Conversations: FHT​

H-CARDD caught up with two former family medicine residents from the University of Toronto and St. Joseph's Health Centre Urban Family Health Team. We asked them where they are now and to comment on how the H-CARDD research findings related to their research project which aimed to educate and train family medicine residents in their practice to be more knowledge and comfortable when caring for patients with developmental disabilities. 

Dr. Matthew Mazurek is a former family medicine resident currently working as a Family Physician in West Toronto.

What led to your interest in developing some training in developmental disabilities within your FHT? 

The idea for our research project came out of our realization that there had been very little formal training on providing care for this population. Indeed, I was initially not even aware of the existence of the excellent Ontario evidence based guidelines ‘Tools for the Primary Care of People with Developmental Disabilities.' When I began to see patients with DD in our residency program, I felt ill equipped to manage these encounters well and provide optimal care. These thoughts led to our initial staff survey at the St. Joseph's Health Centre Urban Family Health Team, which showed only 28% of clinical staff surveyed were aware of the guidelines, and only 40% endorsed feeling comfortable caring for a patient with DD. These training gaps led to our interest in developing an educational seminar to improve care provider knowledge and ultimately quality of care.

Why is it important to address patients with DD in primary care?

Primary care has an increasingly important role in the care of patients with DD, particularly for adults. There are identified gaps in care as patients transition from the pediatric system, where they often have more supports and resources available, to the adult care system. For adults with DD, the primary care physician assumes much of the burden of care due to this lack of resources. A good rapport with a longitudinal primary care provider is also important for optimizing communication and comfort, as well as coordinating specialist care. In addition, there are important preventative healthcare measures such as cancer screening which also need to be addressed on an ongoing basis.

What lessons did you take from the H-CARDD efforts in developing your initiative at St. Joseph's FHT?

I was immediately struck by H-CARDD's previous research on the quality of care provided to patients with DD, as outlined in the ‘Atlas on Primary Care.' Despite the increased rates of chronic and preventable diseases for this population, H-CARDD's research has shown stark gaps in providing ideal primary care, such as a markedly decreased rate of cancer screening compared to the general population. These clear primary care gaps drove us to focus on improving DD education and guideline use for primary care providers at our site. 

What are some of the challenges when doing these kinds of initiatives?

Part of the challenge we faced was maintaining momentum for further educational efforts at our site after our residency program ended.  While the majority of care providers endorsed interest in continued education, busy primary care providers are frequently inundated with multiple educational experiences due to the breadth of primary care. Often these initiatives require champions to provide ongoing support in organizing and implementing such changes. Ideally, further research on DD education by H-CARDD and others will lead to educational sessions being integrated into medical training, which will help avoid this organizational burden to providers.

Do you have any questions or comments on this research?

I am excited to see H-CARDD's continued outstanding work to support meeting the striking care gaps for this population. While our research focused on self-reported provider skills and comfort after an educational seminar, future research can address if such education impacts objective health care outcomes, such as screening rates.

 

Dr. Alison Bruni is a former family medicine resident from the University of Toronto and is currently working as a locum family physician in various locations in Toronto and in rural Ontario.

What led to your interest in developing some training in developmental disabilities within your FHT? 

When working with patients with developmental disabilities, there are some specific medical issues that practitioners should be familiar with, such as screening for conditions of higher prevalence in this population. Having a sister with Down Syndrome has taught me this first-hand.  Unfortunately, training in this field is extremely limited in both medical school and residency.  We surveyed the staff at St. Joseph's Urban Family Health Team regarding their comfort level and skills when working with patients with developmental disabilities and noted a lack of confidence in various clinical capacities. We decided to initiate an educational seminar with the staff to address this lack of training.

Why is it important to address patients with DD in primary care?

It's important for patients with developmental disabilities to have a primary care practitioner who knows them well - this can ease challenges with communication and trust.  Working on an ongoing basis with family members is of utmost importance. Furthermore, these patients can have complex medical conditions that require the involvement of multiple specialists, and primary care can close the gaps in communication.  They can help to coordinate care from inter-professional providers such as occupational therapists and speech-language pathologists.

What lessons did you take from the H-CARDD efforts in developing your initiative at St. Joseph's FHT?

I was inspired by some champions in the community who are passionate about this issue, and realized that I could also initiate changes at my own Family Health Team with some effort and determination.  H-CARDD helped me to become aware of the community resources that are available for patients with developmental disabilities, as well as the health disparities that exist within this population.

What are some of the challenges when doing these kinds of initiatives?

The biggest challenge we had at our Family Health Team was maintaining interest in the initiative over time – it's easy to organize a one-time educational seminar for health care practitioners, however it's more difficult to implement permanent changes in the clinical setting. This is where a group like H-CARDD is so important, because they can maintain initiatives over time and connect different sites in Toronto that are doing similar projects.

Do you have any questions or comments on this research?

Continue the great work – it's so important to learn more about our patients, so that we can better identify how to assist them and care for them!