Canadian Medical Association
Resources

This material is for general information only; please follow the direction provided by your regulatory college, the Chief Medical Officer of Health and your local public health unit.  Last updated May 26, 2020.

Jump to:
Scheduling visits
Office procedures
Office design
Screening patients for COVID-19
PPE and infection control measures
How to get PPE
Talking to patients about COVID-19 risks versus the need for medical care


To reduce the spread of COVID-19, physicians have been advised to see patients virtually (by phone or video), whenever possible.

Information on billing codes, virtual care standards and regulations, by province/territory (Royal College)
Step-by-step guide to implementing virtual care in your practice (CMA)

As some provincial/territorial governments begin to re-open essential services, physicians and their patients have questions about when to schedule in-person appointments.  In general, physicians should  determine whether the provision of a service is in the best interest of each individual patient; this can be  complex. Here are some considerations:

  • Is the patient visit urgent/crucial to the patient's health?
  • Could further delay in provision of the care result in a worse outcome for the patient? 
  • Will offering care in a community setting lessen the burden on hospital facilities, or prevent the need to access acute care in the future?
  • Are there other services developed to address medical needs that patients can be referred to? (e.g., municipal or regional child immunization clinics, COVID care clinics)

Once a decision has been made on the best mode of care, in person or virtually, the rationale should be documented in the patient record.


If it is necessary to see a patient in person, here are some tips:

Scheduling visits

  • Consider providing some care virtually, and some in-person, to reduce the in-person time required. For example, an essential prenatal visit could be divided into a virtual discussion of testing/screening options with a brief in-person physical assessment.
  • Minimize the time patients spend in the waiting room. For example, request patients to wait in their vehicle until the examination room is ready, and then text/phone them when it is time to enter.
  • Ask that, whenever possible, the patient come alone into the clinic.
  • Limit the number of patients in the waiting room.  For example, in a one-hour period, alternate between virtual visits and in-person visits to spread out the time between in-person appointments.

Office procedures

  • Build in extra time for cleaning/sanitizing examination rooms between patients.
  • Limit the number of examination rooms being used.
  • Minimize staff in the office/clinic. Ask what tasks can be done from home or outside of regular hours to minimize staff interactions with each other and patients.
  • Require staff to screen themselves for symptoms before entering the clinic/office; develop a notification protocol for staff to follow if they develop symptoms
  • Ask patients to show their health card, so clinic staff do not have to handle/swipe the card.
  • Request patients to wear a mask (homemade) when visiting the office/clinic, or if necessary, provide non-medical masks at the entrance.

    Office design

    • Increase cleaning and disinfection of the whole office, particularly of high touch areas such as light switches and door knobs.
    • Have visible signage at the entrance reminding patients about COVID-19 symptoms and hygiene practices to reduce the spread of the virus.
    • Equip your waiting room and office with ample tissues, alcohol-based hand rub and a waste basket.
    • Re-configure waiting room seating to adhere to public health physical distance guidelines (two metres). Ex: distance between chairs, designated spaces if there is a line-up
    • Use visual cues (directional arrows, waiting spots, tape on the floor) to maximize physical distancing  
    • Remove toys, magazines, brochures and other shared items from waiting room.
    • Consider providing a protective barrier for reception area, such as glass or plexiglass, so that administrative staff won't require PPEs.

    The CMA has produced Stop the spread posters and videos that can be displayed in clinics/offices to remind patients about the symptoms of COVID-19, and how to protect yourself from transmission.

    Available in English, Arabic, Cantonese, MandarinPunjabi , Spanish and French.

    To share or download this video: right click on the video and select "Save video as…" (on desktop)


    Screening patients for COVID-19

    All physicians' offices/clinics should continue to screen patients for COVID-19 and only see those that pass the screen should come in for an in-person appointment. This can be done by:

    • instructing patients (by email, or through the office/clinic website) to use a self-assessment tool before booking an appointment and again on the day of the appointment. You can use the federal self-assessment tool or a tool recommended by your local or provincial public health agency.
    • instructing staff to screen patients by phone before booking an appointment, and again on the day of the appointment.   

      Patients experiencing severe difficulty breathing, severe chest pain or losing consciousness should call 911 or head to the local emergency department.

      Patients with COVID-19 symptoms should be directed to local COVID assessment centres or offered a virtual visit, to be assessed and to determine the need for further treatment/testing.

      It is important to contact your local public health unit to be familiar with their guidance, including on the diagnosis and reporting of COVID-19, as well as on recommendations regarding self-isolation and testing.

      Some group clinics are using a model where ALL patients with ANY respiratory symptoms are seen by one designated physician in the group, in a designated 'respiratory clinic' (one clinic block of rooms). This can help conserve PPE, if other clinicians are only doing phone and video assessments.


      PPE and infection control measures

      To prevent or limit the transmission of COVID-19 within your practice, it is recommended that you:

        Gloves, long-sleeved cuffed gown (covering front of body from neck to mid-thigh), mask and face or eye protection should be donned before entering the exam room.  PPE should be removed and discarded after exiting the exam room.

        Here is an example from Public Health Ontario of the steps to take in donning and doffing PPE.

        How to get PPE

        PPE supply and distribution

        Each province/territory has its own guidelines for requesting personal protective equipment. The following section will give you some background on who to contact to order PPE for your community practice.

        Newfoundland

        The Newfoundland and Labrador Medical Association has created a PPE contact list for community practices. Physicians can order three emergency PPE kits for use in their office. Once those three kits have been used, they can be replenished.

        The contact list is available here.

        Prince Edward Island

        The Medical Society of Prince Edward Island is asking physicians to submit their requests for PPE supplies to the Government of PEI. Requests for supplies will be assessed and distributed on a weekly business cycle.

        Find more information here.

        New Brunswick

        The New Brunswick Medical Society (NBMS) is partnering with the Department of Health and Service New Brunswick to facilitate the ordering and distribution of PPE. Physicians can order directly from the NBMS every two weeks. Staff will process the orders as they come in and arrange for delivery at the physician’s chosen location.

        For more information: ppe@nbms.nb.ca

        Manitoba

        Doctors Manitoba is encouraging community-based physicians to order PPE through Shared Health, which is maintaining a central supply of PPE. In an effort to conserve PPE, Shared Health has enacted a "framework" to prioritize the delivery of supplies to care settings based on the level of risk to providers and patients. It is also recommending shifting as much patient care to virtual visits as possible.

        More information can be found here.

        Saskatchewan

        In an attempt to ensure stable access to PPE for private, community-based physicians, the Saskatchewan Medical Association, the Saskatchewan Health Authority and the Ministry of Health are working with a private provider, Schaan Healthcare Inc. N-95 masks are not included in the list of available supplies from Schaan. If you are already ordering from another supplier, you don't need to do anything.

        Read more here.

        Alberta

        Alberta Health Services (AHS) is coordinating the allocation of PPE during the COVID-19 pandemic and will distribute the supplies to zone-specific Primary Care Network (PCN) hubs. Member clinics can request supplies through their PCN point of contact who will place an order with AHS supply management. All non-PCN primary care providers that require PPE should contact their PCN hub.

        If you are unsure of your PCN contact or have questions about the distribution process, email: phc@ahs.ca.

        Read more information on using PPE in Alberta here.

        British Columbia

        Doctors of BC is working closely with the province’s various health authorities around the supply and distribution of PPE. Physicians who have offices outside of hospitals are encouraged to contact their regional health authority here.

        Ontario

        Ontario Health is urging physicians to conserve existing PPE supplies, work with their regular suppliers to determine next shipments, and to reach out to other local health-care providers to determine they have extra PPE. If these steps fail, there is an urgent PPE request process:  

        • Determine which of the five regions where your practice is locatedSubmit a request via the appropriate Personal Protective Equipment Intake Form. There are specific forms for OH East-Champlain and OH West; all other regions should use the main PPE intake form. Your Regional Table Lead will work to address your request within the region. They have been directed to address priority populations, with primary care as another sector that requires attention.   
        • If the need cannot be addressed regionally, the Regional Table Lead will escalate your request to the Ministry Emergency Operations Centre. 

        Didn't find your province/territory in this list?

        Contact your provincial medical regulator or provincial ministry of health for more information on requesting PPE.


        Talking to patients about COVID-19 risks versus the need for medical care

        Many patients are extremely anxious about contracting COVID-19 and may be reluctant to seek medical treatment.  Share the facts about COVID-19 in a simple and straightforward way, as well as the precautions being taken in your own practice to reduce exposure to the virus.

        The Centre for Addiction and Mental Health has also created an excellent website to help people manage their anxiety and mental health during the COVID-19 pandemic.

        Additional Resources

        Advice to the profession: reopening practice (College of Physicians and Surgeons of Alberta)

        COVID-19: Tips for Family Doctors  / In-person considerations (Ontario College of Family Physicians)

        Infection prevention and control for COVID-19: Second interim guidance for acute healthcare settings (Public Health Agency of Canada)

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