Programs and Services

Programs and Services delivered by the London Family Health Team are geared to the population groups we serve focusing on chronic disease management, disease prevention and health promotion.

Chronic diseases are long-term diseases that develop slowly over time, often progressing in severity, and can often be controlled, but rarely cured. They include conditions such as cardiovascular diseases (heart disease and stroke), cancer, diabetes, arthritis, back problems, asthma, and chronic depression. Chronic diseases may significantly impair everyday physical and mental functions and reduce one’s ability to perform activities of daily living. Although chronic diseases are among the most common and costly health problems facing Canadians, they are also among the most preventable.

Along with the programs and services listed below, the team also focuses on an immunization program, assisting frail and elderly patients with disease prevention, screening and appropriate care planning as well as palliative care.

Diabetes Management

The aim of this program is to improve the physical health, mental health and quality of life of identified diabetic patients using the Canadian Diabetic Association Guidelines.

Complex Chronic Disease Management Program

Complex chronic diseases include obesity, diabetes, arthritis, heart failure, kidney failure and lung failure. The Complex Chronic Disease Management Program supports the care of patients with four or more chronic diseases through an inter professional collaborative team approach. The patient centered focus integrates self-management goals to maximize the effectiveness of medications, diet, exercise and other lifestyle changes.

Hypertension/Cholesterol Service

The London Family Health Team works with the patient to improve pharmacological and lifestyle management of those with high blood pressure and moderate to high risk cholesterol levels. Hypertension (or high blood pressure) and high blood cholesterol are both major risk factors for heart disease and stroke. The Hypertension/Cholesterol service helps identify patients at risk and provides education and counselling with the aim of reducing complications.

Child, Adolescent and Family Mental Health Program

Early identification, screening and assessment of ADHD and related mental health conditions is vital to developing the right treatment plan for children and adolescents aged 2-18 years of age. The program uses a collaborative approach that involves the patient, family and interdisciplinary professionals that involves addressing treatment adherence as well as how to cope with the challenges of the diagnosis.

Mental Health and Depression Management

The London Family Health Team works to improve and standardize the identification (screening and assessment) and treatment / lifestyle management of patients with chronic depression. The team also works with all patients diagnosed with mental health concerns including anxiety or requires acute situational crisis counseling.

Fully Alive is a psychoeducational group for patients to help reduce anxiety and increase self management skills. These sessions are offered twice a year.

Dementia Management

By identifying patients at risk for dementia as well as those who have been diagnosed with the disease, the team is able to provide education and support to patients and their families. This includes providing comprehensive cognitive assessments, monitoring medications and other treatments and referring to appropriate community specialists and resources.

Nutritional Services

The London Family Health Team dietitian provides dietary screening and counselling to patients in need of nutrition, education, management and support. The service fosters self-efficacy and self-management enabling patients to make positive lifestyle changes and ability to sustain change.

Pharmacy Services

The London Family Health Team pharmacist provides support to family physicians and patients in regards to medication management, compliance packaging, high risk medications, pharmaceutical options and options for medication funding.

Integrative Medicine Seminars

Integrative medicine combines the best of conventional medicine with the best of complementary and alternative therapies.  Seminars are presented several times during the year.

Lung Health Management Program

Through early detection and better management, the Lung Health Management Program aims to improve the health outcomes and quality of life for patients at risk for respiratory diseases and those who have been diagnosed with COPD (Chronic Obstructive Pulmonary Disease) and Asthma.

Renal Group Program

For adult patients with stage 2 or 3 kidney disease, the Renal Group Program focuses on improving the understanding, progression and self-management of the disease.

Patients learn how to read nutritional labels, increase cooking skills, learn how to grocery shop, understand their medications as well as their biomarkers and lab results.

Healthy You Program

The Healthy You Program provides group education sessions helping patients to adopt healthier lifestyles. Patients will learn how nutrition, physical activity, self-esteem, behaviour and the environment affect their body size through intuitive eating. Program activities include learning about nutrients, vitamins and minerals, reading food labels, increasing activity, meal planning, dining out and grocery shopping as well as goal setting.

Geriatric and Frail Elderly Program

The aim of the Geriatric and Frail Elderly Program is to ensure optimum health and quality of life for geriatric and frail patients living with multiple chronic conditions. The program works to strike a balance between clinical guidance, healthcare needs and patient preferences as well as to improve access to health care by providing home visits when necessary.

Smoking Cessation Service

The smoking cessation service supports patients with counselling and medication management to meet their goal of quitting smoking.

Cancer Screening Service

The London Family Health Team supports Ontario’s Cancer Screening Program by helping to ensure patients are up to date with their cancer screening and to provide information and education.