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Diabetes And Community Medicine. Patrick Chen, M.D. Share Our Selves January 30, 2010. Objectives. Highlight services at a community clinic Characterize a diabetic patient population Describe a multi-disciplinary approach . Share Our Selves (SOS). 1550 Superior Avenue

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Diabetes and community medicine

DiabetesAnd Community Medicine

Patrick Chen, M.D.

Share Our Selves

January 30, 2010


Objectives

Objectives

Highlight services at a community clinic

Characterize a diabetic patient population

Describe a multi-disciplinary approach


Share our selves sos
Share Our Selves (SOS)

1550 Superior Avenue

Costa Mesa, CA 92627

(949) 650-0640

www.shareourselves.org


What is sos
What is SOS?

  • 501(c)(3) non-profit organization

  • Health services for OC’s poor and uninsured

  • All services are free of charge

  • 2009 operational budget $6.6 million

  • More than 100,000 patients/clients annually

  • 45 employees

  • 400 volunteers


Our mission statement
Our Mission Statement

We are servants who

provide free care and assistance

to those in need and

act as advocates for systemic change


Sos a brief history
SOS – A Brief History

  • Founded in 1970 to provide for OC’s poor

    • Food

    • Clothing

    • Financial aid

  • Evolution

    • 1984 Medical Clinic

    • 1987 Dental Clinic

    • 2005 Comprehensive CARE Center

    • 2009 SOS Family Center


  • 5 core services
    5 Core Services

    • Social Services

    • Comprehensive CARE Center

    • Family Center

    • Dental Clinic

    • Medical Clinic


    Social services
    Social Services

    • Food

    • Financial Aid

    • Clothing

    • Legal aid

    • Education Classes

    • Fundraising Drives


    Comprehensive care center
    Comprehensive CARE Center

    • Counseling - individual, group therapy

    • Advocacy - case management

    • Resources - linkage to benefits/programs

    • Emergency Services - crisis intervention


    Family center
    Family Center

    • Pregnant women, families with kids 0-5 y.o.

    • Education and in-home support:

      • Prenatal

      • Breastfeeding

      • Parenting

      • Diabetes prevention


    Dental clinic
    Dental Clinic

    • Hygiene, x-rays, extractions, restorations

    • 2 dentists

    • 8124 visits annually


    Medical clinic
    Medical Clinic

    • 15,000 visits annually

    • Chronic program

      • 2200 patients

    • Walk-in clinic

      • ER diversion rate: 29%

    • Specialty clinics


    Sos hoag partnership
    SOS – Hoag Partnership

    • Symbiotic collaboration between two independent non-profit healthcare institutions

    • Hoag provides $1.5 million in-kind support: two physicians, meds, diagnostics, services

    • SOS provides primary care, ER diversion, and follow-up for discharged patients


    Socioeconomic profile
    Socioeconomic Profile

    • Federal Poverty Level

      • Single: $10,800

      • Family of 4: $22,000


    Socioeconomic profile1
    Socioeconomic Profile

    • Medical Services Initiative (MSI)

      • OC’s safety net program

      • < 200% FPL


    Employed providers
    Employed Providers

    • 1.5 FTE Internists

    • Family Physician

    • Physician Assistant

    • Nurse Practitioner

    • 1.5 FTE Pharmacists


    Volunteer on site providers
    Volunteer On-site Providers

    • Internist

    • Cardiologist

    • Nephrologist

    • Optometrist

    • Diabetic Educator

    • Gynecologist

    • Uro-Gynecologist

    • Physician Assistant

    • Nurse Practitioner

    • Physical Therapist


    Sos diabetes program
    SOS Diabetes Program

    • 393 patients

    • 4.4 average visits/yr

    • MSI and Uninsured

    • Geographic focus

    • Demand is increasing


    Sos diabetes program1
    SOS Diabetes Program

    • Labs

    • Specialty Care

    • Medications

    • Education

    • Mental Health

    • Case Management


    A multi disciplinary team
    A Multi-disciplinary Team

    • Primary care

    • Specialty care

    • Pharmacists

    • Diabetes educators

    • LCSW/MFT

    • Case Managers


    Ada guidelines
    ADA Guidelines

    • Targets:

      • Hb A1C

      • BP

      • HDL, LDL

    • Medications:

      • Statins

      • Antiplatelet

      • Immunizations

    • Screening:

      • Neuropathy

      • Retinopathy

      • Nephropathy

    • Lifestyle Changes:

      • Physical Activity

      • Smoking Cessation


    First encounter
    First Encounter

    • How do patients get into the program?

      • Walk-in patient

      • Referral from a hospital

      • Our patient develops diabetes


    First encounter1
    First Encounter

    • Patient Contract

    • Financial Screening

    • Depression screening

    • Medications

    • Referral to a diabetes educator


    Medications
    Medications

    • SOS purchases

    • $4 Pharmacy programs

    • Patients Assistance Program (PAP)

    • Hoag Pharmacy


    Medications1
    Medications

    • Oral diabetic agents

    • Insulin

    • Statins

    • Fibrates

    • Antiplatelets

    • ACE Inhibitor / ARB

    • BP therapy

    • Antidepressants

    • Vaccines

    • ED meds


    Medications2
    Medications

    Value Dispensed 2009

    • SOS - Metformin $167,984

    • PAP – Atorvastatin $372,740

    • Hoag – Insulin $74,852


    Diabetic education
    Diabetic Education

    • Latino Health Access

    • SOS Medication Therapy Management

    • Hoag Diabetes Center


    Diabetic education1
    Diabetic Education

    • Pathophysiology

    • Glucometer Training

    • Nutrition

    • Exercise

    • Medications

    • Insulin Instruction


    Integrative behavioral health
    Integrative Behavioral Health

    • Counselors are Providers

    • Collaboration (“Our patient”)

    • High-risk for depression

    • Behavioral change is critical


    Integrative behavioral health1
    Integrative Behavioral Health

    • Depression Screening

      • PHQ-9 each visit

    • Depression Management

      • Counseling

      • Antidepressants


    Integrative behavioral health2
    Integrative Behavioral Health

    PHQ-2 Depression Screen

    • Score of 3: 83% Sensitivity, 90% specificity

      - Administer PHQ-9


    Integrative behavioral health3
    Integrative Behavioral Health

    • Case Management

      • Care coordination

      • Special needs

    • Family Conference

      • Patient / Family members

      • Provider

      • LCSW / Case Manager


    Family center1
    Family Center

    • Target families of diabetic patients

    • Diabetes Prevention Classes

    • Exercise Classes


    Specialty care
    Specialty Care

    • Nephrology

    • Optometry

    • Cardiology


    Eye care
    Eye Care

    • Bimonthly eye clinic

    • Prescription lenses

    • Retinopathy screening

    • Referral to Ophthalmology


    Foot care
    Foot Care

    • “Feet and Finger sticks” each chronic visit

    • Providers perform microfilament exam

    • Referral to podiatry

    • Hoag Wound Care Clinic


    Nephropathy
    Nephropathy

    • BUN/Cr, Ur. Microalbumin Qyr

    • ACE Inhibitor / ARB

    • Referral to Nephrology


    Dental care
    Dental Care

    • Referral to Cypress College Dental Hygiene Program

    • Referral to SOS Dental Clinic


    Challenges to care
    Challenges to Care

    • Patient resources

    • Transportation

    • Clinical Space

    • Volunteer staff

    • Access to specialists

    • Increasing demand


    The future
    The Future

    • Electronic Health Records

    • Standardized management algorithms

    • Group Visits

    • Self-analysis (targets, outcomes)

    • Open another site


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