Asthma - Molina Healthcare · Your Asthma Control Goals Tips to help control your asthma Your...

Section O-1 Asthma

Molina Healthcare of New Mexico, Inc. Salud services are funded in part under contract with the State of New Mexico

Molina Healthcare of New Mexico, Inc. Provider Manual 2012

Clinical Practice Guideline Stepwise Approach for Managing Infants Young Children and Adults with Asthma

Molina Healthcare of New Mexico, Inc (Molina Healthcare) has approved the U.S. Department of Health and Human Services, National Heart Lung and Blood Institute (NHLBI) Guideline for Managing Infants, Young Children and Adults with Asthma at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. The following documents are also available. Sample Asthma Action Plans for patients in both English and Spanish; A list of Durable Medical Equipment (DME) suppliers who can assist your practice in stocking an

Asthma Closet; and A brochure detailing how to contact the University of New Mexico Telehealth clinic (Project ECHO

[extension for community healthcare outcomes]) for assistance from pulmonary specialists on individual cases.

These Documents are available for review and printing on the Molina Healthcare website at www.molinahealthcare.com in the Clinical Practice Guideline section. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

http://www.molinahealthcare.com/


Molina Healthcare of New Mexico, Inc.

Managing Infants, Young Children and Adults with Asthma The National Heart, Lung and Blood Institute National Asthma Education and Prevention Program Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma, 2007 Full Report was approved by the Quality Improvement Committee on October 5, 2011.



Copyright © 2010 M

erck Sharp & Dohm

e Corp., a subsidiary of Merck &

Co., Inc. All rights reserved. 21004938(3)-01/11-SGR Printed in USA Minim

um 10%

Recycled Paper

Provid

ed as an

edu

cation

al resou

rce by Merck

AS

TH

MA

Asthm

a Self-M

anag

emen

t Action

(A

.S.M

.A.) P

lan

Calculations

Peak Flow Values

Green Zone

Personal Best (PB)Yellow

ZoneC

alculate 80% of Personal Best

PB x 0.8 =Red Zone

Calculate 50%

of Personal Best PB x 0.5 =

Directio

ns fo

r use

: Th

e ASMA Plan is a tool that health care providers can use to engage patients and their fam

ilies in ongoing conversations about the principles of good asthm

a managem

ent and control. The ASM

A Plan is specifically designed to provide a concise plan for asthm

a managem

ent. The patient and fam

ily should be able to dem

onstrate an understanding of the plan and the appropriate use of all asthma m

edications. The A

SMA

P

lan uses signs and symptom

s and/or peak flow readings to m

onitor asthma control.

Give the top 2 copies of the A

SMA

Plan form

to the patient/family. Instruct the patient/fam

ily to keep 1 copy of the plan and to provide the other copy to the patient’s w

orkplace, school, or day care. Keep the

third copy for your records.

Ho

w to

use th

e zon

es: Fill in the num

eric values for peak flow readings (not percentages). U

se the table below to determ

ine 50%

and 80% of personal best peak flow

readings.

Peak fl

ow

measu

remen

t: Patients aged ≥5 years m

ay use peak flow m

eters to monitor their asthm

a. Parents of children aged <5 years should use the sym

ptoms listed on the ASM

A Plan to determine their child’s zone.

Personal best peak flow should be determ

ined when the patient is sym

ptom free. A diary, w

hich is usually a part of the peak flow

meter package, can be used to record personal best. For children, it is a good idea to obtain a

peak flow reading at all asthm

a visits and reestablish personal best regularly.

100%

80%

50%

GR

EEN ZO

NE: List all daily m

edications and corresponding directions in the appropriate boxes. Th

e Green Zone is 100%

to 80% of personal best, or w

hen the patient is free of symptom

s.YELLO

W ZO

NE: Instruct the patient to continue taking G

reen Zone medications and to take all

medications listed in the Yellow

Zone. The Yellow

Zone is 79% to 50%

of personal best, or when

the patient experiences symptom

s listed in the Yellow Zone. It is im

portant to indicate the duration of tim

e that the patient should continue taking these medications and at w

hat point he or she should contact you. R

ED ZO

NE: List any m

edications that the patient should take before contacting you or while

preparing to go to the emergency room

. The Red Zone is less than 50%

of personal best, or when

the patient experiences symptom

s listed in the Red Zone.

A.S.M.A. (Asthma Self-Management Action) PlanA.S.M.A. plan for _________________________________________________________ Health care provider name ____________________________________________ Date ________________________________________________________

Health care provider phone ______________________________________ After hours ____________________________________ Hospital/Emergency Department phone ______________________________________________

GREEN ZONE: Doing Well Even if you do not have symptoms, take these long-term control medicines each day.

Before exercise, take (Medicine) (Dose) (Minutes/Hours before exercise)

YELLOW ZONE: Asthma Is Getting Worse

Signs and symptomsn Cough, wheeze, chest tightness, or

shortness of breath orn Waking at night due to asthma orn Can do some, but not all, usual activities

orPeak flow: _________ to ___________ (L/min) (50%–79% of my best peak flow) RED ZONE: Medical Alert! Signs and symptoms n Very short of breath orn Quick-relief medicines have not helped orn Cannot do usual activities orn Symptoms are the same or worse after 24 hours in YELLOW ZONEorPeak flow: less than ________________ (L/min) (less than 50% of my best peak flow)

DANGER SIGNSn Trouble walking and talking due to shortness of breath n Take q 4 or q 6 puffs of your quick-relief medicine ANDn Lips or fingernails are blue n Go to the hospital or call for an ambulance ( __________________________ ) NOW!People who should have a copy of my A.S.M.A. plan: spouse, school nurse, coworkers, babysitter, family members, friends.Adapted from National Heart, Lung, and Blood Institute. Asthma Action Plan. Bethesda, MD: US Dept of Health and Human Services: April 2007. NIH publication 07-5251.

Add quick-relief medicine and keep taking your GREEN ZONE medicine.________________________________________ q 2 to ___ puffs every ___ minutes for ___ treatments or (short-acting β2-agonist) q nebulizer treatments

q _____________________________________ q 4 or q 6 puffs or q nebulizer (short-acting β2-agonist)

q _____________________________________ ________ mg (oral steroid)

Call your health care provider NOW. Go to the hospital or call for an ambulance if:n You are still in the RED ZONE after 15 minutes ANDn You have not reached your health care provider

Medicine

How much to take When to take it

First

second

Patient coPy

If your symptoms (and peak flow, if used) return to the GREEN ZONE after 1 hour of above treatment:

Continue monitoring to be sure you stay in the GREEN ZONE. orIf your symptoms (and peak flow, if used) do not return to the GREEN ZONE after 1 hour of above treatment:

q Take ________________________________ q 2 or q 4 puffs or q nebulizer every________ hours. (short-acting β2-agonist)

q Add _________________________________ ________ mg per day for ________ (3–10) days. (oral steroid)

q Add _________________________________________________________ per day for ________ days.

q Call the health care provider q before or q within _______ hours after taking the oral steroid.

Heath care provider signature _________________________________________________

Signs and symptoms

n No cough, wheeze, chest tightness, or shortness of breath during the day or night

n Can do usual activities

If a peak flow meter is used: My personal best peak flow is _________________ (L/min)Peak flow: more than ______________________________ (80% or more of my best peak flow)

Copyright © 2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. 21004938(3)-01/11-SGR Printed in USA Minimum 10% Recycled Paper

Provided as an educational resource by Merck

Take this medicine:

Your Asthma Control Goals

Tips to help control your asthmaYour health:

n Take your asthma medicines as your health care provider recommends, even when you feel well.

n Check with your health care provider before taking any over-the-counter medicines.

n Talk with your health care provider about ways to stay healthier.

Where you live, work, or go to school:

n Try to keep your HoUSe clean of dust and molds.

n Avoid cigar and cigarette SMoKe as much as possible.

n Avoid strong oDoRS, such as paint, perfume, and hair spray.

n Wear a scarf or a coLD aiR mask over your mouth when it’s cold outside.

In addition, if you have allergies:

n Wash blankets and sheets once a week in Hot WateR.

n Wash clothing and stuffed toys in Hot WateR.

n Keep PetS out of the bedroom and wash pets weekly.

n Avoid going outside if the PoLLen coUnt is high.

n Cover mattress and pillows with airtight PLaStic coveRS.

Asthma control: What can it mean for you?The goals of asthma treatment are to help you: n Get relief from asthma symptoms, such as wheezing,

coughing, shortness of breath, and chest tightness

n Need a fast-acting inhaler fewer than 2 days a week

n Sleep through the night and not wake up because of asthma symptoms

n Go to work or school and not have to miss days because of asthma

n Join in activities, including sports and exercise

n Avoid unscheduled doctor, emergency room, or urgent- care visits

notes:












q _____________________________________ ________ mg (oral steroid)


Medicine


WoRKPLace/ScHooL/DaycaRe coPy








Signs and symptoms






Take this medicine:

First

second

Parent/Guardian

Date (Signed authorization expires 1 year from this date.)

I, (parent or guardian), hereby authorize that the following steps be taken in conjunction with the attached Asthma Action Plan:

My child, , may carry and self-administer medications as outlined in the Asthma Action Plan, consistent with policies, for a period not to exceed 1 year.

School district/child care personnel may assist my child with use and interpretation of the Asthma Action Plan, consistent with policies, for a period not to exceed 1 year.

School district/child care personnel may administer medications to my child as outlined in the Asthma Action Plan, consistent with policies, for a period not to exceed 1 year.

q

q

q












q _____________________________________ ________ mg (oral steroid)


Medicine


HeaLtH caRe PRoviDeR/FiLe coPy








Signs and symptoms






Take this medicine:

First

second

Do you have asthma symptoms (such as coughing, wheezing, breathlessness, or chest tightness) more than 2 days a week?

Do you have to use your rescue inhaler or nebulizer medication more than 2 days a week?

Does your asthma keep you from getting as much done as you would like at work, school, or home?

Are you waking up at night because of asthma symptoms more than 2 times a month?

If you answered “Yes” to any of these questions, your asthma may not be under control. You should discuss your answers with your health care provider.

Asthma Assessment Tool

YES NO

q

q

q

q

q

q

q

q

Copyright © 2010 M

erck Sharp & Dohm

e Corp., una filial de Merck &

Co., Inc. Todos los derechos reservados. 21004938(7)-01/11-SGR-Spanish US Im

preso en los EE UU con un mínim

o del 10% de papel reciclado

Su

min

istrada p

or M

erck com

o recu

rso ed

ucativo

AS

MA

Plan

de A

cción p

ara el Au

tocon

trol

del A

sma (A

.S.M

.A.)

Cálculos

Valores de flujo máxim

o

Zona verde

Mejor m

edición personal (PB)

Zona am

arillaC

alcule el 80% de su m

ejor medición personal

PB x 0.8 =

Zona roja

Calcule el 50%

de su mejor m

edición personal PB

x 0.5 =

Instru

ccion

es para el u

so:

El Plan A

SMA

es una herramienta que los proveedores de cuidados de la salud pueden usar para lograr que los

pacientes y sus familias participen en conversaciones sobre los principios para un m

anejo y control adecuados del asm

a. El Plan A

SMA

está específicamente diseñado para proporcionar un plan conciso para el control del

asma. E

l paciente y la familia deben ser capaces de dem

ostrar que entienden el plan y el uso adecuado de todos los m

edicamentos para el asm

a. El P

lan ASM

A se vale de los signos y síntom

as o lecturas de flujo máxim

o para m

onitorear el control del asma.

Entregue las prim

eras 2 copias del formulario del P

lan ASM

A al paciente/fam

ilia. Diga al paciente/

familia que conserven 1 copia del plan y que lleven la otra copia al lugar de trabajo, la escuela o al centro

de cuidados diurnos del paciente. Conserve la tercera copia para sus registros.

Có

mo

usar las zo

nas:

Com

plete con los valores numéricos de las lecturas de flujo m

áximo (no con los porcentajes). U

se el siguiente cuadro para determ

inar el 50% y el 80%

de las lecturas de su mejor m

edición personal de flujo máxim

o.

Med

ición

de flu

jo m

áximo

: Los pacientes m

ayores de 5 años pueden usar los medidores de flujo m

áximo para m

onitorear su asma. Los

padres de niños menores de 5 años deben usar los síntom

as que se enumeran en el Plan A

SMA

para determinar

la zona en la que se encuentran sus hijos.

La mejor m

edición personal de flujo máxim

o debe determinarse cuando el paciente no tiene síntom

as. Para registrar la m

ejor medición personal se puede usar un diario, el cual, por lo general, se incluye en el paquete del

medidor de flujo m

áximo. Para los niños, una buena idea es obtener una lectura del flujo m

áximo en cada visita

de control del asma y determ

inar nuevamente la m

ejor medición personal de m

anera regular.

100%

80%

50%

ZO

NA

VE

RD

E: enum

ere todos los medicam

entos y las instrucciones correspondientes en las casillas adecuadas. Se encuentra en la

zona verde cuando de la medición es del 100%

al 80% de la m

ejor medición personal o cuando el paciente no tiene síntom

as.

ZO

NA

AM

AR

ILLA

: indique al paciente que continúe tomando los m

edicamentos de la zona verde y que tom

e todos los

medicam

entos que se enumeran en la zona am

arilla. Se encuentra en la zona amarilla cuando la m

edición es del 79% al 50%

de

la mejor m

edición personal o cuando el paciente experimenta los síntom

as que se enumeran en la zona am

arilla. Es im

portante

indicar el período durante el cual el paciente debe continuar tomando estos m

edicamentos y en qué m

omento debe com

unicarse con usted.

ZO

NA

RO

JA: enum

ere todos los medicam

entos que el paciente debe tomar antes de com

unicarse con usted o mientras se

prepara para ir a la sala de emergencias. Se encuentra en la zona roja cuando la m

edición es inferior al 50% de la m

ejor medición

personal o cuando el paciente experimenta los síntom

as que se enumeran en la zona roja.

Plan de Acción para el Autocontrol del Asma (A.S.M.A.)Plan A.S.M.A. para ______________________________________________________ Nombre del proveedor de cuidados de la salud _________________ Fecha ______________________________________________________

Teléfono del proveedor de cuidados de la salud _______________ Fuera del horario de atención ____________ Teléfono del hospital/Departamento de Emergencias __________________________

ZONA VERDE: buen estado de salud Incluso si no tiene síntomas, tome estos medicamentos de control a largo plazo todos los días.

Antes de hacer ejercicio, tome (Medicamento) (Dosis) (Minutos/horas antes de hacer ejercicio)

ZONA AMARILLA: el asma está empeorando

Signos y síntomasn Tos, sibilancia, presión en el pecho o disnea; n despertarse durante la noche a causa del asma; o bien,n capacidad para realizar algunas, pero no todas,

las actividades habituales.

oFlujo máximo: _______ al _____________ (L/min) (50% al 79% de mi flujo máximo óptimo).

ZONA ROJA: ¡alerta médica! Signos y síntomas n Disnea intensa; n los medicamentos de alivio rápido no ayudaron; n incapacidad para realizar las actividades habituales; o bien,n los síntomas son los mismos que los de la ZONA AMARILLA o empeoraron

luego de 24 horas.oFlujo máximo: inferior a __________________ (L/min) (menos del 50% de mi flujo máximo óptimo).

SIGNOS DE PELIGROn Dificultades para caminar y hablar debido a la disnea n Adminístrese q 4 o q 6 inhalaciones del medicamento de alivio rápido Y n Labios o uñas azules n Vaya al hospital o llame una ambulancia ( _______________________________ ) ¡DE INMEDIATO!Personas que deben tener una copia de mi plan A.S.M.A.: cónyuge, enfermera de la escuela, compañeros de trabajo, niñera, familiares, amigos.Adaptado del Instituto Nacional del Corazón, los Pulmones y la Sangre. Plan de Acción para el Asma. Bethesda, MD: Departamento de Salud y Servicios Humanos de EE. UU.: abril de 2007. Publicación 07-5251 de NIH.

Incorpore el medicamento de alivio rápido y continúe tomando el medicamento de la ZONA VERDE.

____________________________________ q de 2 a ___ inhalaciones cada ___ minutos para ___ tratamientos; o bien, (antagonistas β2 de efecto inmediato) q tratamientos con nebulizadores.

q _____________________________________ q 4 o q 6 inhalaciones o nebulizaciones (antagonistas β2 de efecto inmediato)

q _____________________________________ ________ mg (esteroide oral)

Llame a su proveedor de cuidados de la salud DE INMEDIATO. Vaya al hospital o llame una ambulancia si:n aún se encuentra en la ZONA ROJA luego de 15 minutos Yn no pudo comunicarse con su proveedor de cuidados de la salud.

Medicamento

Cantidad que debe tomar Momento en que debe tomarlo

Primero

segundo

Copia para el paCienteFirma del proveedor de cuidados de la salud _______________________________________

Signos y síntomas n No presenta tos, sibilancia, presión en el pecho ni disnea

durante el día ni la noche;n capacidad para realizar actividades habituales.

En el caso de que se use un medidor del flujo máximo: Mi mejor medición personal de flujo máximo es __________(L/min)Flujo máximo: superior a __________________________________ (80% de mi flujo máximo óptimo o superior).

Copyright © 2010 Merck Sharp & Dohme Corp., una filial de Merck & Co., Inc. Todos los derechos reservados. 21004938(7)-01/11-SGR-Spanish US Impreso en los EE UU con un mínimo del 10% de papel reciclado

Suministrada por Merck como recurso educativo

Tome estos medicamentos:

Si sus síntomas (y flujo máximo, si se usó) vuelven a ser los de la ZONA VERDE luego de 1 hora de transcurrido el tratamiento anterior, haga lo siguiente:Continúe con el monitoreo para asegurarse de permanecer en la ZONA VERDE. oSi sus síntomas (y flujo máximo, si se usó) no vuelven a ser los de la ZONA VERDE luego de 1 hora de transcurrido el tratamiento anterior, haga lo siguiente:q Tome _______________________________________ q 2 o q 4 inhalaciones o q nebulizaciones cada ________ horas. (antagonistas β2 de efecto inmediato) q Incorpore ___________________________________ __________ mg por día durante _______ (3 a 10) días. (esteroide oral) q Incorpore _____________________________________________________________ por día durante _______ días.

q Llame al proveedor de cuidados de la salud q antes o q luego de ___ horas después de haber tomado el esteroide oral.

Sus objetivos para el control del asma

Consejos útiles para ayudarlo a controlar su asmaSu salud:

n Tome sus medicamentos para el asma tal como se lo recomienda su proveedor de cuidados de la salud, incluso cuando se sienta bien.

n Consulte con su proveedor de cuidados de la salud antes de tomar cualquier medicamento de venta libre.

n Hable con su proveedor de cuidados de la salud sobre las maneras para mantenerse más saludable.

En su hogar, lugar de trabajo o escuela:

n Procure mantener su CaSa libre de polvo y moho.

n Evite el HUMo del cigarrillo y el habano en la mayor medida posible.

n Evite los oloreS fuertes, como los de la pintura, los perfumes y los fijadores para el cabello.

n Use una bufanda o una máscara para aire FrÍo sobre su boca cuando esté frío afuera.

Además, si tiene alergias, haga lo siguiente:

n Lave las mantas y sábanas una vez a la semana con aGUa Caliente.

n Lave las prendas y los juguetes de peluche con aGUa Caliente.

n Mantenga las MaSCotaS fuera de la habitación y báñelas semanalmente.

n Evite salir si hay demasiado polen.

n Cubra el colchón y las almohadas con FUndaS de pláStiCo HerMétiCaS.

Control del asma: ¿qué puede significar para usted?Los objetivos del tratamiento del asma son ayudarlo en los siguientes aspectos: n Aliviar los síntomas del asma, como las sibilancias, la tos, la

disnea y la presión en el pecho.

n Disminuir la necesidad de un inhalador de acción rápida a menos de 2 días por semana.

n Dormir toda la noche y no despertarse debido a los síntomas del asma.

n Ir a trabajar o a la escuela y no ausentarse debido al asma.

n Participar en actividades, incluidos los deportes y el ejercicio.

n Evitar visitas no programadas al médico, a la sala de emergencias o de atención de urgencia.

notas:

















Medicamento


Primero

segundo









Copia para el lUGar de trabajo/eSCUela/Centro de CUidadoS diUrnoSFirma del proveedor de cuidados de la salud __________________________

Padre, madre/tutor

Fecha (La autorización firmada vence luego de 1 año a partir de esta fecha).

Yo, (padre, madre o tutor), por medio del presente documento autorizo que se tomen las siguientes medidas junto con el Plan de Acción para el Asma adjunto:

Mi hijo, , puede portar y administrarse los medicamentos tal como se detalla en el plan de acción para el asma, de manera consecuente con las políticas, por un período no superior a 1 año.

El personal del distrito escolar/la guardería puede ayudar a mi hijo con el uso y la interpretación del Plan de Acción para el Asma, de manera consecuente con las políticas, por un período no superior a 1 año.

El personal del distrito escolar/la guardería puede administrarle los medicamentos a mi hijo tal como se detalla en el Plan de Acción para el Asma, de manera consecuente con las políticas, por un período no superior a 1 año.

q

q

q

















Medicamento


Primero

segundo









Firma del proveedor de cuidados de la salud __________________________ Copia para el proveedor de CUidadoS de la SalUd/de arCHivo

¿Presenta síntomas de asma (como tos, sibilancias, disnea o presión en el pecho) más de 2 días a la semana?

¿Debe usar su inhalador de rescate o medicamento nebulizador más de 2 días a la semana?

¿Le impide el asma hacer todo lo que le gustaría en el trabajo, la escuela o el hogar?

¿Se despierta por la noche debido a los síntomas del asma más de 2 veces al mes?

Si contestó “sí” a alguna de estas preguntas, es posible que su asma no esté bajo control. Debe hablar sobre sus respuestas con su proveedor de cuidados de la salud.

Herramienta para la Evaluación del Asma

SÍ NO

q

q

q

q

q

q

q

q

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Molina Healthcare of New Mexico, Inc. Durable Medical Equipment (DME) Providers Who Stock Practitioner Asthma Closet

Molina Healthcare of New Mexico 2008.04.11-ajb/VL/ES

Identification of Issues Evidence presented in regional Asthma Summits occurring in New Mexico and Molina Healthcare of New Mexico's, Inc. (Molina Healthcare) internal Quality Improvement process have noted asthma prevalence disparities in sections of the state. The most significant disparity was noted in Region Four (4) in the southeastern quadrant of New Mexico. Practitioners in the community have noted there are access issues related to time sensitive supplies which may also be a factor in providing care in the office versus transfer to the emergency room (ER) and/or subsequent hospitalization. Process to Reduce ER Visits and Hospitalizations and Increase Patient Compliance with Self Monitoring and Medication Use Identified DME providers have agreed to assist practitioner sites in stocking an "Asthma Closet" as a service to the provider. The practitioner office site notifies the supplier who stocks the items in the practitioner’s office. Items to be stocked are nebulizers and peak flow meters. You may want to contact your local DME provider to see if they would be willing to provide this service. As needed the Practitioner uses the items; The practitioner’s office notifies the DME company by telephone or other means of DME use and identifies the patient as a

Molina Healthcare Member; and The DME provider restocks the item and then bills Molina Healthcare.

Molina Healthcare does not require prior authorization for the above noted equipment. Medication for Nebulizer Treatments in Provider Office Your pharmacy representatives may be able to stock sample medication and saline for your use with patients; Your local hospital affiliation may allow for medication and saline purchase from the hospital pharmacy at a reduced cost; It is appropriate to bill Molina Healthcare for the nebulizer medication but only at the cost incurred; and It is appropriate to bill Molina Healthcare via procedural codes for administration of nebulizer medication.

Aerochambers for Inhalers Aerochambers are distributed by pharmacies with prescription fills. Include an aerochamber when prescribing inhaler medication; and Molina Healthcare Members can get two (2) aerochambers per year without a prior authorization.

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Referral to Molina Healthcare Disease Management Program A referral to the Molina Healthcare Disease Management Program is strongly recommended. Disease management program contacts are conducted by Registered Nurses. This adjunctive service is available to assist the practitioner in reinforcing asthma interventions. The Disease Management Program will forward regular routine reports to the practitioner for the purposes of coordination of care. Referrals to the Disease Management Program can be made by telephone, fax or mail to the following:

Molina Healthcare of New Mexico, Inc. Quality Improvement Department 8801 Horizon Blvd, Albuquerque, NM 87113 Telephone: (505) 342-4660 ext. 182618 Fax toll free: (866) 660-7185 Outside Albuquerque: T o l l f r e e (800) 377-9594 ext. 182618

The Disease Management Referral Form can be accessed at www.molinahealthcare.com.

Goals of Therapy: Asthma Control Peak flow meters are designed as monitoring, not as diagnostic, tools in the office. Whether peak flow monitoring, symptom monitoring (available data show similar benefits for each), or a combination of approaches is used, self-monitoring is important to the effective self-management of asthma. Patients should be taught to recognize symptom patterns indicating inadequate asthma control and the need for additional therapy. Consider peak flow monitoring for patients who have:

Moderate or severe persistent asthma A history of severe exacerbations; and Poorly perceive airflow obstruction and worsening asthma.

Long-term daily peak flow monitoring can be helpful to: Detect early changes in asthma control that require adjustment in treatment; Evaluate responses to changes in treatment; and Provide a quantitative measure of impairment.


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Measures for Periodic Assessment and Monitoring of Asthma Control The National Asthma Education and Prevention Program Expert Panel recommend that ongoing monitoring of asthma control be performed to determine whether all the goals of therapy are met thereby reducing both impairment and risk. The Expert Panel also recommends that the frequency of visits to a clinician for review of asthma control is a matter of clinical judgment. Patients who have intermittent or mild persistent asthma that has been under control for at least three (3) months should be seen by a clinician every six (6) months. Patients who have uncontrolled and/or severe persistent asthma and those who need additional supervision to help them follow their treatment plan need to be seen more often. Evidence for the Above Recommendations The citations are excerpted from the National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute; August 2007, pg. 362. For an adapted copy of the National Clinical Practice Guideline refer to the Molina Healthcare website: http://www.molinahealthcare.com/mhnm/provider/linkeddocuments/CPG01.pdf

http://www.molinahealthcare.com/mhnm/provider/linkeddocuments/CPG01.pdf

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DME Provider Address City State ZIP Telephone Fax

Apria Healthcare, Inc. - Albuquerque

4401 McLeod Road NE, Suite C Albuquerque NM 87109 (505) 881-9111 (505)-884-6906

Apria Healthcare, Inc. - Farmington

1014 A Butler Avenue Farmington NM 87401 (505) 325-7575 (505) 325-8412

Apria Healthcare, Inc. - Clovis

1202 West 21st Street Clovis NM 88101 (575) 763-0202 (575) 769-2899

Apria Healthcare, Inc. - Hobbs

2827 N Del Paso, Suite 101 Hobbs NM 88240 (575) 392-0202 (575) 392-7014

Apria Healthcare, Inc. - Las Cruces

1630 Hickory Loop, E & F Las Cruces NM 88005 (575) 525-2494 (575) 525-0750

Acoma/Canoncito/ Laguna Indian Hospital (Apria)

1570 Pacheco Street Santa Fe NM 87501 (505) 982-2901 (505)-884-6906

Sandia Surgical, Inc. 6120 Signal Avenue NE Albuquerque NM 87113 (505) 883-2817 Toll free (800)753-1589

(505) 888-4552

PULMONARY/ASTHMAPULMONARY/ASTHMA

Have you ever wanted

a consultation with a

pulmonary specialist

without you or your

patient leaving the

clinic?

Please join us! Please join us!

If you would like to If you would like to participate, please contact:participate, please contact:

Kathleen Moseley, RN, MS Kathleen Moseley, RN, MS

Nurse Educator

Office: 505.272.6777

Email: [email protected]

Karen A. LutteckeKaren A. Luttecke

Administrative Assistant III

Office: 505.272.8440

Email: [email protected]

Project ECHOProject ECHO

Department of Internal Medicine

University of New Mexico

Albuquerque, New Mexico 87102

Working to Bring Specialty

Healthcare to All New Mexicans

Project ECHO (Extension for

Community Healthcare

Outcomes) is a new and

innovative model in treating

complex chronic diseases

in rural and underserved areas of

New Mexico. Via technology,

ECHO bridges the gap between

urban healthcare specialists and

providers in rural settings.

Michelle Harkins, MDAssociate Professor: IM Div of Pulmonary, Critical Care and sleep

Pulmonary

Michelle Harkins, MD is beginning the process to conduct an asthma/ obstructive airways disease management clinic. It will initially involve case presentation of complex obstructive airway disease and asthma patients, and then broaden to include a variety of pulmonary diseases.

We envision having training sessions here in our clinic for interested asthma educators as well so that they can go back to their communities to help providers monitor asthmatics. We will also focus on environ- mental triggers for lung disease.

Asthma affects 6

percent of the general

population.

Together we can help

your patients breathe

easier.

Please join us!

Pulmonary Asthma

Telemedicine Clinic will

be held routinely on

the 2nd and 4th Fridays

of the month from 12

Noon to 1 PM.

Pulmonary/Asthma Telemedicine

Section O-2 Diabetes Mellitus



Clinical Practice Guideline New Mexico Healthcare Takes on Diabetes Collaborative

Molina Healthcare has approved the New Mexico Healthcare Takes on Diabetes Practice Guidelines for diabetes management. This guide is available at http://nmtod.com/pdfs/Profguideline2011final.pdf. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://nmtod.com/pdfs/Profguideline2011final.pdf



Managing Diabetes The New Mexico Healthcare Takes on Diabetes Adult Diabetes Practice Guideline 2011 was approved by the Quality Improvement Committee on October 5, 2011.



Section O-3 Hypertension



Clinical Practice Guideline Diagnosis and Management of Hypertension in Adults and Children

Molina Healthcare has approved the U.S. Department of Health and Human Services, National Heart Lung and Blood Institute (NHLBI) guidelines for Diagnosis and Management of Hypertension in Adults and Children. These guidelines are available at: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf



Diagnosis and Management of Hypertension in Adults and Children The National Heart, Lung and Blood Institute Guideline for Diagnosis and Management of Hypertension in Adults and Children was approved by the Quality Improvement Committee on October 5, 2011.



Section O-4 Coronary and Other Vascular Disease



Clinical Practice Guideline Secondary Prevention for Patients with Coronary and Other Vascular Disease

Molina Healthcare has approved the National Heart Lung and Blood Institute (NHLBI) guideline for Secondary Prevention for Patients with Coronary and Other Vascular Disease guidelines. These guidelines are available at http://circ.ahajournals.org/content/113/19/2363.full. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://circ.ahajournals.org/content/113/19/2363.full



Secondary Prevention for Patients with Coronary and Other Vascular Disease The American Heart Association Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Diseases: 2006 Update was approved by the Quality Improvement Committee on October 5, 2011.



Section O-5 Acute Otitis Media



Clinical Practice Guideline Diagnosis and Management of Acute Otitis Media

Molina Healthcare has approved the American Academy of Pediatrics and the American Academy of Family Physicians Subcommittee on Management of Acute Otitis Media guidelines. These guidelines are available at http://aappolicy.aappublications.org/cgi/reprint/pediatrics;113/5/1412.pdf. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://aappolicy.aappublications.org/cgi/reprint/pediatrics;113/5/1412.pdf



Diagnosis and Management of Acute Otitis Media

The American Academy of Pediatrics and the American Academy of Family Physicians Subcommittee on Management of Acute Otitis Media guidelines were approved by the Quality Improvement Committee on October 5, 2011.



Section O-6 Upper Respiratory Illness and Pharyngitis



Clinical Practice Guideline Diagnosis and Treatment of Upper Respiratory Illness and Pharyngitis in Children and Adults

Molina Healthcare has approved the Institute for Clinical Systems Improvement (ICSI) guidelines for Diagnosis and Treatment of Upper Respiratory Illness and Pharyngitis in Children and Adults. These guidelines are available at: http://www.icsi.org/respiratory_illness_in_children_and_adults__guideline_/respiratory_illness_in_children_and_adults__guideline__13116.html. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://www.icsi.org/respiratory_illness_in_children_and_adults__guideline_/respiratory_illness_in_children_and_adults__guideline__13116.html

http://www.icsi.org/respiratory_illness_in_children_and_adults__guideline_/respiratory_illness_in_children_and_adults__guideline__13116.html



Upper Respiratory Illness and Pharyngitis

The Institute for Clinical Systems Improvement Guidelines for Diagnosis and Treatment of Upper Respiratory Illness and Pharyngitis in Children and Adults were approved by the Quality Improvement Committee on October 5, 2011. http://www.icsi.org/guidelines_and_more/gl_os_prot/respiratory/respiratory_illness_in_children_and_adults__guideline_/respiratory_illness_in_children_and_adults__guideline__13110.html

http://www.icsi.org/guidelines_and_more/gl_os_prot/respiratory/respiratory_illness_in_children_and_adults__guideline_/respiratory_illness_in_children_and_adults__guideline__13110.html



Section O-7 Individuals with Special Health Care Needs



Clinical Practice Guideline Therapies for Individuals with Special Health Care Needs

Molina Healthcare has approved the American Academy of Pediatrics guideline for Therapies for Individuals with Special health Care Needs. These guidelines are available at: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;113/6/1836.pdf. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.




Individuals with Special Health Care Needs The American Academy of Pediatrics Guideline for Therapies for Individuals with Special Health Care Needs was approved by the Quality Improvement Committee on October 5, 2011.



Section O-8 Acute Low Back Pain



Clinical Practice Guideline Management of Uncomplicated Acute Low Back Pain in Adults

Molina Healthcare has approved the Michigan Quality Improvement Consortium Management of Acute Low Back Pain Guideline. This guideline is available at: http://guideline.gov/content.aspx?id=24718&search=back+pain. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.

http://guideline.gov/content.aspx?id=24718&search=back+pain



Management of Uncomplicated Acute Low Back Pain in Adults

The Michigan Quality Improvement Consortium Management of Acute Low Back Painguideline was approved by the Quality Improvement Committee on October 5, 2011.

http://guideline.gov/content.aspx?id=24718&search=back+pain

Section O-9 Acute Bronchitis



Clinical Practice Guideline Management of Uncomplicated Acute Bronchitis in Adults

Molina Healthcare has approved the Michigan Quality Improvement Consortium guideline for Management of Uncomplicated Acute Bronchitis in Adults. This guideline is available at: http://www.guideline.gov/content.aspx?id=16317. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.



Management of Uncomplicated Acute Bronchitis in Adults

The Michigan Quality Improvement Consortium Guideline for Management of Uncomplicated Acute Bronchitis in Adults was approved by the Quality Improvement Committee on October 5, 2011.

http://www.guideline.gov/content.aspx?id=16317

http://www.guideline.gov/content.aspx?id=16317



Clinical Practice Guideline Prevention and Treatment of Adult Overweight and Obesity in Primary Care

Molina Healthcare has approved the National Institutes of Health National Heart, Lung, and Blood Institute guideline for Prevention and Treatment of Adult Overweight and Obesity in Primary Care. This guideline is available at http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. For guideline updates please reference Molina Healthcare’s website at www.molinahealthcare.com. If you do not have internet capability a hard copy of the clinical practice guideline can be mailed to you. Call Provider Services in Albuquerque (505) 342-4660 or toll free (800) 377-9594.



Prevention and Treatment of Adult Overweight and Obesity in Primary Care The National Institutes of Health National Heart, Lung and Blood Institute Guideline for Prevention and Treatment of Adult Overweight and Obesity in Primary Care was approved by the Quality Improvement Committee on October 5, 2011.

http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf

http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf

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