IMPACT PLUSCo-Principal Investigators

Dr. Ross UpshurSunnybrook Academic Family Health Team

Sunnybrook Health Sciences Centre

Dr. Howard AbramsUniversity Health Network

Taddle Creek Family Health Team

Co-InvestigatorsDr. Jocelyn Charles, Dr. Leslie Nickell, & Shawn Tracy (Sunnybrook Family Health Team)

Dr. Pauline Pariser (Taddle Creek Family Health Team)Dr. Nasreen Ramji & Dr. Sheila Lakhoo (St. Michael’s Hospital Family Health Team)

Dr. Thuynga Pham (Southeast Toronto Family Health Team)

Collaborating AgenciesToronto Central Community Care Access Centre

SPRINT (Senior Peoples’ Resources in North Toronto)Regional Geriatric Program of Toronto (Sunnybrook)

Research TeamJason Nie, Li Wang, Dr. Jana Bajcar

and all the clinical team members at the 4 participating Family Health Teams

Interprofessional Model of Practice for Aging and Complex Treatments

IMPACT PLUS: a comprehensive model of• Assessment• Care Planning• Mentorship and training

▪ Interprofessional problem solving model▪ Includes PCPs, CCAC worker, pharmacist, RNs,

NPs, social workers, physiotherapist, OT, dieticians, trainees

PLUS ▪ Psychiatrist & General Internist

Patient and

Family

Family Physician

Resident Physician

Pharmacist

Dietitian

PT

OTInternist

Psychiatrist

Social Worker

Nurse

Homecare Coordinator

IMPACT PLUS

Relevance of Psychiatry, CCAC and Social Work

Can address confluence of complex chronic illness with psychiatric co-morbidities and social determinants in real time

Introduces theories and concepts of illness behavior

Supports group process of team

• Relevance of General Internist

• “One Stop Shopping” : Simplifies treatment for multiple conditions

• “Appropriate Use”. Able to say no.

• Gives permission to PCPs

• Transfer of knowledge and modeling of clinical approach to other health professionals and trainees

• Occasionally makes a brilliant diagnosis just like Dr. House.

The IMPACT protocolPatient Selection & Invitation

Team Deliberation

Document. & Debrief

Group Discussion 1

Patient Welcome & Initial Patient Interview

Group Discussion 2

HCP Assessments

Care Plan and Next Steps

IMPACT PLUS

RESULTS

Demographics

Marital Status (%)

Married 30.8% 

Single 48.7%

Widowed 20.5%

Sex (%)Male 39.7% 

Female 60.3% 

Age, mean (SD) 78.94 (13.5)

Number of medications, mean (SD) 12.60 (5.11)

Number of chronic conditions, mean (SD)

9.17 (3.09)

Complexity Score, mean (SD) 21.77 (7.17)

“I didn’t notice the time go by and I was happy to be interviewed by so many people, yeah, and listening to their suggestions and all that, which was great. I mean, you all talk among yourselves, suggest what is best for the patient and I think that is really great, you can’t beat that at all.” ~Patient

“It was like togetherness… I was very much involved in that and I liked it. I felt so much better on the way home. I don’t know why – my heart was lifted and after being so depressed for such a long time, you know, I felt I could laugh again.” ~Patient

Patient experience

“… it’s brilliant and it’s functional and it’s beneficial and it provides security, emotional security and support for not only the patient, but the family.”

Family caregiver experience

“IMPACT is the first time that I really felt like I was involved in interprofessional care It’s my first time that I really felt like a valuable team player and I really felt like I’ve gotten to understand the patient’s condition from more than a nutrition standpoint. To really understand more of what the patient is going through as a whole person.” - Dietitian

Team member experience

Team member experience

“What I feel truly sets this clinic apart is the ability to directly observe professionals from other health disciplines as they interact with the patient. It gives you insight into the role of other disciplines that you simply cannot get any other way and and makes the clinic discussion much more dynamic.” - PGY3 Internal Medicine

Patients : feel cared for and heard, given time to actually surface

what is important Co-develop care plans that focus on what is achievable

given very diverse and complicated treatment burdens

Family caregivers: feel supported able to give voice to their stress feel empowered to continue to deal with difficult and

complex situations

Lessons learned

Health Care Providers: experience true inter-professional learning,

Are able to crowd-source solutions to complex problems

Reduce stress/burnout through group support and validation

that creates a “way forward” with complex patients

increase their willingness to care for a challenging patient

population

Find patients are easier to manage in subsequent primary

care visits

Lessons learned

It’s do-able!

It’s presentable: From Local to International

Everybody likes it

It disseminates: Now in 4 LHIN’s

It’s adaptable: TIP (Telehealth IMPACT Plus)

Successes

Funding model; works for FHTs

PCP “Chagrin Factor”

Team skills

Extending to solo HCPs

Type III Error ( error):

“Necessary but not sufficient”

Challenges

The IMPACT+ team gratefully acknowledges: Our patients and their families Our colleagues Our funding partners

Acknowledgements

Questions/Comments?

IMPACT PLUS