To: Family physicians and nurse practitioners
04-09-2020
Updated Screening Guide for Family Practice

Yesterday, Dr. Robert Strang expanded the criteria for COVID-19 assessment to include two or more of the following symptoms:
  • fever
  • new or worsening cough
  • sore throat
  • runny nose
  • headache


The Quick Reference Screening Guide for Primary Care Providers in Family Practice has been updated to reflect this change, as well as includes a prompt for clerical staff to ask patients if they have tested positive for COVID-19, or have results pending from a swab.
COVID-19: A Pivotal Moment in Community Care

You may be interested in this article recently published in the British Medical Journal. COVID-19: A pivotal moment in community care  provides observations about the rapidly evolving progress that is taking place in the primary health care system as result of the current pandemic.

Primary Health Care and the Department of Family Practice are interested in collecting your experiences and advice, in the Nova Scotian context, about what we are learning and how this can fundamentally change the way we deliver primary care in the future. More information about how to contribute your experiences and observations will be shared shortly.
Reminder: COVID-19 Website Hub for NSHA Staff and Physicians

NSHA has a new website that serves as a ‘hub’ of information about COVID-19 for physicians and NSHA staff. This website replaces both the COVID-19 web page for physicians and the intranet page for staff.
The COVID-19 website hub has a dedicated area for family practice and physicians:

The latest information related to the COVID-19 response is being posted to this website. Information in Dr. Nicole Boutilier’s daily physician update regarding COVID-19, as well as the Department of Family Practice weekly update, will link to documents stored on this hub to ensure that the latest version is accessible.
Temporary Suspension of Routine Cervical Cancer Screening

As all health care efforts focus on responding to the COVID-19 pandemic, Dr. Robert Grimshaw, Medical Director of the NSHA Cervical Cancer Prevention Program, is recommending temporary suspension of routine cervical screening (Pap smears) until further notice.

This applies to routine Pap smear screening in Nova Scotia by family physicians, obstetrician / gynecologists, nurses, and nurse practitioners in all settings. SCREENING Pap tests and HPV tests should not be performed, and will not be reported for the foreseeable future. Some tests already performed may not be processed, depending on human resources.

However, it may be appropriate to perform a NON-SCREENING Pap test in some situations. One such example is a pregnant patient with abnormal bleeding suspected to be of cervical origin. Care providers who perform such a test should include the rationale for testing and processing on the requisition. Any provider who has a significant concern of suspected cervical cancer in a patient, is advised to contact a local gynecologist / colposcopist directly regarding management.
Home Care Services – Continuing Care

Both home support and home nursing services continue to be delivered across Nova Scotia during the COVID-19 pandemic. NSHA and all contracted home care agencies are taking a consistent approach to prioritizing care for clients due to staffing capacity challenges and the need to reduce spread of the virus. As with other parts of the health system, the ability to prioritize care ensures there is capacity and flexibility to respond to COVID-19 spread and outbreaks as needed.

We are committed to working with clients and their families to make sure their essential needs are met in the event that services are disrupted due to pandemic conditions. Clients and families are encouraged to contact their NSHA Care Coordinator if they have any concerns or if their care needs change. If they are unsure who to call please ask them to call our 1-800-225-7225 intake line for assistance.
 
Please continue to refer your patients for Continuing Care services as per usual processes however please keep in mind we continue our essential services planning and delivery.
EHS Field Assessment Units
 
EHS has Field Assessment Units operational in Yarmouth, New Glasgow, HRM and the Cape Breton Regional Municipality. This option is for patients who have a mobility issue that prevents them from accessing a Primary Care Assessment Centre for assessment and/or testing.
 
To refer a patient to the EHS Field Assessment Unit, please call 902-480-3326 . EHS will ask a series of questions based on the referral criteria below:
 
Patient Related Factors
  1. Patient is dependent in ADLs or iADLS (Activities of Daily Living, Instrumental ADLs)
  2. Extremes of age in patients whom are living independently
  3. Patient bed-bound
  4. Patient requiring mobility aid (i.e. wheelchair, crutches)

Environmental Related Factors
  1. No access to transport services either directly (owning a vehicle) or indirectly (having access to a vehicle)
  2. No access to other community based transport options that enable social distancing
  3. Social Isolation and/or limited access to family or neighbour resources.
  4. Not a Long Term Care Facility
  5. Patient in whom the alternative is a scheduled ambulance transport from home to clinic
 
Disease Related Factors
  1. Frailty
  2. Dementia
  3. Immunocompromised
  4. Morbid Obesity
  5. Behavioral Problems
  6. Neuromuscular Movement Disorder
  7. Poor exertional tolerance secondary to severe CHF or pulmonary insufficiency
  8. Severe arthritis