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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.

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Presentation on theme: "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."— Presentation transcript:

1 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


10 Chart Review

11 Workflow 1. Clinical triage (weight, BP, fingerstick check) 2. Informal social time with healthy snacks in conference room as all patients get triaged 3. Interactive educational session lasting approx 45 minutes 4. 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.)

12 Workflow 5. Participants and facilitators share goals with the group for the following month 6. Each patient spends 5 minutes individually with the provider to review their goals and individual needs 7. 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.

13 Educational Handout

14 Educational tool

15 MOLINA-ORTIZ,MD Fri May 9, 2008 2:29 PM Signed ZG is a 58 year old female SUBJECTIVE: 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: Never DM Chart review: Opthalmology visit in last 12 months: yes Podiatry visit in last 12 months: yes On ASA: yes On ACE if appropriate: yes Flu/PNA vaccine up to date: yes Sample Note

16 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 INHOUSE GLUCOSE, FINGERSTICK 149 (*) Low: 70 High: 110 ZG 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 murmur clear to auscultation bilaterally no wheezing or crackles no pedal edema, no lesions or ulcers, good peripheral pulses. HGBA1C 6.5 02/14/2008 HGBA1C 10.8 09/04/2007 HGBA1C 7.3 11/13/2006 LDL 53 02/14/2008

17 ASSESSMENT/PLAN: 58 yo here for DM f/u and educational group Group 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 levels 5. 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 a1c Plan: RANDOM GLUCOSE INHOUSE continue 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.

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

19 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: PatientPre-Group A1cLatest A1cChange SE7.97.8-0.1 B,Z 15.2 9.9-5.3 G,Z10.86.5-4.3 H,D8.68.2-0.4 P,V12.611.5-1.1 D,F11.9- C,M10.3- C,M12.510.8-1.7

20 Successes Improvements in LDL, systolic and diastolic blood pressure Great improvement in weight (group has lost net 16lbs) PatientPre-Group WtRecent WtChange SE1861893 B,Z196195 G,Z268257-11 H,D193189-4 P,V20822416 D,F263252-11 C,M131126-5 C,M174171-3



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