (the) patient.” Dr. Kale concludes, “Those opposed to scrapping parking fees for patients need to recognize that such fees are, for all practical purposes, user fees and a barrier to health care. Using revenue generated from such surrogate user fees for health care is against the health policy objective of the Canada Health Act and could become the subject of a legal challenge.”

This opinion was supported by Dr. Brian Goldman, Host of CBC’s White Coat, Black Art, “I think hospital parking fees should be abolished because they punish patients.”
The highlights of the new hospital parking plan, starting April 1, are:
Hospital visitors will be able to park for free at hospitals in Quebec for the first 30 minutes, instead of paying as much as $10 for that first half hour.
• A flat daily rate will not be applied until a vehicle has been parked for more than four hours, a big change from the current practice of charging the maximum daily rate after 90 minutes.
• Health care institutions must offer weekly and monthly parking passes, as well as books of tickets, at reduced rates.
• Health care institutions must offer daily parking passes that allow motorists to come and go without penalty.

 

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MEDICAL DONATIONS: HOW CAN WE HELP AND WHAT ARE THE DRAWBACKS?

A nice story in the Gazette this week about sharing used medical equipment in Third World countries.
Furniture, bedside tables, equipment from the old Royal Victoria Hospital will be sent to Central Africa to be used in eight hospitals in Cameroon.
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Numerous organizations are identified by the World Health Organization to help distribute medical supplies, equipment, vaccines and donations:

HTTP://WWW.WHO.INT/MEDICAL_DEVICES/MANAGEMENT_USE/DONATION_ORG_ROLES.PDF

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In Canada, HOPE and HPIC are two organizations that help with this cause.

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HPIC (Health Partners International of Canada) is a relief and development organization dedicated to increasing access to medicine and improving health in the developing world.

HPIC is an independent charity that receives donations of medicines, vaccines and medical supplies from Canadian pharmaceutical and healthcare products companies, to be used for humanitarian purposes.  HPIC is funded in part by the Government of Canada, foundations, companies and individuals.

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Since 2012, Santé Kildare has sent supplies to JustWorld International to support the medical clinic located in Jocotenango, Guatemala.  Promoted through the international equestrian community, JustWorld supports basic education, nutrition, health & hygiene, and cultural development programs for children in impoverished communities in Cambodia, Guatemala, and Honduras.

Regrettably, medical equipment donated to developing nations is not always used.

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While medical equipment donations in theory enable hospitals in developing countries to receive expensive and advanced technology, in reality much of the equipment breaks easily and is not repaired.

study of seven hospitals in Haiti found that only 1/3 of the 115 pieces of medical equipment donated after the 2010 earthquake was working after 3 years and 1/2 of the broken equipment could not be repaired. Some of the donated devices, such as incubators for premature babies, were never used because of insufficient electrical voltage in Haiti.

The World Health Organization (WHO) estimates that only 10-30% of all medical equipment donations are ever put into operation.  Not only does the equipment need to be donated, it needs to be shipped, delivered, installed, and the local staff trained.

To address this concern, WHO defined 4 principles for a good medical equipment donation:

  1. Respect the recipient’s request
  2. Assure the donation will benefit the recipient
  3. Keep an open line of communication
  4. Ensure quality

 

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Is it my turn yet?

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It is no secret that we are (extremely) frustrated with long waiting times. Consecutive governments repeatedly promise to fix this problem but wait times only seem to grow longer.
As noted by the Fraser Institute: “excessively long wait times remain a defining characteristic of Canada’s health-care system, but this year (2016) is the longest we’ve ever seen and that should trouble all Canadians.” Bacchus Barua, senior economist at the Institute, continues, “long wait times aren’t simply minor inconveniences, they can result in increased suffering for patients, lost productivity at work, a decreased quality of life, and in the worst cases, disability or death.”
http://globalnews.ca/news/3083826/medical-wait-times-in-canada-are-longer-than-ever-hitting-20-weeks-in-2016-fraser-institute/

 

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The Canadian Institute of Health Information (CIHI) released a report based on The Commonwealth Fund’s 2016 international survey that highlighted this continued issue. According to the survey, Canada scored the poorest of all 11 countries surveyed when it came to access to specialists.  Fifty-six percent of Canadians wait longer than a month to see a specialist—as compared to the international average of 36 percent.

Dr. Josh Tepper, CEO of Health Quality Ontario, along with Vanessa Milne and Sachin Pendharkar, published “Four ways Canada can shorten wait times for specialists” at Healthydebate.ca.  Their prescription for success focuses on simple, achievable concepts:

 

1.Do virtual consults, not visits

Not every patient needs to see a specialist.  Often the family physician needs some guidance and a virtual consult system can help.

The Rapid Access to Consultative Expertise (RACE) is a phone based system available in parts of British Columbia. Family physicians call a central phone number during business hours on weekdays, and a specialist calls back within a couple of hours.

The success of RACE in B.C. inspired a similar program in Ontario, called The Champlain BASE e-Consult service. In this system, primary care providers complete a form that includes patient information and the medical question. Test results and images can be attached. The information is then sent to a specialist.

From 2010 to 2015, the BASE service was used in over 10,000 consultations in the Champlain region. The average wait time for a response from the specialist was two days.  Most impressively, in 40% of cases the patient did not need to see the specialist.

 

2.Add physician directories and e-referrals

Alberta currently offers paperless referrals through e-Referrals. The system includes referrals to Oncologists and Orthopedics.  Family doctors get an idea of wait times BEFORE submitting the referral and can chose a specific specialist.

 

3.Try pre-assessment in specialized clinics

Another approach is adding an assessment step in between the referral and the specialist.  This method has been successfully introduced for patients with severe low back pain (Interprofessional Spine Assessment and Education Clinics (ISAEC)).

Known as CareAxis in B.C., Saskatchewan, Ontario and Quebec, wait times are reduced by training physiotherapists to triage potential surgical candidates.

 

4.Switch to central intake

Pooled referral systems (aka central intakes) allow family doctors to select a specific specialist or the first-available.  Newfoundland, Ontario, Saskatchewan and Calgary all use this model.  Quebec’s model, CRDS, launched in the Fall of 2016, offers central intake for 9 specialties: Cardiology, ENT, Gastroenterology, General Pediatrics, Nephrology, Neurology, Ophthalmology, Orthopedics, and Urology.

Information can be found at:

Tél. : 514-762-CRDS (2737)
Téléc.: 514-732-5121
Courriel: crdsmontreal.ccsmtl@ssss.gouv.qc.ca

https://www.santemontreal.qc.ca/professionnels/medecins/crds-centre-de-repartition-des-demandes-de-services-montrealais/

So…can wait times be fixed?

All four models can help reduce wait times and simplify the process.  However, the authors caution, “Canada is notorious for being a land of pilot projects in health care, where good ideas aren’t scaled well. For systems like this, where getting buy-in from many professionals is crucial, that problem is especially important to overcome.”

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In Response to Dr.Goldman

Thank you Dr. Brian Goldman for supporting my profession.  I went to Mcgill University and studied dietetics and human nutrition which included  4 levels of stage.  It takes 3 and half years to complete this program and when you graduate you become an expert in the field of nutrition care.  I will admit that I did not feel like an expert until I had accumulated a certain amount of professional experience.  Currently, I work at GMF Kildare.  If you want to know what a GMF is click here.  I also work at CLSC Benny Farm.

Dietitians help patients with such a wide variety of issues.  I help the bulk of my patients with chronic disease state management for such illnesses as diabetes, high blood pressure, sub-optimal cholesterol and of course weight management.  Sometimes I see seniors that appear malnourished.  This can be very serious and requires a skilled intervention to prevent further complications.  I have colleagues who specialize in pediatric nutrition and prenatal care and others who are experts in tube feeding on surgical units in acute care.  Another colleague is a home care specialist and provides direct nutrition care in patients own living environment.  Some dietitians are even food service managers who run the acute care, rehab and long term care kitchens; ensuring that patients receive appropriate meals and snacks.

The first time I meet a new patient I will do an initial evaluation.  This can take about an hour. I will ask many health related and social questions to fully understand the client’s lifestyle habits.  This information will help make me the right assessment and give the appropriate intervention for that client.  It’s important to understand that each nutrition care intervention is individualized and created just for that person. This is what I am trained to do and how I am able to help people.  It is just  like doctors who are trained to ask the right questions, make the proper diagnosis and provide the right treatment for each patient they see.

There are so many variables that make up a person’s medical and social history.  Each person’s experience is going to determine what type of nutrition care they will need.  It’s very important to get a sense of what the patient is willing to change. As a professional dietitian, I must be able to work with where the patient is at, on any given day. I need to ask, are they ready to make a big change like reducing simple sugars or are they willing to try something a bit easier like add a glass of water to their daily intake?  Sometimes it takes many nutrition care follow ups before a client is even willing to think about changing a behavior.

I provide information concerning the management, of a disease or condition, but it is the patient’s responsibility to use the information to promote change. The patient always has the right to make the choice that works for them and sometimes that means not following dietary advice.  Not everybody is ready to work on their diet and lifestyle habits. Either way, I provide motivation and can coach clients wherever they may be on the behavioral change continuum.

Caryn Roll