A leading academic Family Health Team that improves the health of our community

SETorontoFHT

wwwsetfhtonca

SETFHT Quarterly Issue 35

Summer 2017

If you have any feedback on these or future newsletter ideas please email us at feedbacksetfhtonca

Quality Improvement at SETFHT

Administrative Office 833 Coxwell Avenue Lower Level Toronto Ontario M4C 3E8 bull T 4164238800 bull F 4164238803

Clinics 840 Coxwell Avenue Suite 105 Toronto Ontario M4C 5T2 bull T 4164696464 bull F 4164696164

1871 Danforth Avenue Toronto Ontario M4C 1J4 bull T 4166997775 bull F 4166997766 wwwfacebookco

msetfht

Your family practice clinic has an active Quality Improvement Committee and one of the overarching goals of this committee is to promote patient safety and continuously learn how to improve care for patients at SETFHT Two residents Dr Roarke Copeland and Dr Stephanie Godard have created a standardized process to guide family medicine residents and supervising faculty physicians in dealing with patient safety incidents potential errors or near-misses noted during their day to day work This system will be used as our resident physicians see and treat patients during their two year specialization training in family medicine Stay tuned for more information

Have you ever given thought to the medical care that you would like to receive in the future or perhaps in the event of an unexpected incident Life can be unpredictable at times So the best time to think about these things is nowmdasheven if you are healthy and well Advanced Care Planning (ACP) is a process that allows you to explore your beliefs and discuss your wishes for future health care needs so that your friends family and health care providers know what is important to you As your life changes it is expected that your personal wishes for your care will change as well So it is important that you know that your advanced care plan can be changed or updated at any time 5 steps to creating an Advanced Care Plan 1) Thinkmdashabout what is important to you 2) Learnmdashabout what common terms and options there are for care 3) Decidemdashwho will speak for you (Power of Attorney Substitute Decision Maker Office of the Public Guardian and Trustee) choose someone that knows you well and that you can trust to speak on your behalf if you are unable to do so 4) Talkmdashstart the conversation around what is important to you and your wishes 5) Documentmdasheither write it down create a video diary or audio recording of your wishes Schedule an appointment with one of our Registered Nurses Nurse Practitioners or your Family Physician to discuss Advanced Care Planning in more detail There are several resources that can help you to work through and create your unique Advanced Care Plan Speak Up Canadarsquos National Campaign for Advanced Care Planning mdash httpwwwadvancecareplanningca Power of Attorney for Personal Care mdash httpwwwcleooncaenpublicationspower Ontario Ministry of the Attorney General mdash httpswwwattorneygeneraljusgovoncaenglishfamilypgtindexphp

Advanced Care Planning The Time is Now to Plan for Your Future

Candice Sockett Nurse Practitioner

Demographics

In order for us to contact you and

keep information updated we ask

that you notify us of ANY demographic changes by phone

email or via the following link

httpsoceancognisantmd

comintakeIntakePortalhtml

eReqRef=951c0073-f111-47ce-b405-

e3ff3f81bcc5

Page 2 Cognitive Behavioural Therapy (CBT) Maria Ierullo Social Worker

Thank you to Maria Ierullo Social Worker for this article Maria and Cara Heitmann Social Worker run a program called Mindfulness amp Anxiety For more information about registering please visit our website at wwwsetfhtonca choose Our Services and then click on Our Programs

Did you know you can have secure

online access to most of your LifeLabs test

results free of charge To register

visit http

wwwlifelabscom

patientsPagesTest-

Resultsaspx using a

desktop computer laptop tablet or mobile device

CBT looks at the connection between what you think what you do and how you feel It believes that making changes to your thoughts and behaviours will change your mood and physical reactions CBT can be helpful for depression anxiety stress anger insomnia and other challenging moods and issues It is usually short-term goal-based and focused on the here and now You will learn skills that will teach you how to understand and challenge unhelpful thinking patterns and increase your engagement in a variety of activities Most people find that the more time they spend practicing the skills in between sessions the more benefit they get out of it There are also many CBT workbooks that you can purchase and work through at your own pace such as

Mind Over Mood (2nd edition) by Dennis Greenberger and Christine A Padesky The Generalized Anxiety Disorder Workbook A CBT Guide for Coping with Uncertainty Worry and Fear

by Melisa Robichaud and Michel J Dugas The Cognitive Behavioural Workbook for Depression A Step-by-Step Program by William J Knaus and

Albert Ellis Mindfulness Therapy Mindfulness is about increasing our ability to pay attention to and accept the present moment whether the moment is pleasant or unpleasant Mindfulness Therapy includes learning how to meditate and other useful concepts such as non-judgment and self-compassion etc Mindfulness therapy is a helpful treatment for many mental health concerns and chronic illnesses including anxiety depression stress chronic pain substance use grief etc It is usually short-term and is often offered in group format Mindfulness Therapy is often combined well with Cognitive Behavioral Therapy There are also several Mindfulness books that you can purchase amp work through at your own pace such as Full Catastrophe Living by Jon Kabat-Zinn The Mindful Way Workbook An 8-Week Program to Free Yourself from Depression and Emotional

Distress by John D Teasdale Mark Williams and Zindel Segal The Mindful Way through Anxiety Break Free from Chronic Worry and Reclaim Your Life by Susan

M Orsillo and Lizabeth Roemer

Page 2

PAC Update Thank you for all those who applied to the Patient Advisory Council Four new members will be

joining our PAC We will continue to connect with you as we increase the membership Our next meeting will be in the Fall

Prescriptions

We ask that you please contact your

pharmacy at least one week prior to your medication running out They can fax a

prescription renewal request to

4164696164 ndash Your provider may not always sign off on

repeats and this could require an

appointment We need at least 2-5 days to respond to

any prescription requests

Controlled drugs (narcotics benzos

stimulants sleep aids) can only be renewed

by the issuing provider ndash This may

require an appointment

Page 3 De-prescribing Benzodiazepines Kaila MacMillan Pharmacist

Do you take a sleeping pill If yes we want to hear from you

Sleeping pills are a hot topic here at the South East Toronto Family Health Team right now We are trying to reduce the number of people using sleeping pills especially those who are 65 years and up

Why worry about sleeping pills The verdict is out Many sleeping pills have dangerous side effects This is especially true with drugs called benzodiazepines or drugs called z-drugs (see list below) These medications can help with sleep at first but they have a negative effect on the brain People who take these drugs are more likely to develop memory problems such as dementia or Alzheimerrsquos People who take these drugs are also more likely to get dizzy and fall down They are more likely to get in a car accident if they drive Not only are these pills dangerous but they donrsquot actually work that well The body gets used to the effects of these medications very quickly On average people get an extra 22 minutes of sleep when they take these pills and only 1 out of 13 people will see that 22 minute benefit Meanwhile 1 out of 6 people taking benzodiazepines will have a serious side effect

But I take a low dose and Irsquove never had a problem Even if you take a low dose and even if you havenrsquot noticed any problems you are still at risk In fact many people donrsquot realize how much the drugs are affecting them until they stop Often people describe feeling more alert when they stop Many people report improvements to mood and quality of life once they stop these medications

If these drugs are so risky should I just stop right away If yoursquove been taking a benzodiazepine or z-drug for a long time itrsquos best not to stop all at once The body gets used to these medications and you can have bad side effects if you stop too quickly The best way to stop is to slowly reduce over weeks or even months If yoursquore interested in decreasing or stopping your medications talk to a member of the team and they can help you

But I still have sleep problems how can I get a good nightrsquos sleep There are many things you can do to improve your chance of sleeping well Donrsquot watch TV or look at bright

screens before bedtime Avoid caffeine in the afternoon or evening Avoid alcohol before bed too While many

people drink alcohol to feel sleepy alcohol leads to fractured sleep with many night time awakenings and it

lowers the quality of sleep Try to get some exercise during the day so that your body is tired when bedtime

comes Only use your bed for sleep and intimacy so that your body doesnrsquot associate the bedroom with being

awake If you canrsquot sleep donrsquot lay in your bed awake get up and do something calming until you feel sleepy

again All of these little tweaks called lsquosleep hygienersquo can help improve your chances of success

Examples of benzodiazepines and z-drugs

Alprazolam (Xanaxreg)

Chlorazepate

Chlordiazepoxide

Clobazam

Clonazepam (Rivotrilreg Klonopinreg)

Flurazepam

Diazepam (Valiumreg)

Lorazepam (Ativanreg)

Nitrazepam

Temazepam (Restorilreg)

Oxazepam (Seraxreg)

Triazolam (Halcionreg)

Eszopiclone (Lunestareg)

Zaleplon (Sonatareg)

Zolpidem (Ambienreg IntermezzoregEdluarreg Sublinoxreg Zolpimistreg)

Zopiclone (Imovanereg Rhovanereg)

Electronic Records Access

Did you know that

MGH (formerly Toronto East General

Hospital) has My Chart which allows patients to access

their health records Go to http

wwwteghoncabins

content_pageasp

cid=2-7535amplang=1 to

learn more Access your health records Anytime

Anywhere

We all know that exercising is good for us (for a list of some of the benefits see the box below) The challenge for most people is doing it consistently over time There are two things involved with activity that are essential for health The first is sitting less Sedentary time is not the same thing as exercising too little even people who exercise daily can have a lot of sedentary time The second component is moving more and in order to do this consistently itrsquos best if you can find activities you can enjoy Start by reducing your sitting time Think about how much of your day is spent sitting We are often sitting when we do things like commuting working at our desks watching TVmovies using our phones reading and relaxing Here are some tips to reduce your sedentary time Try stretching or taking a short walk if yoursquove been sitting more than an hour (whether It be at work or while yoursquore at home) Set a timer to remind you to get up every hour Find different ways of sitting that engage your core (like on an exercise ball or backless chair) See if your company offers standing desks or better yet adjustable desks so that you can stand or sit Try standing while you are reading If you take public transit try standing rather than sitting Mindful movement involves paying attention to how your mind and body feel during and after exercise This is the best way for you to learn the best exercise for you Exercise shouldnrsquot be stressful or painfulmdashit should help you manage your stress It should be pleasurable rather than something you dread doing If it isnrsquot you will not reap its many benefits nor will you keep it up What are your barriers to being active If you are not currently active then you have barriers Here are some common barriers we often hear Irsquom too lazy I donrsquot have the energy Irsquom too busy I donrsquot have the time My (knees foot back or other body part) hurts Itrsquos too cold outside Irsquom too out of shape I donrsquot want to put on a swimsuit People will laugh at me Do any of these resonate with you Once you learn about what your barriers are you can start taking steps to overcome them If you want some help working on this book an appointment with your SETFHT dietitian todaymdashwersquoll be happy to help you get moving ldquoExercise is for health and vitalitymdashnot for earning the right to eatrdquo mdash Michelle May

SETFHT Quarterly is a publication of the South East Toronto Family Health Team

Editor Tessa Catchpole Thank you to all our contributors in this edition of the SETFHT Quarterly

Candice Sockett Nurse Practitioner

Cara Heitmann Social Worker

Julie Seale Registered Dietitian

Kaila MacMillan Pharmacist

Maria Ierullo Social Worker

Dr Stephanie Godard amp Dr Roarke Copeland Family Medicine Residents

If you have any feed-back please email us

at feed-backsetfhtonca

Back Page

SETorontoFHT

wwwsetfhtonca

wwwfacebookco msetfht

Welcome to our newest group of family medicine residents

Administrative Office 833 Coxwell Avenue Lower Level Toronto Ontario M4C 3E8 bull T 4164238800 bull F 4164238803

Clinics 840 Coxwell Avenue Suite 105 Toronto Ontario M4C 5T2 bull T 4164696464 bull F 4164696164

1871 Danforth Avenue Toronto Ontario M4C 1J4 bull T 4166997775 bull F 4166997766

Small Changes Make a Big Difference Get Moving Julie Seale Registered Dietitian

SETFHT Quarterly

Reduces Health Risks Improves Quality of Life

Diabetes + prediabetes Strength

Depression Balance

Heart disease Mood

High blood pressure Energy

Osteoporosis Stress tolerance

Some types of cancer Sleep quality

Premature death Cognition + memory

Angelo Gunanayagam Melini Gupta Shirley Hu Bahar Najafilarijani Smriti Pradhan Ankit Rastogi Sandy Van Alex Copeland Leah Hutchinson Celine Sandor

Joining our 840 Coxwell site are Jasmyne Carnevale Lizotte Katy Harrington Cristina McHenry Mathura Sabanayagam Alexandra Stoianov Venus Valbuena

Joining our 1871 Danforth site are Nico Sheppard-Jones Daniel Pang Lora Rotstein Jessica Wilson Anna Yu Jenny Chen

A Warm Welcome as well to Mohamed Farah and Charlie Petch our

newest Clinical Administrative Support team members

Leah Ethier Nurse Practitioner (covering Candice Sockettrsquos mat leave)

Gisele Iskandar Pharmacist (replacing Kaila MacMillan)

Jennifer Wong Manager QI amp Patient Safety

A Fond Farewell to Karen Lilley Clinical Administrative

Support (retired) Candice Sockett Nurse Practitioner

(starting mat leave in August) Kaila MacMillan Pharmacist

Welcome amp Farewell