In This Issue - January 2023

UPDATE:
- COVID-19
  - Changes to Public Health COVID-19 Phone Support
  - Covid-19 Antivirals
  - COVID, Cold, and Flu Care Clinics in Niagara
- Update from Vaccine Preventable Disease Program
REVIEW:
- Welcome New Physicians!
- Borderline Personality Disorder
- Importance of Oral Health Services
- Respiratory Surveillance
EDUCATIONAL OPPORTUNITIES
- FREE WEBINAR: CPS National Grand Rounds
- FREE TRAINING: Clinician-Client Communication to Enhance Health Outcomes
MEDICAL ADVISORIES & MEMOS

UPDATE: Changes to Public Health COVID-19 Phone Support Coming Feb. 6

At the beginning of the pandemic almost three years ago, Niagara Region Public Health (NRPH) launched a set of dedicated COVID-19 Information Lines to provide reliable, up-to-date, COVID-19 information and support to the Niagara community, including health care professionals. On some days earlier in the pandemic, Public Health would receive over 900 calls. The busiest month saw over 1000 calls come into the health care professional extension alone.

As the intensity of the pandemic has lessened and calls to Public Health have greatly decreased, changes are being made to our phone support for COVID-19 inquires. Public Health is integrating COVID-19 services back into our regular business operations. Beginning Feb. 6 the dedicated COVID-19 Information Line will no longer be an option, however, health care professionals can call 905-688-8248 then dial

Ext. 7425 for COVID-19 vaccine questions
Ext. 7330 for COVID-19 disease questions (for example, testing and self-isolation)

Additionally, COVID-19 information can be found on our website.

UPDATE: COVID-19 Antivirals

Paxlovid

In December, Ontario Health updated their recommendations on which patients would benefit from receiving Paxlovid. This recommendation, along with additional clinical guidance documents can be found on Ontario Health’s webpage. Prescribers must determine whether adopting suggested information is clinically appropriate for individual patients through a risk-benefit assessment.

Paxlovid should be strongly considered for individuals who have a confirmed COVID-19 diagnosis, present within 5 days of symptom onset, and meet one or more of the following criteria:

The individual is 60 years of age or older;
The individual is 18 years of age or older and is immunocompromised;
The individual is 18–59 years old and is at higher risk of severe COVID-19 due to
- 1 or more comorbidity, or
- Not up-to-date with COVID-19 vaccination including recommended booster doses.

Individuals who are at a higher risk of poor outcomes from COVID-19 infection based on social determinants of health should be considered priority populations for access to Paxlovid.

Eligible patients can get a Paxlovid prescription from

Their primary care provider
Participating pharmacies (eligible patients should confirm process and availability for getting a prescription with their local pharmacy)
COVID, Cold and Flu Care Clinics

Visit our frequently asked questions webpage for more information and resources.

Evusheld

As of December 2022, circulating variants of COVID-19 are no longer susceptible to Evusheld (Tixagevimab and Cilgavimab). Therefore, Ontario Health no longer recommends routine use of Evusheld for pre-exposure prophylaxis for any patient group, including immunocompromised patients, nor for treatment of COVID-19. See Ontario Health’s Recommendation on the Use of Evusheld for more information.

UPDATE: COVID, Cold, and Flu Care Clinics open in Niagara

COVID, Cold, and Flu Care Clinics (CCFCCs) have been opened across the region to test, assess, and provide treatment for people with COVID-19 and other cold and flu-like illnesses.

Appointments for Niagara Health CCFCC: 905-378-4647, ext. 41985.
Appointments for the primary care CCFCCs: 289-267-2879.
All CCFCCs are closed on statutory holidays.

Niagara Health
Niagara Falls site – 5546 Portage Road, Niagara Falls
Monday, Wednesday, and Friday – 8 a.m. to noon

Primary Care: Centre de santé communautaire Hamilton/Niagara
Vanier site – 1 Vanier Drive, Welland
Saturday – 9 a.m. to 5 p.m.

Primary Care: Niagara North FHT
145 Carlton Street, Unit 7, St. Catharines
Monday, Tuesday, Wednesday, and Friday – 5 p.m. to 8 p.m.
Thursday – noon to 8 p.m.

Primary Care: Niagara North FHT
1882 Niagara Stone Road, NOTL
Thursday – noon to 8 p.m.
Friday – 9 a.m. to 5 p.m.

Primary Care: Quest CHC
145 Queenston Street, St. Catharines
Tuesday, Wednesday, and Thursday – 4:30 p.m. to 8 p.m.

UPDATE: Vaccine Preventable Disease (VPD) program

This is a friendly reminder that Niagara Region Public Health is sending Immunization Notices to elementary school students with incomplete immunization records this winter.

Please ensure your practice has enough vaccine supply to manage the increased demand in getting students caught-up on missed routine vaccines:

Please dispose all outdated print resources from the VPD program. Previous URLs and/or QR codes have expired or are no longer applicable. New after care sheets, vaccine notification tear-off pads and reporting vaccinations posters can be ordered from our website.

For more information contact the VPD program at 905-688-8248 or 1-888-505-6074 ext. 7396 or read our memo for the record review timeline and implications for your practice.

REVIEW: Welcome New Physicians!

Niagara Region Public Health would like to extend a welcome to the new physicians in 2022

REVIEW: Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental health condition that severely impacts a person's ability to regulate their emotions. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others. Common symptoms can include intense bouts of anger, depression or anxiety, dissociation, and self-harm.

Treatment for BPD is Dialectical Behaviour Therapy, and sometimes medications to help reduce specific symptoms.

Referral Options:

If your patient is between the ages of 17-25 and has had no prior counselling, refer to Niagara Region Mental Health’s Youth Mental Health and Addiction Services (YMHA).
If your patient is under the age of 25 and uses substances, the Community Addiction Services of Niagara (CASON) also provides DBT services. Referrals can be made by calling 905-684-1183.
If your patient does not meet the criteria for YMHA or CASON, please contact the Access Line at 1-866-550-5205 for additional referral options.

REVIEW: Importance of Oral Health Services

Over the past three years, routine dental services have been suspended due to the climate of the pandemic. In the 2021 - 2022 school year, 49% of Niagara's screened grade 2 students had tooth decay. To account for service disruptions, Public Health is offering dental assessments to all elementary students (JK - grade 8). In addition, kindergarten students in priority schools will also be offered fluoride varnish.

Primary care professionals offer a unique and ideal setting to integrate oral health education and assessments into appointments. It is essential for primary care providers to check their patients' teeth during well-child visits. Often, many children do not see a dentist until the age of five. Incorporating dental assessments can help identify oral health issues early and reduce barriers.

Patients 17 and under can be referred to Public Health’s Dental Program or to the Healthy Smiles Ontario program for free dental services and programs.

REVIEW: Respiratory Surveillance

Surveillance Update: Influenza activity decreasing

Public Health Ontario’s most recent respiratory laboratory surveillance data indicates activity for influenza A is moderate and decreasing consistent with the tail end of the influenza A season; influenza B activity remains low
Provincially, RSV is the most commonly-circulating non-COVID-19 virus; there are early signs that enterovirus/rhinovirus may be increasing again
In Niagara, there are 918 lab-confirmed cases of influenza so far this season; 18,340 across Ontario

2022-2023 Respiratory Season

Data source: Public Health Ontario’s Ontario Respiratory Pathogen Bulletin, data as of January 13, 2023. Please note: Coronavirus refers to non-pandemic human coronaviruses, not the novel coronavirus (COVID-19).

Niagara reports flu activity surveillance information weekly on Fridays

For more detail on the 2022 to 2023 respiratory season, please visit Public Health Ontario’s page for the Ontario Respiratory Pathogen Bulletin.

Free Webinar: CPS National Grand Rounds: Promoting Early Relational Health and Child Development in Canadian Resident Education and Clinical Practice Moments

This session is aimed at pediatricians, family physicians and clinical staff who work with children and families.

Learning objectives:

Recognize the impact of safe, stable, nurturing relationships on children's development and health
Describe the "keystones" principles of attachment, autonomy, and self-regulation
Discuss, model, and praise specific parenting behaviors that promote early relational health and child development
Identify resources to help incorporate concepts into resident training and clinical practice

Presented by Dr. Blair Hammond, Co-founding Director and Director of Medical Education at the Mount Sinai Parenting Center in New York in partnership with the Canadian Paediatric Society's Early Years Task Force

Date: Thursday Feb. 9, 12 - 1 p.m. Register in advance for this webinar

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Free Training: Clinician-Patient Communication to Enhance Health Outcomes

When: March 1, 2023 8:30 a.m.-12:30 p.m.

Where: Virtual through Zoom

Effective clinician-patient communication underlies successful medical care. Research has demonstrated that using more effective communication skills results in

Improved diagnostic accuracy
Increased patient involvement in decision-making
Increased likelihood of adherence to therapeutic regimens
Increased patient and clinician satisfaction
Reduced likelihood of exposure to malpractice litigation

The objectives of the program are to

Improve awareness of a clinician’s roles regarding the importance of communication as an essential aspect of healthcare and
Understand that complete clinical care consists not just of “find it and fix it” but of four communication skills: Engage, Empathize, Educate, and Enlist

For more information and to register click here. Registration closes February 24.

MEDICAL ADVISORIES & MEMOS

January 11 MEDICAL ADVISORY: New COVID-19 Vaccine Products for Children and Other Updates
January 3 MEMO: Record Review for ISPA Required Vaccines – Elementary Schools

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