Last Updated: April 4, 2022
Primary care is integral to an effective healthcare system and it is essential that care is delivered in the manner most appropriate for patients during the COVID-19 pandemic. This resource outlines recommendations and strategies to support you in providing optimal care during the COVID-19 pandemic while balancing your patient’s best interests.
The MOH provides separate isolation guidance for individuals who live, work, volunteer or are admitted in the highest risk settings, including (MOH, March 9, 2022):
Primary care providers who do not work or volunteer in such high risk settings should follow the same isolation guidelines as other community members (described in detail in Testing and isolation requirements). Having immunocompromised patients in one’s primary care practice does not constitute a highest risk setting, however it is recommended that primary care providers wait an additional 5 days after returning from a 5 day isolation before seeing immunocompromised patients.
Presume any household members with COVID-19 symptoms have COVID-19.
All household members should isolate (stay home) UNLESS any of the following apply**:
Healthcare workers should follow any work self-isolation policies.
Obtain COVID-19 testing for the symptomatic person:
If COVID-19 testing is NEGATIVE, the HCW can discontinue isolation.
If COVID-19 testing is POSITIVE, asymptomatic HCWs who have not had a positive COVID-19 test in the last 90 days should:
Healthcare workers who are following workplace self-isolation should:
Under routine operations asymptomatic close contacts that work in highest-risk settings may return to work:
Please see Management of Cases and Contacts of COVID-19 in Ontario (April 11, 2022) for guidance during critical staff shortage
* highest risk settings include: hospitals including complex continuing care facilities and paramedic services; and congregate living settings, including long-term care homes, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, and correctional facilities.
**Wear a well-fitted mask in public, physical distance and maintain other public health measures for 10 days following last exposure if leaving home. HCW should NOT visit or attend work in any highest risk settings and not visit individuals who may be at higher risk of illness (i.e., seniors or immunocompromised) for 10 days after your last exposure.
Healthcare workers (HCWs) with a positive COVID-19 rapid antigen test (RAT) or polymerase chain reaction (PCR) test must isolate (stay home).
Healthcare workers who are close contacts who have previously tested positive for COVID-19 in the last 90 days (based on positive rapid antigen test or molecular test results) can attend work in the highest-risk setting, as long as they are currently asymptomatic. These individuals are advised to self-monitor for symptoms for 10 days after last exposure.
For early RTW:
Under routine operations, asymptomatic close contacts that work in highestrisk settings may participate in testing for early return to work:
Please see Management of Cases and Contacts of COVID-19 in Ontario (April 11, 2022) for guidance during critical staff shortage
** highest risk settings include: hospitals including complex continuing care facilities and paramedic services; and congregate living settings, including long-term care homes, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, correctional facilities and home and community care settings.
Healthcare workers (HCWs) with COVID-19 symptoms should presume they have COVID-19 and isolate (stay home) while awaiting test results.
Where possible, the HCW should obtain COVID-19 testing:
If COVID-19 testing is NEGATIVE, the HCW can discontinue isolation when they have been fever-free for 24 hours AND symptoms have been improving for at least 24 hours (48 hours for gastrointestinal symptoms).
If COVID-19 testing is NOT AVAILABLE or POSITIVE, the HCW must isolate (stay home):
HCWs in highest risk settings* should follow workplace guidance to return-to-work (RTW). In general, HCWs who are not immunocompromised can RTW:
For routine operations, COVID-19 positive cases that work in highest-risk settings may return to work:
Please see Management of Cases and Contacts of COVID-19 in Ontario (April 11, 2022) for guidance during critical staff shortage
* highest risk settings include: hospitals including complex continuing care facilities and paramedic services; and congregate living settings, including long-term care homes, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, correctional facilities and home and community care settings.
Original content for this section was developed with input from and support by Ontario College of Family Physicians (OCFP), Ontario Medical Association (OMA), Association of Family Health Teams of Ontario (AFHTO), Ontario Medical Association (OMA) SGFP, Nurse Practitioners’ Association of Ontario (NPAO) and Registered Nurses’ Association of Ontario (RNAO).
It was reviewed and endorsed in 2020 by the Provincial Primary Care Advisory Table established by the Ministry of Health. For more information, including organizations and members involved, see the Acknowledgement and legal section.
Subsequent updates are developed by CEP.
Primary care has a critical role to play in the effort for a successful flu campaign. Aside from physically administering the vaccine, communication by trusted health professionals about the importance of the vaccine is directly linked to its uptake: 69% of survey respondents reported that the opinion of their family doctor, general practitioner or nurse practitioner was an important factor in their decision to get the flu vaccine. (PHAC, 2019).
Key health professional groups should consider engaging in or supporting public education campaigns related to the importance of receiving the flu vaccination, the variety of options available, the safety precautions in place and the need to plan in advance.
For more information, see Guidance on seasonal influenza vaccine and antiviral drug use for health care providers in Canada for the 2018–2019 influenza season (NCCID, Sept 2020), Vaccine uptake in Canadian Adults 2019 (PHAC, 2019), and Recommendations on the use of COVID-19 vaccines (NACI, Sept 2021)
A shorter observation period should be considered only if the recipient:
Though COVID-19 has created a complex environment for vaccination delivery, family physicians, nurse practitioners and registered nurses should maximize all opportunities to administer the flu vaccine. Practices will need to consider alternate means of delivery for the 2020-2021 season and develop outreach strategies. In some regions, Ontario Health Teams, in partnership with local long-term care facilities and home-care agencies, hope to work with community-based practices to administer the vaccine to vulnerable or housebound persons and to those living in congregate settings.
Opportunistic immunization
All Ontarians over 6 months of age should be vaccinated. During the pandemic, concerted efforts should be made to vaccinate:
Leverage your EMR to identify patients
When running reports in your EMR to identify patients consider the following:
If you are unsure of how to use your EMR to support proactive panel management, there are free Ontario MD resources to help you:
EMR Progress Assessment Tool: Free, evidence-based, online self-assessment for providers to assess their EMR use and make improvements to enhance patient care. The EPA investigates key functional areas: Practice management, information management, and diagnosis/treatment support.
Click below on the implementation checklists for information and actionable advice on:
Adapted from: Guidance on seasonal influenza and antiviral drug use in Canada for the 2020-2021 influenza season in the context of COVID-19 (NCCID, Sept 2020); Guidance on the use of influenza vaccine in the presence of COVID-19 (NACI, Sept 29, 2020); Guidance for influenza vaccine delivery in the presence of COVID-19 (NACI, August 5, 2020); Considerations for Planning Curbside/Drive-Through Vaccination Clinics (CDC, July 27, 2020)
Consider patient needs along with the presenting condition. Whether delivering care virtually or in person, the fundamental principle is that the quality of care is not compromised, and the standard of care is met (OCFP, 2022).
While virtual care is a helpful tool to access care during the pandemic, the pressures that existed earlier on have now diminished (e.g., unavailability of COVID-19 vaccines, lack of personal protective equipment). In most cases, in-person care can now be provided safely and appropriately and can resume based on clinical need and patient preference.
It is important to consider the patient’s best interests when balancing the type of visit. Take into consideration the patient’s preferences and clinical condition.
No (CPSO, 2021). Even in the absence of a negative test result or vaccination, in-person care can be provided safely by taking appropriate precautions (screening patients and using necessary PPE). While you can encourage eligible patients to get vaccinated, patients cannot be denied access to necessary in-person care based solely on their vaccination status.
The right balance between providing in-person and virtual will vary by physician practice. Every practice is unique, and the decision about the care provided will require judgment on the part of the physician to determine how best to serve their patients’ needs. The pressures that existed at a different stage in the pandemic (e.g., lack of PPE, high number of cases) have now diminished. When taking appropriate precautions, in-person visits can now be provided safely and appropriately, and may be in your patient’s best interest in some instances.
Your patient’s best interests will include taking into consideration the type of visit they would prefer. In this situation an in-person visit should be offered as long as you are able. To ensure that the appropriate safety precautions are in place, see the PPE section for more information.
Consider the following principles as a guide for determining whether in-person care is appropriate (OCFP, 2021):
See patients in person for conditions where:
Consider patient needs:
Providers should determine appropriate PPE based on the patient’s positive or negative screening results. PPE is not determined by vaccination status. See PPE section for more information.
For an in-depth look at the different remote tools available, see OntarioMD’s comprehensive overview of the different virtual care options.
The technology required to conduct a remote patient encounter is widely available and cost effective.
Hardware
For telephone calls, you may consider using earphones/headphones for better sound quality and to ensure patient privacy. For video visits, reliant internet connection, a video camera and a microphone is needed. To ensure optimal connection speed, use hardwired internet. You can use speedtest.net to test the speed. Hit “Go” and anything above 10 Mbps will be ideal for video calls. Consider using earphones/headphones/headset for better sound quality and to ensure patient privacy. Consider using a secure USB drive if you cannot save and edit third-party forms through your electronic medical record (EMR) and you still need secure electronic storage. Consider securing it with a strong password.
For more information and recommended hardware see: Virtual Care Hardware Considerations (Kaplan, 2020).
Software
For telephone calls, no software is required. If you are using a Voice over Internet Protocol (VoIP) phone application (such as RingCentral, FanGo) ensure that you have received patient consent (verbal is sufficient) to use the application for your patient encounter. If you’re new to video visits, the key decision is whether to use general videoconferencing tools (e.g. Skype and Teams by Microsoft, Facetime by Apple, Zoom.us and/or Google Hangouts) or software platforms designed specifically for health care (e.g.EMR-integrated platforms, VirtualCare, iTelemed, Adracare, etc.). For more information, see OntarioMD’s comprehensive overview of the different virtual care options.
There are advantages to each:
Please note, if you opt to use a general videoconferencing platform you may need to configure the platform settings to protect the patient’s privacy:
Additionally, unless you are using virtual care technologies where consent is handled at sign-up, you must ask patients for their consent (verbal is sufficient).
An EMR is not required to conduct a remote patient encounter. Any direct-to-patient telephone, telemedicine and video calling platforms can be used without an EMR.
Please note, Unless you are using virtual care technologies where consent is handled at sign-up, you must ask patients for their consent (verbal is sufficient). Once you’ve completed your virtual encounter, document, as before, in the patient’s medical record.
If necessary, you can save patient forms and documents onto a secure USB.
Much like providing care in-person, the provider and patient need to have an arrangement to meet at the same time, even if the patient has to first enter a “virtual waiting room”.
Depending on what platform you are using, the virtual waiting room can take the form of waiting in the “lobby” of a virtual platform until the host invites the patient in or entering the room first and giving the provider some time to join into the same link.
If you are using OTN, there is a “virtual waiting room” functionality built in.
Be prepared for longer visits, at first, as you and your patients become accustomed with the new visit format. Consider spacing your scheduled appointments out to include “buffer”/”overflow” time. Alternatively, give the patient a window of time for their appointment (e.g. “I will call you between 2pm and 4pm”). This gives you some flexibility and manages expectations of the patient.
When confirming a remote patient encounter, ensure all of the necessary appointment information has been provided to the patient. This includes:
When and where the visit takes place
How to cancel the appointment
How to address technical issues
Healthcare offices provide many visible cues that assure patients that they are in a professional office to see a medical professional. Most of those cues are absent in virtual care.
Key recommendations:
Healthcare offices provide many visible cues that assure patients that they are in a professional office to see a medical professional. Most of those cues are absent when providing care over the phone.
Key recommendations:
No, you are not required to use OTN.
Any direct-to-patient telephone, telemedicine and video calling platforms can now be used. Please note, unless you are using virtual care technologies where consent is handled at sign-up, you must ask patients for their consent.
Allocate the appropriate amount of time based on patient’s indicated ailments and needs when they scheduled the appointment as you would when providing in-person care. The time will also depend on whether it is a routine visit or a follow-up visit.
Be prepared for longer visits, at first, as you and your patient become accustomed with the new technology. For patients that may struggle with technology, try to arrange support and be prepared to troubleshoot tech issues. But, don’t spend too much time trying to fix connection problems. You can always switch to simpler solutions, such as the phone, when difficulties arise.
Virtual care is not exclusive to encounters handled over the internet. You can always use the telephone to conduct your encounter.
Androids: To block an Androids number from being displayed, before entering the phone number, enter *67, and then the patient’s phone number. Alternatively, open voice app and go into Settings, under “Calls” turn “Anonymous Caller ID” on.
iPhone: To block an iPhone number from being displayed, before entering the phone number, enter #31#, and then the patient’s phone number. Alternatively, go into your iPhone Settings, scroll down to Phone, and tap “off” on “Show My Caller ID”.
Landlines: For landlines, before entering the phone number, enter *67, and then the patient’s phone number.
Yes. The ministry has made a policy change allowing physicians to accept scanned copies of completed and signed Patient Enrolment and Consent to Release Personal Health Information (E/C) forms from patients electronically via email or photo transmission by cell phone.
An original patient signature on the form is not required provided that the patient’s signature is legible on the scanned copy or picture of the E/C form. Physicians should ensure patients have their correct email address when transmitting the E/C form electronically as the completed E/C form contains the patient’s personal information including their birth date and health card number. If electronic submission is not possible, completed forms can also be returned by mail to the physicians’ offices.
With many working remotely, it is important to ensure you have good cybersecurity measures in place. The Cyber Centre has seen an increase in reports of malicious actors using COVID-19 in phishing campaigns and malware scams.
Good cyber hygiene practices include:
For more information about cybersecurity and COVID-19, see the OMA’s page on Cybersecurity (OMA, 2020) [login required].
Adapted from:
Virtual Care Playbook (CMA, 2020).
Virtual care telephone and video codes frequently asked questions (OMA, 2020).
A practical approach to virtual ambulatory care during an impractical time (CFP, April 6, 2020)
Shift to Virtual Care: Primary care response to COVID-19 Pandemic (AFHTO, June 15, 2020).
OHIP Bulletin 11260, Patient Enrolment Processes during COVID-19 (MOH, May 7, 2020).
A remote patient encounter is the same as an in-person one with a few additional key elements.
Adapted from:
Adopting and Integrating Virtual Visits into Care: Clinical Guidance (draft) (Ontario Health (Quality), 2020).
Virtual Care and COVID-19 (OntarioMD, 2020).
OHIP Bulletin 4745, Changes to the Schedule of Benefits for Physician Services (Schedule) in response to COVID-19 influenza pandemic effective March 14, 2020 (MOH, March 13, 2020).
Evolving in the era of COVID-19 (UBC, April 14, 2020).
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
The fundamental method of protecting workers is through the application of the hierarchy of hazard controls (NIOSH, January 13, 2015). Although PPE is the most visible of the hierarchy of controls, it is the last tier and should not be relied on as a standalone primary prevention program. The PPE tier refers to the availability, support and appropriate use of physical barriers between healthcare workers and an infectious agent/infected source to minimize exposure and prevent transmission (PHO, March 2022).
An Organizational Risk Assessment should be performed in order to assess the efficacy of an organization’s hierarchy of controls, including the protocols for prioritizing and distributing PPE (PHO, March 2022).
See Delivering patient care in-person and Delivering patient care remotely for information about logistics for different visit types.
Public Health Ontario currently recommends that fit-tested, seal-checked N95 masks, along with eye protection, gown, and gloves be worn during all interactions with patients with suspected or confirmed COVID-19. If a fit-tested, seal-checked N95 mask is not available, a well-fitted surgical/procedural mask, KN95 mask, or non-fit tested N95 mask may be used (PHO, March 2022).
Before every patient interaction, conduct a point-of-care risk assessment to determine the PPE required. See PHO’s advice on performing a risk assessment. Examples of risk factors to consider in your risk assessment that may increase transmission risk include:
All patients (and those accompanying them) should wear a mask and perform hand hygiene while at the office/clinic, regardless of COVID-19 status. Patients who are symptomatic for COVID-19 or have a recent exposure MUST wear a surgical/procedure mask or KN95 mask (MOH, February 14, 2022). A sample patient handout on wearing and disposing of masks is available on the OCFP’s Clinical Care – Office Readiness page.
HCWs should wear a surgical/procedure mask for all interactions with and within 2 metres. If the patient is unmasked, eye protection (goggles or a face shield) is required. If the patient is masked for the entirety of the visit, eye protection may be used based on clinical discretion.
HCWs should wear the following PPE:
The circumstances in which airborne transmission is possible are not clearly established, however, it is recommended that airborne precautions be used when performing aerosol generating procedures (AGMPs) on patients with suspected or confirmed COVID-19 (OH, February 25, 2021). An N95 mask (not a medical/procedural mask) must be used as part of airborne precautions when performing aerosol generating procedures (AGMPs).
The use of a fit-tested, seal-checked N95 mask is recommended for healthcare providers who are caring for patients with suspect or confirmed COVID-19, and must be worn when performing AGMPs. In instances where a fit-tested N95 mask is unavailable, or not required (e.g., when caring for patients who screen negative for COVID-19), healthcare providers should wear a well-fitted surgical/procedural mask, KN95 mask, or (non-fit tested) N95 mask (PHO, March 2022).
KN95 masks are similar to N95 masks, with the main difference being that they are not tested to North American standards (they are tested to Chinese standards) (Health Canada, November 29, 2021). This can lead to more variability among KN95 masks; some may be equivalent to N95 masks and some not. Overall, when deciding between a surgical/procedure mask, KN95 mask, and non-fit tested N95 mask, the better the mask fits in terms of minimizing air gaps, the more protection it will likely provide. In many instances, KN95 masks will minimize air gaps better than a surgical/procedure mask, but this must be determined by the individual wearing the mask. Healthcare providers should consider mask fit, mask availability, and their organizational and personal risk assessments when choosing a mask (PHO, March 2022).
If caring for patients who screen negative for COVID-19:
If caring for patients who screen positive for COVID-19 (suspected or confirmed COVID-19 infection or contact):
Ontario Health has implemented the Pandemic PPE Transitional Support (PPTS) program, which will temporarily allow free access to PPE for primary care providers who do not have established PPE supply chains or whose supply chains have failed. This allows providers to effectively skip Step 3 of the escalation process below. For more information, see Pandemic PPE Transitional Support (PPTS) FAQs (OH, August 4, 2020).
The following escalation process provides steps for you to access PPE for your practice/organization (OH, 2020):
Toronto
Central
North
East
West
The MoH has issued an order for Mandatory Reporting of PPE Inventory, once per week, between Thursday and Monday. To report your PPE supply to the ministry, access the inventory reporting tool. The tool is open from 8 a.m. to 5 p.m. daily. Instructions for participation are published on the Ontario Health website.
Ontario Health has asked for healthcare providers to save and store used, unsoiled N95 unsoiled N95 respirators for decontamination using validated sterilization and disinfection methods. Store N95 respirators separately in labelled and dated storage containers.
To help extend the supply of PPE, Ontario Health suggests that providers switch to reusable PPE options wherever they can be safely implemented (OH, February 25, 2021).
Eye protection
Isolation gown (disposable or cloth)
Latex or nitrile gloves
Headbands, caps and other garments
Incorrect doffing is very common and leads to contamination of the healthcare worker, their clothes or the environment.
Common doffing errors:
Mask
Order of removal
Headbands, caps and other garments
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
COVID-19 environmental cleaning protocols are the same as for other common viruses. The cleaning products and disinfectants commonly used in healthcare settings are strong enough for COVID-19.
See Health Canada’s list of approved disinfectants to ensure your supplies are approved for disinfecting in a healthcare setting.
Disinfectant wipes that meet healthcare standards may be used for cleaning small noncritical items between patients (stethoscopes, blood pressure cuffs, etc.) (Public Health Ontario).
Disinfectant wipes that meet healthcare standards may also be used for items that cannot be soaked. However, family physicians and primary care nurse practitioners should do this with caution, as it may be difficult to reach adequate disinfectant contact time (Public Health Ontario).
See COVID-19: Cleaning equipment and Family Physician Offices (BC CDC) resource on cleaning frequency by type of surface and list of disinfectants and cleaning agents known to be effective against coronaviruses.
E.g. stethoscopes, blood pressure cuffs, etc.
Clean in between patients and at the end of each shift.
Clean in between patients and at the end of each shift.
Whether symptomatic or not, after every patient visit, areas within 2 metres of the patient should be disinfected.
Clean in between patients and at the end of each shift.
E.g. chairs, tables, floors.
Clean at least twice a day.
E.g. workstations, cell phones, light switches, door knobs, tables, chairs, door handles, clipboards, front office counter.
Clean at least twice a day.
To support of the government’s efforts to limit the spread of COVID-19 in Ontario, the Minister of Health has made an Order under the authority of subsection 45(2.1) of the Health Insurance Act (March 13, 2020) to temporarily list, as insured services, the provision of assessments of, or counselling to, insured persons by telephone or video, or advice and information to patient representatives by telephone or video, as well as a temporary sessional fee code.
Additionally, as part of Ontario’s continued efforts to stop the spread of COVID-19, the Ministry of Health (May 5, 2020), established temporary payment mechanisms to facilitate hospital and physician payments for medically necessary services provided to patients who are not currently insured under OHIP or another provincial plan.
These new fee codes are not limited to COVID-19 screening or COVID-19 patients and came into effect March 14, 2020.
Effective May 1, 2020, physicians can now submit claims for services provided on or after March 14, 2020 using the new fee codes for insured patients.
Effective May 5, 2020, physicians can submit claims for services provided on or after March 21, 2020 using the new fee codes for uninsured patients.
The Ministry of Health and the Ontario Medical Association (OMA) have reached an agreement to extend existing temporary physician funding initiatives (including K-codes) under the Ontario Health Insurance Plan (OHIP) to September 30, 2021 (March 8, 2021).
K080A-K083A require a diagnostic code to be submitted on the claim. If the claim is submitted without a diagnostic code the claim will be reject as “V21-Diagnostic Code Required”.
For current OTNInvite users (PEM physicians with rostered patients, GP focus practice designated physicians, and specialists): continue to bill as usual with the Ontario Virtual Care Program fee code(s) (see Virtual Care Billing Information Manual (MOH, 2020)) and any applicable automated premiums (e.g. age premiums, focus practice psychotherapy premium) will continue to be applied automatically to the payment.
For new OTNinvite (any physician) users: Bill the new temporary K codes.
If preferred, physicians eligible to bill under the Ontario Virtual Care Program (PEM physicians with rostered patients, GP focus practice designated physicians, and specialists) must complete the OTN billing registration form to begin billing the virtual care program codes.
For telephone or non-OTN viritual visits: Bill the new temporary K codes.
No, remote visits do not qualify for special visit premiums.
Yes, K080, K081 and K082 are included in-basket for capitated and salaried primary care enrolment models.
No, for those in a FHO/FHN, patients who obtain care outside the group will not count towards outside use. If the ministry is unable to complete the necessary computer programming, they will make any necessary access bonus adjustments retroactively.
No, for FHO/FHN provision of services to non-rostered patients, the application of the Hard Cap ceiling for these services will not be enforced.
Yes, A001 and A007 are the equivalent to K080 and K081.
For Alternate Payment Program contracts, K080, K081 and K082 will be shadow-billed and the appropriate flow-through and shadow-billing premiums (if applicable) applied based on the specific contract.
Yes, the new K codes can be used for follow-ups. Use the code with the closest workflow and dollar value.
Yes K087 (minor assessment), K088 (intermediate assessment) and K089 (counselling) can be used for providing care to IFH/uninsured patients. See above for details and claim submission requirements.
Claim submission requirements
Details for submitting your claim
No, the new K codes only cover services rendered by telephone or videoconferencing.
Adapted from:
OHIP Bulletin 4745, Changes to the Schedule of Benefits for Physician Services (Schedule) in response to COVID-19 influenza pandemic effective March 14, 2020 (MOH, March 13, 2020).
Virtual care telephone and video codes frequently asked questions (OMA, August 7, 2020).
Introduction of Fee Code for Physicians Providing Services by Telephone or Video or Working in Designated Assessment Centres (OMA, 2020).
Virtual Care Key Messages and FAQs (OntarioMD, 2020).
OHIP Bulletin 4756, Funding for physician and hospital services for patients who do not have provincial health insurance during COVID-19 effective March 21, 2020 (MOH, May 5, 2020).
Effective March 14, 2020, a new diagnostic code has been created for the COVID-19 outbreak:
Code: 080
Description: Coronavirus
The new diagnostic code should be used when treating patients with suspected or confirmed COVID-19 and/or when treating a patient by telephone/video for suspected or confirmed COVID-19. Use the appropriate diagnostic code when treating a patient for unrelated diagnoses by telephone/video due to COVID-19 related concerns.
In response to the COVID-19 pandemic, the Office of Controlled Substances has issued a short-term subsection 56(1) exemption from the Controlled Drugs and Substances Act in the public interest (March 23, 2020. This exemption authorizes pharmacists to prescribe, sell or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances. Please note that the CDSA exemption expires on the earliest of these dates: September 30, 2021, or the date in which it is revoked or replaced by another exemption (OCP, August 21, 2020).
Starting June 15, 2020, the Ministry of Health has ended the dispensing recommendations communicated on March 20th to lessen the risk of drug shortages. Pharmacists and dispensing physicians may dispense medications in accordance with pre-COVID-19 dispensing policies (i.e. maximum 100-days’ supply if the prescription allows).
Permit pharmacists to extend and renew prescriptions for controlled substances.
Permit pharmacists to transfer prescriptions for controlled substances to other pharmacists.
Permit pharmacists to adapt a prescription for a controlled substance, including part-filling or de-prescribing.
Permit practitioners to verbally prescribe prescriptions for controlled substances.
Allow an individual to deliver controlled substances to patients (at their homes or an alternate location).
As always, ensure your prescriptions are complete, specific to your patient, and include both you and your patient’s identifying information so pharmacists can validate the authenticity of the prescription.
Where possible, it’s important to continue to use established channels such as phone, fax, your EMR or other e-prescribing systems when issuing a prescription. This helps to prevent fraud, avoid undue pressure on pharmacists to verify the authenticity of prescriptions, and to deliver safe and timely care to patients.
If necessary, CPSO, CNO, and OCP have made an exception to allow the use unencrypted email for the purpose of sending prescriptions to pharmacists during the declared emergency. If you wish to use unencrypted email to send prescriptions to a pharmacist, you must obtain the consent of the patient for this purpose and explain that unencrypted email may not be secure.
Given the extra care required for prescribing opioids/narcotics for chronic pain, or within the context of addictions treatment, you must continue to use traditional routes of communicating prescriptions for these drugs. However, you can adapt the above new protocols that allow for verbal authorization (Health Canada, March 23, 2019).
New fee codes
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
Over time, the build up of stress can lead to feelings of extreme exhaustion and being overwhelmed. Signs of burnout include (CMA, 2021):
Start by assessing where your mood is on the self-assessment tool. Then use the resiliency tips below to help manage your stress.
Stress can be managed by using the 5 Cs of Resilience Framework (CSPL, 2020):
Given the uncertainty around COVID-19, it is important to recognize what we can control and let go of things we cannot control.
It can be valuable to reflect on why you do the work you do as a family physician/primary care nurse practitioner and how it aligns with your values.
Maintain connections at work and in your personal life. Spend time together with friends and family over text, email, phone calls or video calls.
It may be helpful to have a buddy system at work and use the “HELP” acronym to check in (CMA, 2020):
Use the ABC123 – Psychological First Aid Tool (CMA) to reduce symptoms of acute anxiety and other emotional distress.
Exercise, sleep, laugh, be kind and learn to enjoy down time.
Identifying and addressing the needs of staff is the first step to reducing the risk of burn-out. Organizations should express gratitude towards their health care professionals along with efforts to hear, protect, prepare, support and care for them especially during these unprecedented times.
Arrange a variety of input and feedback channels and involve healthcare staff in decision making (e.g. listening groups, suggestion box).
Reduce the risk of healthcare workers acquiring the infection by providing PPE, rapid access to COVID-19 testing if symptomatic, resources to reduce risk to family members, and workplace accommodations for providers at high risk due to age or medical conditions.
We are all in this together, therefore it is important healthcare workers are comfortable relying on others, and asking for help. Provide training to staff and access to experts in order to provide high quality of care to patients.
Support the physical needs, including access to healthy meals and hydration at work, lodging for providers who have rapid-cycle shifts, transportation assistance for sleep-deprived workers, assistance with other tasks and support for child-care. Support emotional and psychological needs, including general and individualized resources.
Provide holistic support for healthcare workers and their families. This includes lodging for those living apart from family, support for tangible needs, check-ins, and paid time off if quarantine is necessary.
Discussing the COVID-19 pandemic with your family is difficult and these conversations can be more challenging if your work requires you to be exposed to the virus (CMA Joule Boldly, March 23, 2020). To help eliminate stress in your household (BCCDC, March 16, 2020):
For more information on managing the mental wellbeing of your child during the pandemic see Maintaining Regular Primary Care Practice in the COVID-19 Context > Child mental health.
The ministry has established the COVID-19 Advance Payment Program to address any cash flow issues that may arise during the COVID-19 outbreak and sustain physicians’ practices and ensure business continuity that will enable them to return to regular practice as soon as the outbreak begins to subside.
The COVID-19 Advance Payment Program provides monthly, interest-free, automated advance payments to eligible physicians in May, June and July 2020 that will be recovered from physicians’ billings in five equal monthly instalments starting in November 2020.
Physicians will automatically receive the advance if their monthly payment is below the 70% of average payments over the previous 12 months (April 1, 2019 to March 31, 2020). Physicians do not need to apply to the program. If eligible, the program will automatically top up eligible physicians’ payments to 70% of the historical monthly average for each month of the 3 months that the program is in place starting in May 2020.
Physicians may opt out of the program at any time by contacting the ministry. Physicians who want to opt out for the month of May can do so by returning their payment to the ministry by submitting a cheque to the Financial Management Branch, 49 Place d’Armes, 3rd Floor Kingston, Ontario K7L 5J3. The cheque is to be made payable to the Minister of Finance. Providers should also indicate this cheque is for the re-payment of the advance payment, including the specified month. For other options to return the payment, you can contact the Service Support Contact Centre at 1-800-262-6524. Physicians are still able to opt out for the second and third payments (June and July RA) by contacting the Service Support Contact Centre as well.
See the OHIP Bulletin 4754 COVID-19 Advance Payment Program (MOH, April 22, 2020) for details.
See the OMA’s COVID-19 Advanced Payment Program FAQs [login required] (OMA, June 19, 2020) for program eligibility, payment calculation, repayment terms and details for providers under specific payment models (fee for service, patient enrolment models and alternative funding agreements).
See CMA’s Financial guidance for physicians during COVID-19 (CMA, August 20, 2020) for details on COVID-19 financial supports for providers.
See OMA’s Financial relief for physicians (OMA, June 19, 2020) [login required] for a multitude of financial aid resources including key federal programs available for eligible physicians.
General resources
Resources to help with parenting and reduce stress in the home
Health and wellness programs and supports
Health and wellness programs and supports
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach. They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.
A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:
• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP
In addition to our clinical working group the CEP also obtained feedback from others, including:
• Arun Radhakrishnan, MSC, MD, CM, CCFP
• Central Region Primary Care Leadership
• David Daien, MD, CCFP
• David Makary, MD, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH
The Testing and isolation requirements for healthcare workers section was curated and edited by Dr. Andrea Chittle, MD, CFPC
Lastly, for certain sections (Delivering patient care in person, Planning for flu season and Flu vaccination and flu vaccination clinics during COVID-19), the CEP also obtained feedback from others, specifically:
Provincial Primary Care Advisory Table, established by the Ministry of Health
• David Price (Chair), MD
• Andrea Sereda, MD
• Annelind Wakegijig, MD
• Beth Sweeney
• Cathy Faulds, MD
• David Daien, MD
• David Kaplan, MD
• Kamila Premji, MD
• Kelly Van Camp
• Kim McIntosh, MD
• Michael Green, MD
• Rebecca Carson
• Sarah Newbery, MD
• Thuy-Nga (Tia) Pham, MD
System stakeholders
• Registered Nurses Association of Ontario
• Association of Family Health Teams of Ontario
Thank you to everyone who supported the development of this resource.
Conflict of interest
• Clinical Leads receive compensation for their role
• Clinical Working Group receive an honorarium for their participation
• Focus group and usability participants receive a small token of appreciation (e.g. gift certificate)
The Primary Care Operations in the COVID-19 Context resource is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the Primary Care Operations in the COVID-19 Context resource for commercial purposes or any modifications of the Tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: info@cep.health).
Developed by:
In collaboration with:
With support from:
