Transcript Group Medical Appointments - Virginia Health Care Foundation

Group Medical Appointments
Chesapeake Care Free Clinic
Mary Beth Carr, NP
GMA Overview
• Why GMA? Support and efficiency
• Started 2004 with diabetics and a volunteer
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endocrinologist, pt had to attend the education
sessions offered by the hospital to take part
NP led started 2/08 with HTN diagnosis led with
an RN, over 200 pts have participated
NP led expanded to diabetes in Feb 2010 – led
with a DNE, 24 pts to date
Chesapeake Care Free Clinic
HTN GMA
• Monthly HTN GMA Group-elements included-definition of
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high BP, dangers of uncontrolled BP, importance of
staying on medications life long, how meds work and
side effects, smoking cessation (referrals), moderate
ETOH, eating and activity plans, stress management,
also brief physical exam. Labs reviewed and meds
refilled. At least 2-3 hours. Confidentiality form signed.
Data from 2/08-6/09 gathered
Total 77 pts, pt diagnosed with HTN on meds.
Originally looked at BP at baseline and repeat BP
6/12/24 mos, also weight, LDL and dx mental health
Chesapeake Care Free Clinic
Data
• 1 year data 40 patients from 2/08-11/08
• Lost 14 people to follow up (26%)
• Of the 40 patients 24 were at goal (below 140/90) at
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first HTN GMA, 16 above goal.
At 1 year 27 pt were at goal, 13 above goal.
Of those that started at goal 17 stayed at goal, (42%) 7
went up (17%), 10 went from above goal to goal (25%),
6 stayed above goal from start to finish (15%) (failure??
Need to look at improvement of BP)
67% of pts that went through HTN GMA are at goal at 1
year. Need to compare that data to those that did not
attend GMA.
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Other Data
• Surprising result-53% gained weight from
2-15 lbs in one year. Since then we have
instituted more info on weight loss and
exercise in the class.
• Of note-LDL went down in 50% of pts
(most placed on statins), only 8 had
mental health diagnoses
Chesapeake Care Free Clinic
Successes and Challenges
• Successes-started the process! Reported
pt satisfaction, volunteer RN involvement,
part of our culture now, flexibility-use
what you have that day, BPs improved
• Challenges-need more staff, bottlenecks,
need other providers involved, constant
education of front desk, have had all
barriers mentioned
Chesapeake Care Free Clinic
Final Thoughts
• Collecting data is a lot of work! (even with
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EMR)
I am satisfied that 67% of the pts are at goal, I
would like to have another intern to collect the
statistics after 6/09 (another 100 pts at least)
Don’t focus on those already at goal-just make it
easy for them to get their meds
Focus on those that are above goal
Work on weight loss
Chesapeake Care Free Clinic