Tara Kiran Profile picture
family physician @UnityHealthTO, Fidani Chair in Improvement & Innovation @UofTFamilyMed, Scientist @MAP_Health @ICESOntario, mom of 3, tweets are my own
Jun 10 12 tweets 3 min read
Fun fact: nearly every person in Denmark 🇩🇰 has the name of their GP (or group of GPs) on their healthcard

It's an organized system where 98+% have access to primary care.

How do they do it? One key lies in how GPs are organized. 🧵

(photos of Christian Folsach's practice) Image GPs in Denmark are small business owners, similar to family doctors in Canada. They rent or own the office space, hire staff who work in the office, and pay for everything from internet to paper. Most practices in Denmark are small with b/w 1 to 3 GPs working together. Image
Jun 3 12 tweets 3 min read
How is that >98% of Danes have a GP? Part of the answer lies in their approach to training physicians.

Here's a summary of some of what I've learned on my trip to Denmark 🇩🇰 🧵

(the photo here is a wall of some of the 170+ residents trained at the practice I visited) Image After high school, most Danes take a gap year where they typically work and travel (the average is 2 gap years but several take even more). They would then apply and gain admission to medical school which is 6 years in total.
Oct 16, 2023 9 tweets 4 min read
Today we concluded the #OurCare Manitoba Priority Panel, our 5th & final reference panel on primary care in Canada

30 members of the public, randomly selected, spent >30 hrs since the start of Sept, learning, deliberating & coming to consensus on recommendations for better 🧵 Image These members of the public, roughly represented the demographics of the province — with one exception. We deliberately overrepresented people who identified as First Nations, Métis or Inuit. Image
Apr 28, 2023 25 tweets 10 min read
In 2021, family docs were being blamed for seeing too many patients virtually, purportedly causing more people to visit the ED

Our latest research @JAMANetworkOpen @ICESOntario shows that simply was NOT true 🧵

w/ @RickGlazier1 @DrMichaelGreen1
jamanetwork.com/journals/jaman… Image Let's start by going back to fall 2021. Most people had been vaccinated and we thought we were heading out of the pandemic. We were starting to try and clear the backlog of care.

EDs were overcrowded and some people blamed it on family docs.
Apr 4, 2023 24 tweets 10 min read
Primary care is in crisis. How can we do better?

We brought Ontarians into a room and asked them.

Today we release their final report.

35 volunteers, randomly selected
39 hrs of learning & deliberation
23 recommendations for better🧵

#OurCare
https://t.co/1aXw6oLCP5ourcare.ca/s/OurCare-ON-P…
We were blown away by interest in this process

1250+ people volunteered to be part of the panel!

From those, we randomly selected 36 to roughly represent the demographics of Ontario, over-representing equity-deserving groups

(ultimately 1 wasn't able to participate)
Feb 12, 2023 7 tweets 6 min read
Today we’ll hear the draft recommendations from a group of 36 everyday Ontarians about how to make the #primarycare system better

They were randomly selected from 1250 who volunteered

They’ve spent 40+ hrs learning from experts and each other

What’s been in the curriculum? We started virtually with talks from

@ElizabethMuggah on primary care in ON

@AndrewDPinto @snewbery1 @DrFitzsimon and F Garwe on equitable access

And myself on models of care from other countries

Talks all available here: OurCare.ca/Ontario
Dec 12, 2022 16 tweets 5 min read
Primary care is the front door of the health care system

But for too many people in Canada, that front door is now closed

In my latest commentary @CMAJ, I propose some bold reforms to keep the door wide open 🧵 1/

cmaj.ca/content/194/48… We need to begin by acknowledging that primary care is in crisis

Even prior to the pandemic, 4.6 million people in Canada did not have a regular primary care clinician

Our research has suggested that problem is only getting worse 2/
Apr 27, 2022 10 tweets 8 min read
Vaccination continues to be your best protection against serious illness from #COVID19

How many doses do you need?
2,3,4...5?

We summarize the latest recommendations in our updated resource confusedaboutcovid.ca @OntarioCollege @UofTFamilyMed

rebrand.ly/3rd-dose 🧵 The number of doses you need depends on
-your age
-whether you have a weak immune system and
-whether you live in a setting were you have a higher risk of getting COVID

Here we've summarized recommendations for people who do NOT have a weak immune system 👇🏽
Apr 7, 2022 18 tweets 4 min read
Why have so few Ontarians received Paxlovid, a drug that can reduce the risk of hospitalization for those at higher risk of #covid?

Here are some of my observations as a family doc 🧵 To start, there has been too little public communication about treatments available, who qualifies & where they can access it

We’ve tried to fill this gap with resources like this one

dfcm.utoronto.ca/sites/default/… via confusedaboutcovid.ca

But we need a big multi-channel campaign
Feb 8, 2022 8 tweets 5 min read
Most people who become infected with COVID can recover at home without any treatment

But there are now medications doctors can prescribe to keep high-risk folks from getting seriously ill

Which meds? Who can get them? We break it down in our latest @ ConfusedAboutCOVID.ca To start, all these meds are meant for people who are at high risk of getting seriously ill from COVID

That's b/c of the limited supply but also b/c the research studies were done in these groups.

Who qualifies? Call your doctor if any of the below applies 👇🏽👇🏽👇🏽
Jan 26, 2022 7 tweets 7 min read
You just found out your child has COVID. What should you do?

How can you best care for your child? When should you call the doctor or take them to the ED?

Our latest resource provides the answers 🧵

ConfusedAboutCOVID.ca

dfcm.utoronto.ca/sites/default/… Image To start, if your child has COVID symptoms, assume COVID. Most don't need a test.

They will need to self-isolate along with everyone who lives with them

(see details here: rebrand.ly/Feeling-Unwell) Image
Jan 24, 2022 30 tweets 14 min read
*NEW* Our latest study @AnnFamMed @RickGlazier1 shows that team-based primary care, coupled with payment reform, can improve patient outcomes & reduce ED use

annfammed.org/content/20/1/24

We desperately need to expand team-based primary care in Canada

(a mega 🧵) #Primarycare is the foundation of a high-performing health system. Yet, primary care has been in crisis for the last 2 decades—challenged by an outdated payment model, growing patient need, rapidly growing evidence, and dysfunctional electronic medical record systems
Jan 22, 2022 10 tweets 4 min read
Thanks to the 1000's of people who have powered our 3rd dose effort. We've made amazing progress in a short time—and still have further to go.

A thread on why 3+ doses continues to be important and where we need to focus 🧵 Image We now have more real world data showing that 3 doses is better than 2 at preventing infection and serious illness with Omicron

These two slides were shared by Dr. Allison McGeer and summarize data on infection and hospitalization with 3 v 2 doses in the UK ImageImage
Jan 13, 2022 12 tweets 11 min read
Are you confused about #COVID?

How do you know when you have it?
Who can get a test?
When to use a RAT?
When to call a doctor?

You're not alone.

We @UofTFamilyMed @OntarioCollege have pulled together answers to common COVID Q's
dfcm.utoronto.ca/confused-about…

Here's a rundown 🧵 1. How do you know you have COVID?

Bottom line: If you have symptoms, assume you have COVID

(Most people don't qualify for a PCR test)

dfcm.utoronto.ca/sites/default/…
Jan 12, 2022 4 tweets 2 min read
I've been thinking a lot about the patients in my practice who still say no to the COVID vaccine

They are not anti-vaxxers

Most have difficult lives—newcomers, BIPOC, histories of homelessness, trauma, poverty

They (reasonably) mistrust gov't & are victims of misinformation We should certainly not be taxing these individuals or denying them healthcare

That goes against the principle of healthcare based on need as @picardonhealth @globeandmail so eloquently puts

theglobeandmail.com/canada/article…
Nov 16, 2021 8 tweets 4 min read
I know some parents are reasonably worried about the risk of myocarditis following COVID-19 vaccination for children 5 to 11

Here's what we know about the risk and why experts think it will be much LOWER in this age group than with teens/adults 🧵 First, it seems that kids have a lower predisposition for myocarditis and pericarditis.

Ontario data show the natural incidence of myocarditis and pericarditis (pre-COVID) was much lower for those <12

(data courtesy @DrJeffKwong via Dr. Upton Allen)
Sep 30, 2021 10 tweets 3 min read
Like many parents, I'm struggling to understand why the Ontario government is so strongly against using rapid testing to prevent the spread of #covid in schools.

THREAD 🧵 Is it because the tests are in low supply or too expensive to purchase?

No. My understanding is the feds are purchasing and distributing the rapid tests to provinces
Sep 29, 2021 8 tweets 3 min read
Let’s prevent a junior-edition of the vaccine “hunger games”

Instead, let take a schools-based approach so every child age 5-11 has a chance at getting the #covidvaccine once approved

New oped @TorontoStar from @SabiVM @NoahIvers and I

thestar.com/opinion/contri… via @torontostar A schools-based approach would be most EFFECTIVE

Studies estimate that uptake of the HPV vaccine was almost 4 times higher in school-based programs compared to community-based ones

ncbi.nlm.nih.gov/pmc/articles/P…
Jun 18, 2021 11 tweets 3 min read
I want to start by acknowledging the confusion and frustration that the latest NACI statement has caused those who got the AZ vaccine—and the pharmacists and primary care clinicians supporting them

As I write, I know many are on the phone rescheduling appts

A few thoughts 🧵1/ NACI has said that an mRNA vaccine is preferred as the 2nd dose for those who received AZ for their 1st

They also reassure folks who got AZx2 that they have very good protection against severe death and hospitalization 2/

canada.ca/en/public-heal…
Jun 16, 2021 8 tweets 3 min read
1. Data is still emerging on myocarditis post-vaccination and whether it's a consequence of the vaccine or coincidence

At this time CDC/PHAC still encourage vaccination in those 12+

Here's a short thread on what you should know 🧵

(More details here: cdc.gov/coronavirus/20…) 2. When has myocarditis been reported?

Myocarditis after vaccination has been noted
-more commonly with 2nd dose
-usually within a few days after vaccination
-mostly in males, 16+ or older