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Diabetes And Community Medicine Patrick Chen, M.D. Share Our Selves January 30, 2010.

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Presentation on theme: "Diabetes And Community Medicine Patrick Chen, M.D. Share Our Selves January 30, 2010."— Presentation transcript:

1 Diabetes And Community Medicine Patrick Chen, M.D. Share Our Selves January 30, 2010

2 Objectives 1.Highlight services at a community clinic 2.Characterize a diabetic patient population 3.Describe a multi-disciplinary approach

3 Share Our Selves (SOS) 1550 Superior Avenue Costa Mesa, CA 92627 (949) 650-0640

4 What is SOS? 501(c)(3) non-profit organization Health services for OCs 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

5 Our Mission Statement We are servants who provide free care and assistance to those in need and act as advocates for systemic change

6 SOS – A Brief History Founded in 1970 to provide for OCs poor Food Clothing Financial aid Evolution 1984 Medical Clinic 1987 Dental Clinic 2005 Comprehensive CARE Center 2009 SOS Family Center

7 5 Core Services Social Services Comprehensive CARE Center Family Center Dental Clinic Medical Clinic

8 Social Services Food Financial Aid Clothing Legal aid Education Classes Fundraising Drives

9 Comprehensive CARE Center Counseling - individual, group therapy Advocacy - case management Resources - linkage to benefits/programs Emergency Services - crisis intervention

10 Family Center Pregnant women, families with kids 0-5 y.o. Education and in-home support: –Prenatal –Breastfeeding –Parenting –Diabetes prevention

11 Dental Clinic Hygiene, x-rays, extractions, restorations 2 dentists 8124 visits annually

12 Medical Clinic 15,000 visits annually Chronic program –2200 patients Walk-in clinic –ER diversion rate: 29% Specialty clinics

13 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

14 Socioeconomic Profile Federal Poverty Level –Single: $10,800 –Family of 4: $22,000

15 Socioeconomic Profile Medical Services Initiative (MSI) –OCs safety net program –< 200% FPL

16 Employed Providers 1.5 FTE Internists Family Physician Physician Assistant Nurse Practitioner 1.5 FTE Pharmacists

17 Volunteer On-site Providers Internist Cardiologist Nephrologist Optometrist Diabetic Educator Gynecologist Uro-Gynecologist Physician Assistant Nurse Practitioner Physical Therapist

18 SOS Diabetes Program 393 patients 4.4 average visits/yr MSI and Uninsured Geographic focus Demand is increasing

19 SOS Diabetes Program Labs Specialty Care Medications Education Mental Health Case Management

20 A Multi-disciplinary Team Primary care Specialty care Pharmacists Diabetes educators LCSW/MFT Case Managers

21 ADA Guidelines Targets: –Hb A1C –BP –HDL, LDL Medications: –Statins –Antiplatelet –Immunizations Screening: –Neuropathy –Retinopathy –Nephropathy Lifestyle Changes: –Physical Activity –Smoking Cessation

22 First Encounter How do patients get into the program? –Walk-in patient –Referral from a hospital –Our patient develops diabetes

23 First Encounter Patient Contract Financial Screening Depression screening Medications Referral to a diabetes educator

24 Medications 1.SOS purchases 2.$4 Pharmacy programs 3.Patients Assistance Program (PAP) 4.Hoag Pharmacy

25 Medications Oral diabetic agents Insulin Statins Fibrates Antiplatelets ACE Inhibitor / ARB BP therapy Antidepressants Vaccines ED meds

26 Medications Value Dispensed 2009 1.SOS - Metformin $167,984 2.PAP – Atorvastatin $372,740 3.Hoag – Insulin $74,852

27 Diabetic Education 1.Latino Health Access 2.SOS Medication Therapy Management 3.Hoag Diabetes Center

28 Diabetic Education Pathophysiology Glucometer Training Nutrition Exercise Medications Insulin Instruction

29 Integrative Behavioral Health Counselors are Providers Collaboration (Our patient) High-risk for depression Behavioral change is critical

30 Integrative Behavioral Health Depression Screening –PHQ-9 each visit Depression Management –Counseling –Antidepressants

31 Integrative Behavioral Health Over the past 2 weeks, how often have you been bothered by any of these problems? Not at all Several days More than half the days Nearly Every Day Little interest or pleasure in doing things 0123 Feeling down, depressed, or hopeless 0123 PHQ-2 Depression Screen Score of 3: 83% Sensitivity, 90% specificity - Administer PHQ-9

32 Integrative Behavioral Health Case Management –Care coordination –Special needs Family Conference –Patient / Family members –Provider –LCSW / Case Manager

33 Family Center Target families of diabetic patients Diabetes Prevention Classes Exercise Classes

34 Specialty Care Nephrology Optometry Cardiology

35 Eye Care Bimonthly eye clinic Prescription lenses Retinopathy screening Referral to Ophthalmology

36 Foot Care Feet and Finger sticks each chronic visit Providers perform microfilament exam Referral to podiatry Hoag Wound Care Clinic

37 Nephropathy BUN/Cr, Ur. Microalbumin Qyr ACE Inhibitor / ARB Referral to Nephrology

38 Dental Care Referral to Cypress College Dental Hygiene Program Referral to SOS Dental Clinic

39 Challenges to Care Patient resources Transportation Clinical Space Volunteer staff Access to specialists Increasing demand

40 The Future Electronic Health Records Standardized management algorithms Group Visits Self-analysis (targets, outcomes) Open another site

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