In This Issue - October 2024

Program Updates
- Accessing and Updating Immunization Records
- Community Paramedicine Referrals
- National Breastfeeding Week
- COVID-19 Testing Updates
Announcements
- Antiviral Resources
- Respiratory Surveillance
Primary Care Advisory & Liaison Group
- Enhanced 18-Month Well-Baby Visit
Educational Opportunities
- Free, unbiased, MAINPRO-accredited CME
- Autism Spectrum Disorder in Primary Care: Assessment, Counseling and Next Steps

Accessing and Updating Immunization Records

In late spring, Niagara Region Public Health activated the Ministry’s Immunization Connect Ontario (ICON). ICON is a secure and confidential online system for patients to update and retrieve their immunization information. Patients and parents/legal guardians can continue to report vaccinations online for their children 0 to 17 years of age and can now also access their immunization records through ICON.

ICON provides patients ownership and control over their personal health information by allowing them to directly access and share their records with primary care providers through appropriate channels.

Implications for Practice

Starting Dec. 1, 2024, health care professionals will no longer be able to access patient immunization records through Public Health.
If you need a patient’s immunization record in order to provide service, ask the patient or parent/legal guardian to visit Public Health’s vaccine website to access their record for you
- Children 16 years of age and older must request their own records due to privacy laws
Remind parents/legal guardians and children 16 years of age and older that they are responsible for reporting their vaccines directly to Public Health. Using ICON to report fulfills this responsibility

You can now order new immunization record resources for your office. This includes updated notification and how to access your immunization record tear off pads and an access and update your child’s immunization record poster.

Community Paramedicine Referrals

Community paramedicine is a growing field of paramedicine practice that utilizes paramedics in advanced roles and scope providing a more proactive and preventive approach to care.

Niagara Emergency Medical Services’ (EMS) Mobile Integrated Healthcare provides patient-centered visits 24 hours per day, seven days a week. These are delivered in the patient's home or where they're at and is based on patient needs. Programs don’t typically have an end date and paramedics perform monthly wellness visits and visit on a p.r.n. or ad-hoc basis.

Advancements in point of care procedures support quality bedside/chairside testing to help avoid emergency room visits. Paramedics can conduct point of care blood work, HbA1c, remote patient monitoring and urinalysis as well as medical directives to treat exacerbations in the home and give routine injections such as Prolia, Aranesp & B12. They also support in falls detection and monitoring.

Primary care providers, Home and Community Care Support Services, and allied agencies may refer eligible patients to the Community Paramedic High User and Long-Term Care programs.

National Breastfeeding Week was October 1 - 7

Niagara Region Public Health supports patients in navigating breastfeeding and infant feeding. Public Health nurses offer one-on-one support year-round and can answer questions related to breastfeeding, bottle feeding, and transitioning baby to solids.

If you have a patient who would benefit from infant feeding support, please refer using the online Family Health Referral form or print and fax.

Patients can also book an infant feeding appointment online or call Niagara Parents at 905-684-7555 or 1-888-505-6074 ext.7555.

COVID-19 Testing Updates

The Province of Ontario recently made some changes to COVID-19 vaccine and testing guidelines detailed in a memo shared by Public Health on Oct. 9. As a reminder, these province-wide changes include:

Updated COVID-19 test eligibility (inclusive of both rapid antigen tests and PCR testing) to a Test-to-Treat approach
Outside of high-risk settings, publicly funded COVID-19 testing will only be available to Ontarians eligible for COVID-19 treatment
Public Health offices are no longer distributing COVID-19 rapid antigen test kits
The antigen test ordering pathway for eligible health system partners will continue to be through the PPE Supply Portal. The distribution of free rapid antigen tests under this program is voluntary and will not be reimbursed by the province. Rapid antigen tests ordered from the PPE Supply Portal must also be distributed free-of-charge.

Antiviral Resources

Health care providers are encouraged to discuss antiviral treatment options with eligible patients before they get sick and create a plan to ensure patients get the appropriate therapeutic within the treatment window.

Resources

COVID-19 – See Ontario Health's recommendations and resources on the use of COVID-19 treatment
Influenza – See Public Health Ontario’s resource Antiviral Medications for 2024-25 Seasonal Influenza: Public Health Considerations

Respiratory Surveillance

Public Health Ontario’s most recent respiratory laboratory surveillance data indicates activity for influenza is low
Provincially, Entero/Rhinovirus is the most commonly circulating virus amongst samples tested (based on percent positivity)
In Niagara, there have been 6 confirmed cases of influenza this season; and 202 across Ontario

Niagara reports flu activity surveillance information weekly on Fridays. For more detail on the 2024 to 2025 respiratory season, please visit Public Health Ontario’s page for the Ontario Respiratory virus Tool.

Enhanced 18-Month Well-Baby Visits

PCAL reconvened last month to review the implementation of the enhanced 18-month well-baby visit (EWBV) and Public Health’s book club program. In September and early October, PCAL leads connected with colleagues across their catchments to learn the facilitators and barriers in implementing the EWBV in their practice. Thank you to those who shared their perspectives.

These connections are important! Your input to PCAL Leads informs Public Health on the context of public health issues across primary care in Niagara, influences communication strategies and shapes interventions that aim to reach those most vulnerable in our community.

Update: Enhanced 18-Month Well-Baby Visit

Public Health aims to increase the number of primary care providers delivering the EWBV to improve connections to community resources that support healthy child development and school readiness.

The enhanced visit includes the completion of well-baby care and additional documentation of a discussion on the child's development using two age-appropriate screening tools (i.e., 2020 18-Month Rourke Baby Record and 18-month LookSee Checklist) completed by the primary care provider in collaboration with the caregiver.

Why 18 months? For some families, this visit may be the last regularly scheduled visit with a primary care provider before a child enters school. This visit can reduce the number of vulnerable children at school entry, as measured by the Early Developmental Instrument (EDI) scores (assesses the developmental health and wellbeing of children in Senior Kindergarten) and can improve connections to community resources that support healthy child development and school readiness.

Percentage of Children Vulnerable by EDI Domain in 2022/2023

In 2023, Niagara remains higher in vulnerability compared to the province as measured by the EDI. Vulnerability means that a child scored below the 10th percentile. These children are at increased risk of difficulties and, without additional support, may continue to experience challenges. Evidence indicates that the pandemic and ongoing socioeconomic stressors have heightened the risks associated with adverse childhood experiences (ACEs) which increases susceptibility to poor health outcomes across the lifespan.

Why is Early Literacy Important?

Early literacy experiences are a stronger determinant of lifelong health than occupation or income. Literacy supports understanding, empathy, critical thinking, and the capacity of lifelong learning. Early literacy develops positive self-esteem in children and builds communication skills and helps children to recognize moods and feelings. For parents, research has associated shared reading with improved parenting style, reduced maternal depression and stress levels, and enhanced parental sense of competence and self-esteem.

18-Month Book Club

Sharing books and stories fosters attachment and early relational health between the child and caregiver through closeness and responsiveness.

Public Health offers an 18-month Book Club aimed at fostering a love of reading, supporting child development, and alleviating the effects of ACEs on health. Research shows that parents are likely to follow the guidance of their primary care provider, and when given a "prescription" to read, families often embrace this valuable recommendation.

Free, unbiased, MAINPRO-accredited CME

Family physicians and nurse practitioners, did you know you are eligible for free one-on-one or small group discussions (academic detailing visits) with a trained clinical pharmacist? Each visit provides one Mainpro+ credit (for family physicians and second-year residents) or participation certificate (nurse practitioners).

Academic detailing visits are offered by the Centre for Effective Practice (CEP), a non-profit group, free of commercial interest, that aims to close the gap between evidence and practice
Visits may be done virtually or in person. During the visit, you will receive up-to-date clinical pearls, tools and connections to helpful resources.

For a list of available topics and to sign up for a virtual visit, click here. New topics added twice yearly! Pharmacotherapy for Weight and Obesity Management coming in November!

To sign up for an in person visit email Silvana Ferrara to arrange a time that works best for you.

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Autism Spectrum Disorder in Primary Care: Assessment, Counseling and Next Steps

Niagara Children's Centre and Niagara Health are offering a CME accredited* presentation by Dr. Kaitlyn Siu on Tuesday, November 26.

Learning objectives:

Review autism diagnostic criteria and understand new referral pathways
Learn practical tips for counselling families about autism, filling out disability paperwork and answering common questions
Increase knowledge of Niagara Children’s Centre services including SmartStart Hub and referral pathways

This is a hybrid event. Arrival at 6:00 p.m. ‘LIVE’ meeting starts at 6:30 p.m. Spaces are limited. Pre-Register by clicking one of the following links:

Attend In-Person at White Oaks Resort & Spa (253 Taylor Road, Niagara-on-the-Lake): REGISTER HERE (by November 19, 2024)
Attend on Zoom: REGISTER HERE (by November 26, 2024)

*Earn up to 1.5 credits from the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada.

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Visit the Professional Development Opportunities page for more in-person and online opportunities available to health care professionals in Niagara.

Medical Advisories & Memos

MEMO: October 21 - RSV Immunization Updates and Eligibility Reminders
MEMO: October 9 - COVID Updates
MEDICAL ADVISORY: October 7 - Pertussis Cases Continue to Rise in Niagara

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