1 / 23

DM Group Visits at Phillips Family and Mt. Hope Family Practic e

DM Group Visits at Phillips Family and Mt. Hope Family Practic e. Elizabeth I. Molina Ortiz, MD MPH. Objectives. Present an update on the progress of DM group visits at the Institute for Family Health Reflect on our pilot group, which continues at Phillips Family Practice

triage
Download Presentation

DM Group Visits at Phillips Family and Mt. Hope Family Practic e

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DM Group Visits at Phillips Family and Mt. Hope Family Practice Elizabeth I. Molina Ortiz, MD MPH

  2. Objectives • Present an update on the progress of DM group visits at the Institute for Family Health • Reflect on our pilot group, which continues at Phillips Family Practice • Addition of group visits at Mt Hope Family Practice • Step by step approach at organizing these visits • Highlight successes

  3. Spring 2007 • Started group visits at Phillips Family Practice with support from Dr. Andreas Cohrssen, residency director • Began by inviting patients from panel of two physicians, focusing on: • Spanish speaking patients • Those needing further intense education • Uncontrolled DM markers (A1c, LDL, BP, etc)

  4. Spring 2007 • Created list of patients • Called patients to introduce idea of group visits one month prior to starting visits • Reminder phone calls one week and one day prior to monthly visit • Created monthly calendar of topics which would be addressed throughout the year • Group continues to this date, led by Dr. Venkataraman and Dr. Borrero, with additional support from psychologist

  5. Mt Hope Family Practice • August 2007– February 2008 • Established patient panel and developed physician-patient relationships • Worked with AmeriCorps volunteer developing curriculum for monthly group visits • Identified Spanish speaking patients in need of intense education and improved DM control • After five months at Mt Hope Family Practice, started to introduce the idea of group visits to our patients

  6. February 2008 • Held our first monthly meeting • Reminder phone calls, letters and flyers were sent • Core group of 8 patients with diabetes attend

  7. Samples • Letter • Physician Schedule • Workflow • Physician Chart Review • Educational Handout • Physician Note • Improvements and successes

  8. Sample Letter

  9. Chart Review

  10. Workflow • Clinical triage (weight, BP, fingerstick check) • Informal social time with healthy snacks in conference room as all patients get triaged • Interactive educational session lasting approx 45 minutes • A prize is awarded to participant with most improved measure based on theme for the month (i.e.: most improved A1c, LDL, Blood pressure, etc.)

  11. Workflow • Participants and facilitators share goals with the group for the following month • Each patient spends 5 minutes individually with the provider to review their goals and individual needs • If need is identified, separate follow up appointments two weeks after group visit are made. Otherwise, patient follows up in one month for next group visit.

  12. Educational Handout

  13. Educational tool

  14. MOLINA-ORTIZ,MD Fri May 9, 2008 2:29 PM SignedZG is a 58 year old femaleSUBJECTIVE:Patient presents for f/u visit and diabetic group education.Zoila Gil is feeling well. Has no complaints No polyuria, no polydipsia, no Chest pain, nor shortness of breath Patient Active Problem List:DIABETES UNCOMPL ADULT-TYPE II [250.00]BENIGN HYPERTENSION [401.1]LIPIDOSES [272.7]MITRAL VALVE DIS NEC/NOS [394.9]SCREENING MAL NEOP-BREAST NOS [V76.10]MORBID OBESITY [278.01]DYSTHYMIC DISORDER [300.4]ANXIETY STATE NOS [300.00]ROUTINE MEDICAL EXAM-ADULT [V70.0]Tobacco Use:NeverDM Chart review:Opthalmology visit in last 12 months: yesPodiatry visit in last 12 months: yesOn ASA: yesOn ACE if appropriate: yesFlu/PNA vaccine up to date: yes • Sample Note

  15. OBJECTIVE:Filed Vitals:|----------------------|| | 05/01/2008 || | 12:48 PM ||----------------------|| BP: | 110/80 | Pulse: | 73 | Temp: | 96.8 °F (* | TempSrc:| Oral | Weight: | 250 lbs (* || SpO2: | 98% ||----------------------| Results for orders placed on 05/01/2008-RANDOM GLUCOSE INHOUSEGLUCOSE, FINGERSTICK 149 (*) Low: 70 High: 110ZG appears well, in no apparent distress. Alert and oriented times three, pleasant and cooperative. Vital signs are as documented in vital signs section.Rrr, no murmurclear to auscultation bilaterally no wheezing or cracklesno pedal edema, no lesions or ulcers, good peripheral pulses.HGBA1C 6.5 02/14/2008HGBA1C 10.8 09/04/2007HGBA1C 7.3 11/13/2006LDL 53 02/14/2008

  16. ASSESSMENT/PLAN:58 yo here for DM f/u and educational groupGroup Educational Topics Discussed: 1. Discussed long term effects of elevated glucose.2. Reviewed normal blood pressure levels, at group members' request 3. Shared each member's blood pressure and their progress in management of their 4. Discussed nutritional interventions and other lifestyle modifications to high LDL levels5. Reviewed goals set from previous meeting and set new goals.6. Reviewed appropriate amount of fruits and vegetable intake per day 250.00 DIABETES MELLITUS TYPE II-UNCOMPL (primary encounter diagnosis)Note: well controlled. Much improved a1cPlan: RANDOM GLUCOSE INHOUSEcontinue current management-need for individual appointment did not become apparent during our group visit. Therefore, individual appointment was not scheduled in two weeks.-follow up in one month for next group visit.

  17. Successes • 5th group session • Feeling of camaraderie • Accountability • Responsibility • Greater confidence in self management • Two members started insulin • Positive peer pressure

  18. Successes • 100% of group members on ASA, ACE/ARB, have podiatry referrals (or monofilament documentation), ophthalmology referral, PNA, flu vaccines • 100% have decreasing A1c levels:

  19. Successes • Improvements in LDL, systolic and diastolic blood pressure • Great improvement in weight • (group has lost net 16lbs)

  20. More information… • http://diabetesgroupvisits.wikispaces.com/

More Related