Transcript Patient Self-Management: in Primary Care Team SPANK: St

Patient Self-Management:
in Primary Care
Team SPANK: St Peter Aims for New Knowledge
March 9, 2004
•Devin Sawyer, MD
•Joseph Wall, MHA
•Shari Gioimo, MA
•Janet Wolfram, CDE
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A Residency Program- Full Scope FM
37,000 patient visits a year
Residents & UW med students- 6 per year
Aprox. 300 diabetics
Participated in WSDC II and RWJ grant
Getting better at a TEAM APPROACH to
chronic care and patient Self-Management
What we have done lately…
• WA Diabetes Collaborative, 2000-2001
• Focused on Patient Self-Management
• The role of each player: providers, medical
assistants, administrative support, patients,
and mentors
• RWJ funding for Advancing Diabetes SelfManagement ($300,000)
What is Self-Management?…
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Checking blood sugars
Taking meds (pills and shots)
Eating right (CDE, doctor, other diabetics)
Exercising (30 mins/day, 150 mins/week)
Checking feet
Making appointments (PCP, eye doc, CDE)
What is missing?
24/7/365
• “The patients right and responsibility to make
decisions that make sense within the context of
their lives”
• “Education and support refocused on helping
patients make & achieve goals and outcomes that
they themselves have selected”
• “Must acknowledge and support the patients role
as the key decision maker in self-management”
• Patient role? Provider role? Staff role? Others?
The NPR news report on
‘effective diabetes care’ in 2003
N Engl J Med, 2003; 348,5:383-459
(Steno-2 study in Copenhagen)
An Experienced TEAM
Motivated
Enthusiastic
With a Gung Ho attitude
Our program…
• MA Planned Visits with goal setting
• Provider Visits with emphasis on patient goal
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setting
Medical Group Visits
Registry to support patient care (CDEMS)
Exercise opportunities
Patient Mentoring (buddy system)
Newsletter
CDEMS: Our Run Charts
CDEMS: Our Run Charts
What it has taken to get us here…
• MA training (Boldt Center)
• Provider training (faculty development, and
resident workshops and precepting BBSWAR)
• Patient education
• Practical description of self-management:
an SMG cycles (new way of thinking for
our clinic)
How do we teach this to the MA’s?
• A new curriculum for the MA’s (A new
service for diabetes educators?)
• Skills in-service; foot checks, CDEMS,
planned visits, phone skills, group visits
(Camp SPANK)
• Shadowing
• On the job training
MA planned visits:
(see standing orders)
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They follow the standing orders
Introduce SMG
Occur 1 week before provider visit
90% of our MA’s perform planned visits
This frees up some of the provider time
How do we do and teach this to
the providers?
Big Bad
Sugar WAR
The 15 minute encounter: A tool
Big Bad Sugar W.A.R.
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Background
Barriers
Successes
Willingness to change
Action plan
Reinforcement
An Action Plan:
• Something the patient comes up with and
WANTS to do
• Should be REASONABLE
• Behavior specific
• Should answer the questions:
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What?
How much?
When?
How often?
• Confidence level (likelihood-of-success) 1-10
Patient Goal Quality
• Evaluate, record, and track patient SMG quality
– 1 point for activity (what- i.e.: briskly walk, or stop
skipping breakfast)
– 1 point for location (where- i.e: around Capital Lake,
or at home and at the office)
– 1 point for frequency (how often- i.e: M,W,F, or 5 days
a week)
– 1 point for time/duration (how long- i.e.: for 45
minutes at 7:00 am, or 8 am before I leave for work)
– 1 point for LOS score (from 1 to 10)
SMG quality over time:
Clinic SMG By Date
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3.5 3.6
3.4
3.0
2.9
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2.4
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2.0
1.5
1.0
1.0
1.0
1.0 1.0
1.5
1.0 1.0
2.0 2.0
3.6
3.1
4.0
4.0
3.8
3.2
4.2 4.2
3.4
2.6
2.0 2.0 2.0
1.6
1.3
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The Group Visit
The Group Visit
• Developing patient oriented self-management
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curriculum
More providers (faculty), more staff being trained
More patients coming
Now an educational expectation for residents
High patient satisfaction
Outcomes in 2001:
– HbA1C of our practice:
7.7
– HbA1C of those who come to DGV: 6.3
Patient Data Registry
(CDEMS)
• Free from the DOH, developed locally
• MA’s do data entry and us for patient
outreach
• PCP’s use patient report with the patient
visit
• PCP/MA team can query their data to target
care (outliers), for patient recall, and for
patient goal reinforcement
Exercise Opportunities
• Walking Club
• Pedometer Program
• “SPFP Moves With You” Video
Walking Club
Pedometer Program
“SPFP Moves With You”…
The Video
Patient Mentoring
(buddy system)
• Patients are supporting Patients
• One patient calls another about 2 months after the
provider visit to “check-in” with their SMG
• Sent a card with a patient’s information
• Provides additional support and accountability
• Bridges the gap between the planned/provider visit
and the beginning of the next cycle
What is next? Spread…
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Graduate trained providers
More grant money- Phase II
In-service local providers- Elma
Provide training to local MA’s
A role in the STEPS grant
Contact Info…
• Devin Sawyer, [email protected]
• Joseph Wall, MHA- (360)493-4001
[email protected]
• Shari Gioimo, Medical [email protected]
• Janet Wolfram, Diabetes Educator
[email protected]