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Initiatives

The Grey-Bruce OHT is working to develop a better connected and seamless healthcare experience for patients, clients, caregivers, providers and family members. Explore the priority populations we’re focusing on and the projects we have underway.

Our Priority Populations

The Grey-Bruce OHT has identified three priority populations to focus on for collaborative system improvement. These populations include: Frail Seniors, individuals with Mental Health and Addiction concerns and Unattached Patients.

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Frail Seniors

According to the 2021 Census, there are 45,725 adults 65+ in Grey-Bruce and 10,904 of them experience frailty. This represents 24% of older adults and 6% of the total Grey-Bruce population. By 2040, the projected number of older adults living with frailty is expected to be 18,708.

 

Older adults living with frailty need an integrated approach to healthcare so that their physical, mental, social and emotional needs are well met. This requires collaboration across many system partners and the Grey-Bruce OHT is well positioned to make a positive impact on the health of frail seniors in our communities.

Individuals with Mental Health & Addition

Since 2021, an estimated 21,900 adults within the Grey-Bruce OHT patient population have experienced mental health and addiction issues. Furthermore, approximately approximately 1600 to 1800 children and youth access community child and youth mental health services each year.

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Unattached Patients

Many residents of Grey-Bruce do not have a regular family doctor or have a family doctor that practices outside of Grey-Bruce. The Grey-Bruce OHT is working with local service providers to improve access to primary care while working to increase service options for unattached patients.

With initiatives such as our Virtual Urgent Care Clinic, residents and visitors are able to avoid an emergency room visit and receive timely access to care.

+  OUR MISSION  +

Through the power of our partnerships, collaboration and consensus-building, we will be able to bring about meaningful change in our community.

Current Initiatives and Projects

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Virtual Urgent Care Clinic

The Virtual Urgent Care Clinic OHT Designated Project, funded by Brightshores Health System in partnership with the Grey Bruce OHT wrapped up on September 30, 2023. During the six month period from April 1, 2023 to September 30, 2023, the clinic serviced 2316 patients, and facilitated 1661 ED diversions. This program received tremendous positive feedback from patients accessing the service, and provided care for 1122 unattached patients in Grey Bruce.

 

As of October 2, 2023, patients from Grey Bruce will be able to access virtual care from www.urgentcareontario.ca. The Grey Bruce OHT will continue to work with Ontario Health West to develop follow up and referral pathways for unattached patients. The Grey Bruce OHT team will continue to work on finding sustainable funding for unattached patient care, and hopes to receive positive feedback soon from three proposals that were submitted this summer for funding opportunities.

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Grey-Bruce OHT Hypercare Communication Project

Hypercare improves communication for partners across Grey-Bruce by creating a seamless, secure, and timely closed-loop system that allows providers to collaborate remotely and make decisions about patient care.

 

Nine partner organizations are currently connected with the Grey-Bruce OHT Hypercare Communication project with 60 total users.

Partners involved in the project include: Bruce County, CarePartners, Grey Bruce Hospice, Grey County, Home & Community Care Support Services South West, Owen Sound Family Health Team, and Palliative Care Grey-Bruce.

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Primary Palliative Care Remote Care Monitoring

Primary Palliative Care Remote Care Monitoring gives patients more timely support from a palliative care nurse and their primary care provider during the palliative care journey.
 

This project is a new initiative between the Owen Sound Family Health Team and Grey-Bruce OHT partners. Patients receive an easy-to-use, encrypted tablet for remote care management that connects them with an integrated palliative care nurse navigator. The nurse supports patients, families and caregivers with symptom management advice, assists with decision-making, and offers care-planning guidance in a timely manner.
 

Over 50 patients have been enrolled in the Primary Palliative Care Remote Care Monitoring project since January 2023. Our goal is to extend this initiative to other Family Health Teams in Grey and Bruce counties so that more patients can benefit from this innovative approach to palliative care.

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Supportive Outreach Service

The Support Outreach Service (SOS) provides person-centred, multi-disciplinary, multi-sectoral health and social mobile response to improve health outcomes and health equity of highly marginalized individuals who experience barriers in access to traditional health services in Grey and Bruce counties.

 

The collaborative mobile SOS team, supported by nurse practitioners and physicians trained in addictions medicine, partner with healthcare and social service organizations to offer addictions care, comprehensive mental health care, COVID-19 response, crisis management, medical care, system and social services navigation.

SOS operates Monday to Thursday from 8:30 a.m. – 6:00 p.m. and can by contacted by telephone at 519-379-8743 or email at sos@cmhagb.org. Please note that messages are not reviewed 24/7.

To hear from SOS team members in the community, watch the SOS Helps video on YouTube.

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Let’s Go Home

In September 2022, the Grey-Bruce OHT endorsed the Let’s Go Home (LEGHO) program, a bundled-care initiative administered through Home & Community Support Services of Grey-Bruce.

 

LEGHO provides hospitalized patients access to free community services for a short period of time to ensure a successful recovery period. The goals of the project are to reduce emergency department visits and decrease hospital re-admissions to the hospital.
 

A care planner assesses each client, links clients to the various services they may need and performs regular check-ins. In addition to care planning, all clients have access to transportation, Meals on Wheels and Home Help core services.

Become part of the Grey-Bruce OHT.

Get involved! We invite all members of the local health and community care landscape in Grey and Bruce counties to become a member/partner/affiliate or reach out with your comments, concerns or contribution.

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