Midterm Flashcards
What are the key competencies for Physiotherapy?
Expert Communicator Collaborator Advocate Scholarly Practitioner Professional Manager
What are the criteria for professional status?
Grounded in theory and research Relevant to basic social values University level extensive training Autonomy Motivation, commitment Sense of community w/in practice Code of ethics National organization and culture. Sanction by the community
What are some OT/PT practice domains?
Home care Orthopaedics Medicine ER Neurology Health promotion and wellness Cardio-respiratory Oncology Sports Medicine Mental Health Vocational Rheumatology Burns/plastics Amputees Disability management Developmental Paediatrics Geriatrics Neonatology TBI Teaching Research
What is the starting salary for OT? PT?
Echelon 1
- 69
- 56
Echelon 3 (masters degree)
- 83
- 71
What is part of the Profile of Practice of OT in Canada (2012)
Professional Practice Manager Change Agent Collaborator Scholarly Practitioner Communicator
Core Competency of an OT is enabling occupation.
What is a change agent?
As a change agent, OT responsibly use their expertise and influence to advance occupation, occupational performance and occupational engagement.
- Advocate
- Work for population and community change
- Collaborate
What is important to being a successful change agent?
Believe that change is possible. Work collaboratively with institutional staff. Work collaboratively with management. Draw on evidence. Build team motivation.
What are the three types of change agents?
Change generators: Identify a need and for example develop a program.
Change resistors: Someone who goes against change. (Opposition is good such as resisting budget cuts).
Change recipients: Help adopt changes suggested by others.
What are characteristics of a change agent?
Reflective in practice. High self-efficacy Stronger internal locus of control Optimistic Adaptable Visionary
What is the definition of an advocate?
Its responsibly use their knowledge and expertise to promote the health and well-being of individual clients, communities, populations and the profession.
What are some examples of advocacy for CAOT and CPA?
CAOT: Elder abuse, seniors caring for seniors.
CPA: 15 position statements. Building national outcomes database. The value of PT. Health care for Aboriginal communities. Pain management and opioid crisis.
Both have strategic partnerships.
What is global health?
Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants and solutions… and is a synthesis of population based prevention with individual level clinical care.
- Broader level (population) trends in health care
- Equal access and equity to health care
Global health is “a collection of problems which turn on the quest for equity” or the quest for health equity.
Define Disability
A complex phenomenon, reflecting an interaction btwn features of a person’s body and features of the society in which he or she lives.
ICF
Impairments
Activity limitations
Participation Restriction
WHO:
An outcome of the interaction between a person with an impairment and the environmental and attitudinal barriers that he/she faces
Disability Statistics from WHO
1 billion people w/ disability (world’s largest minority)
785 million adults and 95 million children
15% of the global population
80% developing countries
Chronic diseases account for 2/3 of years lived w/ disability in low and middle income countries.
What is the link between disability and poverty?
50% of disability is preventable and linked to poverty.
There is a reciprocal relationship between disability and poverty. People are disabled because they are poor (lack of access to services…), but people are also poor because they are disabled (increase cost of living due to disability.
The lower the income of the country (by quintile) the higher the percentage of people w/ disabilities.
What does rehabilitation as a health strategy mean?
We think of rehabilitation professions and institutions. Rehabilitation as a health strategy aims to enable people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction w/ the environment.
(i.e. there is palliative, supportive, preventative, so rehabilitation is another strategy)
What are some ways of providing access to rehab services in other countries?
Capacity building: training OT/PTs in other countries.
McGill SPOT: Handicap International training rehabilitation professionals in HAITI where there is a lot of need, but not a lot of resources i.e. 2 PTs and 1 OT or something like that.
What are some examples of providing access to assistive devices?
Only 10-15% of people with disabilities can access assistive devices in the developing world.
Mold for chairs for children with disabilities.
What is community-based rehabilitation?
Aims to promote rehabilitation, poverty reduction, equalization of opportunities and social inclusion of all people with disabilities through the combined effort of people with disabilities themselves, their families, organizations and communities and the relevant governmental and non-governmental health, education, vocational, social and other services.
Much more integrated approach
Actively involves people with disabilities.
What is a health care system?
WHO:
A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism, well-trained and adequately paid work force, reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicine and technologies.
What are some controversies surrounding health care systems?
Who should pay
Who should be paid (in the public system)
How much should they be paid
Who should do what? Reserved acts
How should they be regulated
Where should resources be allocated (prevention/promotion vs treatment debate).
History of Healthcare in Canada: 1900-1945
Prior to 1940 there was limited health care legislation in Can
Health care concerns were considered private and local matters
Families and communities were responsible
History of Healthcare in Canada: 1945-1960
The development of hospital insurance in CAN:
1946: Saskatchewan Hospital Service Plan
Introduced by a social democratic government (Tommy douglas)
Only hospital services at first, but for everyone
History of Healthcare in Canada: 1957
Hospital Insurance for All
Canadian House of Commons unanimously passed the Hospital Insurance and Diagnostic Services Act
Federal-provincial cost-sharing program for hospital care (50% fed/50% province)
By the end of 1961 every province in CAN had adopted a public hospital insurance plan.
History of Healthcare in Canada: 1960-1970
The Struggle for Medical Insurance:
The social-democratize government in Sas lead the way again in medical care insurance.
1962 NA first public medical insurance went into effect in Sas
A doctor strike was launched to protest the plan
-Bc the public system set regulations on what a professional could charge.
Medical Insurance for All
1964
1966
1972
64: Royal Commission on Health Services (hall commission) recommends government-sponsored, comprehensive and universal health services across CAN
66: Medical Care Insurance Act passed in house of commons and comes into effect July 1968
72: All the provinces had implemented a medical insurance in accordance with the cost-sharing programme.
History of Healthcare in Canada: 1970-1990
Federal-Provincial Conflict: The federal government tried to establish more clarity over their role in health care:
1977: Establishes Programs Financing: Money to provinces in a per capita “block grant”
1984: Liberal Health Minister Monique Begin puts into place the Canada Health Act with more controls by the federal government to extra-billing and user fees.
Canada Health Act- 4 principles that Tommy Douglas proposed
What are the components of the Canada Health Act (1984?
Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis.
Universality: All insured residents are entitled to the same level of health care.
Accessibility: All insured persons have reasonable access to health care facilities.
Portability: A resident that moves to a different province or territory is still entitled to coverage from their home province.
Comprehensiveness: All necessary health services, include hospitals, physician and surgical dentists must be insured.
History of Healthcare in Canada: 1990-2004
Years of Challenge and Change:
Financial “game-changer”: 1995 Canada Health and Social Transfer which substantially reduced the cash portion of federal transfers to provinces.
Provinces begin serious cost-cutting measured and reexamine they health care systems.
Prohibits extra-billing
What is the main aim of Health Public Policy?
What is Health in All Policies
The main aim of healthy public policy is to create a supportive environment to enable people to lead healthy lives.
Health in all policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seek synergies and avoids harmful health impacts, in order to improve population health and health equity. (i.e. sectors such as trade, industry and agriculture need to be accountable for health consequences)
Compare the governance of health care in QC before and after Bill 10.
Before: Minister of Health->Ministry of Health and Social services/ 14 advisory boards-> 18 Health and Social Service Agencies-> 95 Health and Social Service Centre (CSSS), not part of CSSS: rehab centres, some hospital centres, child and youth protection centres, some residential and LTC centres.
After: Minister of Health and Social Services-> Ministry-> 13 CISSS, 9 CIUSS-> 7 non-merged institutions, 5 non-targeted institutions.
What is Bill 10?
An act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies.
Introduced by Health Minister Gaetan Barrette Sep 2014.
Came into for April 1, 2015
Provides territorial integration of health and social services, through set up of territorial health and social services, creation of institutions with a broader mission and two-tier management structure.
Integrated centres receive a single budget for all their activities and file unified financial statement for all institutions.
Abolish boards of individual health institutions, mainly hospital boards and merge them into 28 regional boards. The intent is to increase continuity of care, it will be easier to keep track of patients throughout treatment.
How many professional orders and regulated professions are there in QC?
46 and 54
What is the Conseil Interprofessionnel du Quebec (CIQ)
Mandate is to group together all of Qc professional orders.
W/ ‘Office des professions du Qc’ serves as an advisory body to the government.
Receives no government funding.
Both OEQ and OPPQ falls under this council.
Minister of Justice is responsible for professional legislation.
The Minister of Justice Reports to the Quebec National Assembly.
The Minister makes decision on policy, appoints certain officials and members of the Office des professions du Qc and is responsible for budget planning.
What is the Office Des Professions du Quebec?
Government agency mandated to ensure every professional order fulfils its function of protecting the public.
- Advises government (professional legislation)
- Functional control and supervision
- Ensures each order adopts regulations required under the Professional Code
- May pass regulations establishing rules and standards to be obeyed by al professional orders.
What is The Professional Code?
Aspects used to determine if a profession should be regulated and supervised by a professional order:
- knowledge required to engage in activities
- Degree of independence
- Personal nature
- Gravity of prejudice
- Confidential nature
Profession is regulated it had Reserved Title and Reserved Acts
What are Reserved Acts for OT and PT?
OT: Decide on use of restraints, assess neuromuscular function in a person w/ an impairment of physical function, evaluate an individual w/ mental health difficulty, assessment of student to determine plan of action.
PT: Treating a wound, pelvic floor dysfunction, tracheal suctioning, introduce an instrument past the pharynx or nasal passages.
How do Professional Orders Operate?
Mandated by the government to ensure the protection of the public, vested w/ power to regulate the practice of the profession and exercise oversight.
They respect the Professional Code
Control admission to the profession and regulates its practice, issuing of permits, professional inspection and disciplinary procedures.
OPPQ and OEQ
How many CISSS are there and what is the criteria for a CISSS?
13
Emerge from the merger of public institutions in the same region and where appropriate the health and social services agency in that region
Evolve within a management structure reduced from 3 to 2 hierarchal levels
Be at the core of their Reseau Territorial de Services (RTS)
What is the criteria for a CIUSS and how many are there?
9
Same model as CISSS
Be in a health a social service region with a university that offers a full undergraduate medicine program or operates a designated university institute centre for social services and
Exclude university hospitals, with the exception of CIUSS Estrie, which has integrated the Centre Hospitalier Universitaire de Sherbrooke (CHU de Sherbrooke).
What is a non-merged institution? How many are there?
What are they?
7
Non-merged institutions include university hospitals (except CHU Sherbrooke) and academic institutions.
CHU de Quebec- UdeLaval
Institut universitaire de cardiologie et de pneumologie de Quebec-UdeLaval
Centre Hospitalier de L’Universite de Montreal (CHUM)
Centre Universitaire de Sante McGill (CUSM)
Centre Hospitalier Universitaire Sainte-Justine
Institut de Cardiologie de Montreal
Institute Philippe-Pinel de Montreal
What are Non-Target institutions? How many are there? What are they?
5
Non-target institutions maintain their current status.
CLSC Naskapi
Centre regional de santé et de services sociaux de la Baie-James
Centre de santé Inuulitsvik
Centre de santé Tulattavik (baie Ungava)
Conseil Crie de la Sante et des services sociaux de la Baie James.
With the act what was the change in the number of institutions?
182 to 34 Institutions
What must each CISSS and CIUSS do to properly integrate public services?
Be at the core of a RTS
Be responsible for the delivery of care and services to the population of its territory (including public health component)
Assume population responsibility
Organize the core and complementary services in its territory as part of its multiple missions based on the needs of its population and territorial realities
.
Enter into agreements with other institutions and parter organization of the RTS (i.e. family med groups).
What are the factors influencing the health and social services basket of services in QC?
Evolution of the population according to group age
Growth rate
National and International Migration
Prevalent Health and Social Issues
What are some common health and social issues affecting Canadians in QC?
Diabetes, stroke, obesity, cancer…
Gambling, alcoholism and drugs, domestic violence, sexual assault, teenage pregnancy, troubled youth, discrimination, homelessness.
What partners are involved in health and social services?
Provincial governments Health Canada Public Health Agency Health Professional Associations (CPA) Voluntary Organizations Justice/Revenue Canada Educational Institutions Research Agencies Third Party Insurers Accreditation Bodies Regulatory Bodies Population
Who do you go to for the approval of a new device like a CPM? What is the role of this organization?
Health Canada -Prevent -Promote -Efficient and accessible -Reduce health inequalities -Health information (Leader, funder, guardian, service and information provider).
What populations fall under the federal rather than provincial government for health care?
Veterans (this is about portability)
Aboriginals
Inmates
What is the role of the Ministry of Health and Social Services (MSSS)
Province-wide health objectives
Budget allocation (takes funding from fed government, taxes and government corporations)
Equitable distribution of resources in the regions
What insurance plans do residents of Quebec have?
Health Insurance Plan:
- Established in 1970, covers all QC residents.
- Individual registered with the Regie de l’assurance malady du Quebec (RAMQ) take advantage of an array of insured services such as optometry, medical devices, dentistry, visual and hearing aids, prostheses.
Drug Plan:
- 1997
- Basic protection to all Quebecers, membership in a drug insurance plan is compulsory
What is the CSST?
Commission de la Santé et de La Sécurité De Travail:
-Occupational Health and Safety Plan on behalf of government
-Responsible for administering two key Acts: 1) Industrial accidents and occupational diseases 2) Occupational health and safety
The CSST oversees: Protection of income Right to return to work Temporary assignment Danger-free maternity program Right to refuse work Compensation for dependents Importance for OT/PT
Triad of CSST, employer and therapist.
Plan provides QC businesses with essential insurance service and workers are protected.
Pays for rehab services in the public and private sector to help get people back to work.
What is the SAAQ?
Societe de l’assurance automobile.
1978 Automobile insurance plan where all Quebecers are compensated when physically injured in a car accident.
Objective: provide fair compensation to all accident victims who have been injured, regardless of responsibility and reduce administrative cost of automobile insurance.
Importance for OT/PT- third party payer for public and private rehab.
What are the levels of care?
Primary: More generalized care. Often points of access to health care system (family docs)
Secondary: More specialized care, referral often from primary care (ex: orthopaedic surgeon or hand specialist).
Tertiary: Center for highly specialized care (neurosurgery, burn unit)
Quaternary Care: Extension of tertiary care, even more specialized
What are the points of service in the QC health care system? What are their roles?
Hospital Centers (CH): Diagnostic services, medical care, nursing care, psychosocial, preventative and rehabilitation services.
Residential and extended long term care centres (CHSLD):
Adults experiencing a loss of functional or psychosocial autonomy. Substitute living environment with various services such as rehabilitation.
Local Community Service Centers (CLSC/CSSS):
Offer day-to-day preventative, curative, rehabilitation and reintegration health and social services (home care).
Rehabilitation Centers (CRDP or CRDI): Rehab on the premises of health care establishment (in or out patient) or in the home Adaptation, rehabilitation, social integration and community participation; supervisory and family support services.
Child and Youth Protection Services (CPEJ):
Offer young ppl and families psychosocial services, child placement and family mediation services, custody counselling, adoption services.
Private or Public Clinics
- Group practices or sole practice
- Primary health care, rehab or chronic disease management
Community agencies: Wide array of services (ex: home care for elderly, meals on wheels, soup kitchen, shelters for abused women)
Elements of Private Rehabilitation Services to Consider
Payment: Fee for service, CSST, SAAQ, private insurance, sub-contract
Format: Franchise, several points of service or a single clinic
Team: Multidisciplinary or one profession only
Owner or Employee: Who owns the clinic (conflict of interest)
What was the layout of health care in QC before Law 10?
MSSS controlled 18 Agencies by Region which was responsible for 95 CSSS with 5 types of establishments (CH, CLSC, CPEJ, CRDP/CRDI, CHSLD) plus community organizations and private clinics.
What are the changes that happened with Law 10?
There are no longer regional agencies. The 13 CISSS and 9 CIUSS should each have the 5 services as before. There is no layer of middle management. The non-merged institutes are the large university centres (MUCH)
The CIUSS/CISSS met make links in the community to the resources.
Within each region a patient should get all the services they need at one spot.
What are the anticipated changes from Law 10?
Wider range of resources available
Better coordination of services for clients (continuum of care)
Better communication flow of client info
Strengthen decision making power of MSSS
Save $220 million/year.
What are the CISSS and CIUSSS responsible for?
Plan, coordinate, organize Human resource planning Develop agreements with resources in RTS Easier access to services Management of the entire population of its territory
What was the reaction to Law 10?
Too much ministerial power and centralization of decision
Decreased community involvement
Potential loss of linguistic, cultural and community identity related to services
Increased stress and workload for remaining workers
Workers may have to relocate
Specialist may disbar from smaller hospitals
How does rehabilitation fit into this new health care model?
A patient can come into the CIUSSS/CISSS from hospital or home.
EX:
Home care rehab and support, intensive and specialized rehab, shot or long term functional recovery, long term care rehab.
What are RUIS?
Each region in Quebec has an affiliated university with a medical school: McGill University de Montreal University Laval University de Sherbrooke
University teaching hospital and faculty of medicine.
Each is designated a geographic area based on catchment areas and parameters such as culture and demographics.
Mandate: Organization of tertiary health services as well as supply of human resources to RUIS region. (provide tertiary support services in a wide geographic areas from the university)
Contractual agreements with local networks
Research partnerships and funding.
What are the 2 CIUSSS in Montreal where there is a faculty of medicine and allied health professionals?
What are their affiliated hospitals?
Other acute care centres in Montreal?
McGill
MUHC: MGH, Royal Vic, Children’s, Neuro, Lachine, Montreal Chest
Additional McGill Affiliated Acute Care Hospitals:
Lakeshore, Jewish, St Mary’s
UdeM
CHUM: Notre Dame, Hotel Dieu, St-Luc
Additional:
Ste. Justine, Maisonneuve Rosemont, Sacre Coeur, Inst. de Cardiologie
Other:
Verdun, Jean Talon Hospital, Santa Cabrini
What is a level one trauma centre?
Emergency and operating room staff equipped to handle the highest level of trauma, ICU.
What is the difference between a multidisciplinary and interdisciplinary team?
MD:
Skills of team members from different disciplines are utilized
Each discipline approaches care from their own perspective
Team meetings are typically done in the absence of the patient.
ID: Different disciplines have a more integrated approach
Team approach to history, assessment, goals
Teamwork done collaboratively with client (client-centred).
What are the role of OT/PT in acute care?
In and outpatient rehabilitation services.
Wide variety of specialty areas (neurology, ICU, trauma)
Assessment and treatment- often highly acute situation
Acute care assessment and treatment (pace often fast and volume is often high)
Discharge planning for next level of care very important.
What are the different organizational structures in which a OT/PT could work in acute care?
Functional (multidisciplinary): Director then: HR, Nursing, Professional service
- Traditional hierarchical structure
- Divides organizations into department according to functions performed (OT/PT department)
- Best for small organization
- Centralized management philosophy
- Assigns managerial responsibilities to member of functional area (i.e. manager of OT or PT).
Product/Program/Service (inter professional)
Director then: Neurology, medicine, Sx, so report to chief of the program for neurology or med or Sx (Nurse or doctor as boss).
-Organized by program not discipline
-Designed around client not provider
-Designed for rapidly changing, complex organization
-Increasingly widespread in health care sector CAN
-Highly decentralized, decision making at level closest to point of action
-Shift from department to program managers.
ex: surgery or head injury program
Matrix
Report to manager of PT/PT and head of the program.
-Dual authority system including both functional and product management
Rehab centre with different program and OT/PT departments
Why is productivity and case load management important in acute care?
Human resource planning Recruitment/ retention Funding Health care outcomes and weight times Based on past/ not future
PT/OT really need to show stats.
What are elements of communication in acute care?
OACIS: Computer medical Record
General hospital charts
Communication with team members, families, colleagues, other institutions, managers.
Effective Communication:
Specific
Directed
Acknowledged
What are the communication challenges in acute care?
Patient does not stay in hospital for long period
Medical team may have many members, so message may not be consistent
Private environment not always available
Other services may have schedule patient at same time as PT/OT
What are the graded levels of communication assertion?
Level 1: Observation or Concern
Level 2: Option or alternative
Level 3: Challenge or clarification
Level 4: Direct order or action
What is the difference between an incident and an accident?
Incident: an action or situation that has no consequences on the health or well being of the client, personnel or the health care professional
Accident: An action or situation where there is a risk or consequence on the health and well-being of the client, personnel or health care professional.
What are required organizational practices to enhance patient/client safety and minimize risk?
- Safety Culture
- Communications
- Medication use
- Workforce/worklife
- Infection control
- Risk assessment
What elements of quality assurance need to be considered in acute care
Norms to provide the highest quality service
Develop benchmarks and indicators
Create quality assurance team
Develop policies and procedures
Ex: late reception or rehab referral policy
What are challenges clinicians in acute care face?
Communication Constant High level of Activity Client Related Workspace Issues Staffing Issues
What are the interacting locations of care in terms of rehabilitation services?
Acute care hospital
Home
Long-term care if they do not have the potential to return home or they may go to rehab first and then long term care if home doesn’t work out.
Rehabilitation hospitals (in or outpatient)
What it the mission and goals of a rehabilitation centre?
To offer adaptation and rehabilitation services and social reintegration services.
Goal is to increase functional independence for: ADLs IADLs Mobility Leisure and Sport Return to work Community reintegration
What are examples of rehabilitation centres in Greater Montreal?
Children:
MAB-MacKay, Centre de Readaptation Marie-Enfant, Institut Raymond-Deward, Jewish Rehab Hospital
Adults and Elderly Constance-Lethbridge Lucie-Bruneau Gingras-Lindsay Jewish Rehab Julius-Richardson MAB-MacKay Villa-Medica (private)
What are some features of Rehab centres within the Quebec Health Care System?
- Affiliated with a CIUSSS or CISSS
- Second line of care (need a referral by professionals from the first line of care (hospitals or CLSC)
- Interdisciplinary: The daily interventions of the clinicians are complementary
- Client-centred approach (pt goals)
- Some rehab centres offer specialized and sub-specialized care (SCI).
What type of management is there at the JRH?
Mixed or product/program
What type of clients are seen in rehab centres?
Developmental disorders CP Neuromuscular degenerative conditions TBI Primary language disorders Work injuries Burns MS, Parkinsons Amputation Sensory Impairments SCI
What is Functional Intensive Rehabilitation?
Intensive daily inpatient rehabilitation (clients are hospitalized)
Length of stay depends on the impairments, activity limitations and needs
Aim: To develop the required capacity to safely return home by optimizing functional, cognitive and emotional recovery.
Usually daily interventions.
Who are the interdisciplinary team members in rehab?
Nursing and physician (to ensure medical condition remains stable)
OT, PT, social worker, psychologist/neuropsychologist, specialized educator, SPL, other (nutrition, orthotics).
How does the interdisciplinary team function in rehabilitation?
- Assessment of functional status.
- Establishment of individualized intervention plan based on the client’s personal goals.
- Daily treatment to optimize functional independence and increase physical, cognitive and affective recovery.
What is the role of the physiotherapist in rehabilitation?
Examples of PT interventions
To increase functional independence for bed mobility, transfers, ambulation and stairs (balance, gait, coordination, motor control)
Focus on body function/structure impairments impacting on activity, participation and quality of life. (Focus lower limb and motor impairment)
Interventions: Aerobic training, balance, ROM, strength, gait, task-oriented training, motor control and strength of UE and LE. Ambulation, walking aid and assistive devices.
What is the role of the OT in rehabilitation?
Examples of OT interventions
Increase functional independence in basic ADLS and IADLs, transfers and mobility to allow the person to safely return home or resume premorbid level of functioning.
Focus on activity limitations and participation restrictions.
Interventions: splinting, motor and cognitive rehabilitation (functional activities), task-oriented training, positioning of UE, home visits, recommendations for assistive devices, compensatory strategies, driving assessment.
What are the roles of some of the other team members in the rehabilitation setting?
Nurse: monitor health status, education, health promotion.
SLP: Communication-cognitive disorders and dysphasia.
Dietician
Psychologist: Help with grief and adjustment to changes and losses
Social worker: Coordinate discharge, financial and social stressors, counselling resources.
What are the characteristics of ambulatory rehabilitation
Outpatient services.
Focus: Social reintegration and recovery of previous life habits (return to work/school)
Less intensive schedule of interventions then inpatient
Interdisciplinary team according to needs
Interventions in real-life setting
What is the focus of community reintegration rehab?
Increasing functional independence: IADLs Ambulation without a cane Independence to climb stairs Resume leisure activities and driving Return to work
How is health promotion and education part of the rehabilitation process?
Information about prevention of a disease
Energy conservation techniques
Pain management
Education to caregiver and family members
Use of assistive device or compensatory strategies
Fall Prevention
Management of specific medical conditions
How can PTs/Ots be change agents and advocates in rehab?
1) Other team members: promote functional independence and clients needs
2) Family members: client capacity, task modification, strategies to help or support
3) Employers: Task modification
What are some communication challenges in rehabilitation?
Communication between institutions (incomplete charts, difficulty communicating with physicians)
Different philosophies across professions (functional independence vs providing efficient care, treatment priority)
Access to medical charts
What are some other challenges in rehabilitation?
Limited therapy time-> need thousands of reps to make changes
High case-load for clinicians
Generalization of skills learned in therapy
Delays and what time
Access to rehab in rural areas
What are some safety issues in rehab?
Risk of injury during transfers (both pt and Pht)
Infection control
Summarize the overview of the Health Care Continuum
Acute Care Hospital (regional or specialized hospital) Rehabilitation services (functional intensive rehabilitation or community reintegration rehabilitation) Community resources (CLSC)
How did private practice first start and what have the changes been since it was first initiated.
Started in late 80s because there were long waitlists in public setting as well as budget cuts, prioritization of post-surgery patients and aging of the population.
Initially most of the referrals for private practice were from the CSST and SAAQ, now private practice offer multidisciplinary services and can be specialized. Very different from when it first started
What are the two associations for private practice in quebec?
AQEPP-Associate Quebecois de ergotherapie en pratique privée
FCPPQ: Federation des clinic privée de PT Quebec
Private clinics do not need to be a part of these association, but it is important to join because they do a lot of work for the private setting.
What do all private settings need?
A mission and vision statement.
What are some examples of private clinics in montreal?
Franchise: Action Sport Physic, Kinatex, Physic Extra
Individually Owned: Bonaventure Physio, Hand in healing
Most offer a multidisciplinary approach rather than individually owned.
What types of hierarchies exist in private practice? For franchises?
Franchises can have different models:
1) An owner and CEO (may be the same person).
VP of Administration who is responsible for therapists and secretary. VP of Operations who is responsible for rehabilitation aspect or PT/OT.
2) Owner and the head of PT team (pt, trp, at), head of OT team (Ot), head of psychologists
- In this model if a PT has a problem with an OT they have to speak to the head of PT who then speaks to the head of OT to resolve the issue.
What can a TRP do?
They can do treatment with a patient but they cannot do the initial assessment. There must be a referral from a physio or a doctor.
There are also certain therapies they cannot perform.
Technicien de Réadaptation Physicique
What are some features of payment and access to private practice?
Patients can be admitted directly, they do not need a referral.
45% of income comes from public programs (CSST, SAAQ, IVAC) in private practice.
Private insurance or client payments for services.
The difference here is that patients are paying directly for the services so they need to know ahead of time what they will be paying for and receiving.
What is the clientele for private practice?
Diverse, have to be prepared to deal with diversity as treatment approaches will have to reflect different clientele.
Children, adults, rcmp, high performance athletes, sedentary life-style, muscle-skeletal conditions, pelvic floor, chronic paint, diverse SES.
What sorts of conditions are seen in private practice?
Clinics can be specialized or generalized.
Musculoskeletal, post-op rehab, sports injuries, mental health, neurological conditions, women’s health.
What are some services provided by private practice?
CSST SAAQ Home-care (may overlap with CLSC) Work site assessment Work hardening: real or simulated work conditions to prepare for work.
How does CNESST work with private practice?
Physicians are the primary referrals.
Patient has to be reevaluated by MD after 30 treatments or 12 weeks.
CNESST pays for the treatment, so physio has to charge CSST fee
Potential sources of conflict:
Md/Employee/Employer/Union
Return to work, adapted work, wait time for specialized services
Often PT/OT caught in ethical dilemma (necessity of treatment)?
How does the SAAQ work with private practice?
Physician referrals
First 15 treatments accepted
Pt/ot needs to fill a report after 15 sessions (wait of acceptation to continue treatment)
SAAQ fees
Clinics may decide to have patient pay of their treatment and have the patient request the reimbursement from SAAQ.
What are the roles of OT/PT in private practice?
Assessment Treatment plan (developing and carrying out) Supervise students Charting Patient education Evidence Sharing
What are the roles as a manager/business owner?
Maintenance of clinic Advertising Marketing Accounting Taxes and insurance, rent Human resources Recruitment of staff
How can OT/PTs play a role a change agents and advocates in private practice?
Referral services
Path of care (PT refer to physician)
PT/PT roles: Competencies that can only be performed by PT or OT.
Benefit of paying for a service
Involvement with local community (health promotion)
Change agent or advocacy at individual, community or professional level.
What are some communication considerations in private practice?
Protection of electronic documents
Using social media to promote business
Electronic transmission of information about patients.
Communicate w/ CSST and SAAQ coordinators, physicians other health care professionals, family members.
What are some safety issues in private practice?
Hand washing Communicable diseases Falls Skin Allergic Reactions Biomedical Materials
What are some components of OPPQ and OEQ inspections?
Code of ethics, charts and documentation, maintenance of office, biomedical material, safety hazards, professional fees logos.
What are the components of admission in private practice and how does this differ from public?
Referral not required
Assessment can be global or specific
Patient Education is a Huge Component of private practice compared to public. At the end of each assessment thoroughly explain condition and treatment plan. Frequency of treatment.
60min
HSOAPIER
What are the essential elements of a chart for OPPQ?
- Id client
- Reason for consultation
- PT diagnosis
- Goals and treatment plan
- For each visit: date, description of services provided, client response to treatment and evolution of symptoms.
- Client consent.
What are some components of treatment?
Patient education HEP Passive techniques Active techniques Functional Exercise Pain management
Frequency that patient comes is less then public. Time spent on each component will depend on the patient.
What is important for discharging a patient?
Patient education Make sure they are prepared to go home (prevent rein jury) HEP Progressive Referral CSST
How can the competition of private practice be managed?
Something that makes your clinic unique.
Quality of care (continuing education, patient education and involvement).
Accessibility of care (opening hours, fees charged, services offered).
What are the pros and cons of private practice?
Pros: Competitive salary, specialize in one type of clientele, dynamic environment, more continuing education opportunities, active and involved clients, if owner may have greater freedom of schedule.
Cons: Night shifts, less advantageous social benefits, may loose expertise in clientele not seen in private practice, smaller network, non unionized, non permanence, if owner may have longer working hours, more responsibility.
What is the origin of CLSC?
Launched in early 1970s to move services away from hospitals into the community. 147 initially.
A CLSC offers a wide variety of services tailored to the need of the local population.
What were some problems with the CLSC prior to law 10?
Lack of harmonized services
SILO work
Duplication of services (Pt had an evaluation in the hospital and then again when they got to the CLSC).
What was the first thing that happen before law 10 in the CLSC?
SAPA this was a department within the the CLSC that brought together PT/OT to become one rehab department. This was better since there was better communication, information sharing and less duplication.
How did law 10 impact CLSC?
18 CLSCs and 182 health institution amalgamated to optimize network efficiency.
Shift in the Philosophy:
Home care is at the front and centre of the system, heart of the system: because the goal is to decrease weight time, get people back to their home as soon as possible so home care needs to be there to react to the hospitals.
Home care is different than an institution because professionals are invited guests in a clients home (social dynamics).
What is the goal of home care rehabilitation services?
Offer a continuity of care received across a continuum of services.
Maximize clients functional independence within a secure home environment and develop activities to enhance client’s well-being.
What are the rehabilitation objectives of home care?
Work with hospital to plan for safe return home.
Safe home environment
CLSC objectives correspond to rehab hospital objectives.
Optimize independence in ADLs/IADls.
Continuity of rehab as an outpatient if required (home care is expensive so go to out patient rehab when they can).
How does the communication structure work in rehabilitation services in the CLSC?
Top down approach and a bottom up approach.
The chain of communication is: Therapist, Clinical Support Specialist, Program manager, Director, Director General. This structure works well especially CSS which communicates each week with therapists and program manager.
What programs fall under the CLSC?
SAPA: Home Care Mental Health DI-TSA (Deficiance Intellectual) Familier-Enfants Jeunesses Services Généraux
What is SAPA?
Soutien a L’autonomie des personnes âgées et a la déficience physique adult:
-Loss of autonomy related to aging (physical, psychological and social disability associated with aging).
Guidelines for SAPA: General approach Maintain people in community Respect cultural differences Distribute quality services
(SAPA services: OT, PT, nursing, volunteer, homemaking)
What has been the impact of creating a rehabilitation department?
Better continuity from 1 institution to the other Increase communication Decrease charting Strong rehab team (800+) Better Knowledge Sharing Use of resources Fluidity between institutions
How are referrals for the CLSC received?
What does the CLSC do once a referral is received?
Family Hospital Doctors Public Curators Foster Homes Client Community Members Rehab Centres
Referrals are received at a centralized intake and then forwarded to appropriate department.
Nurse determines need of client if they’re require rehab.
Identify pt priority (1-4)
Who are the clients of CLSC?
Clients and their caregivers.
Across the spectrum of age and condition
A lot of generalized reconditioning.
What are some components of CLSC assessment?
Posture
Coordination
ROM, Strength, Neuro, gait, balance, environment, stairs.
What is the role of an OT in home care?
Client maintain functional autonomy in home environment.
Eliminate barrier
Task analysis
Maximal functioning within home
Use theoretical approach: Occupation, Environment and Person
Occupation Performance areas (ADLS, IADLs)
Performance Components (cognition)
Environment
Ex: Dysphasia, mobility eval, driving screen.
What is the role of at PT in home care?
Maintain/improve functional capacities and prevent loss of autonomy.
Motor capacity
Technical aid
Pain control
Skin integrity
ex: HEP, balance, gait and stair training, manual therapy.
How can you be a change agent in Home Care?
Ethics Committee Home adaptation program Link to specialized services Trained on elder abuse and neglect Intervenant rectaux worker (acute care) Discharge planning meetings in the hospital Regroupment des ergo (available equipment in the home) Community housing project Reduction of restraints
What are central concepts in the provision of service in LTC?
Context of Care:
Continuum of care- carry over profile from CLSC
Milieu de Vie- LTC is not a hospital, make it like a home setting
Person Centered Care
Individualized Care Plan
Quality of Life
End of Life Care
What are some Interdisciplinary team programs in LTC?
Restraint Reduction
Fall Prevention
Skin and wound care
Environment
What are the members of the interdisciplinary LTC team?
Resident, Maintenance, Housekeeping, Family, Companions, Art Therapy, Educator, Therapeutic Rec, OT/PT, and much more- big Team.
How have professional teams changed in LTC?
They used to be more multidisciplinary where each professional brings their own goals for the resident. Now it is more interdisciplinary by involving the family in team meetings and arriving at interdisciplinary goals.
What professional services are provided in long term care? Why is this important?
Medicine, pharmacy, x-ray.
Try to keep residents from needing to go to emergency or acute care.
What is the role of an OT in LTC?
Admission: Safety Screen within 24 hours.
Full assessment within 4-6 weeks: Canadian Occupational Performance Model (ADL, positioning, performance, environment)
Reviewed on an annual basis
ex of OT interventions: Splinting, wheelchair position, dysphasia.
What is the role of a PT in LTC?
Safety screening on admission
Maintaining Functional Mobility
There are fewer PTs in LTC, mainly TRP( Requires PT referral from MD, can intervene on safety issues, but not on treatment post acute medical conditions)
2 part time PTs in LTC: Role in evaluation, wound care and restraint)
Ex: Walking program, transfer, treatment modalities, balance training.
Fall prevention and Restraint Reduction are important in LTC. What are the elements in fall prevention? How are restraints used in LTC
Identification of fall risk (Tool Scott Fall Risk Assessment)
Action Plan (Exercise, environmental modification, Safety measures)
Interdisciplinary communication
Restraints such as bed rails, prevent or limit freedom of movement by a person. There is actually greater risk of injury associated with use of restraints then of falling without restraints.
Pt, OT, MD, RN or Social worker can order restraints. Trend is to avoid restraint usage.
Restraints have psychological and physical consequences (loss of autonomy and quality of life) Increase risk of falling
What is the important element of skin and wound care program?
Prevention
Identify risk, educate and preventative strategies (positioning, wheelchair and surfaces to reduce pressure sores).
What are risk factors for wounds and sores?
Intrinsic:
Extrinsic:
Intrinsic: Physiological and musculoskeletal, postural control and movement, sensation, perception and cognition.
Ext rinsing: Shearing, friction, humidity
What is the biggest challenge in LTC?
Balancing safety with client autonomy.
What are other challenges in LTC?
Managing Teams Ensuring Quality Services Harmonization of Service Delivery financial Context Individual Culture in Centers
