Group Medical Appointments Chesapeake Care Free Clinic Mary Beth Carr, NP.

Group Medical Group Medical AppointmentsAppointments

Chesapeake Care Free ClinicChesapeake Care Free ClinicMary Beth Carr, NPMary Beth Carr, NP

Chesapeake Care Free Chesapeake Care Free ClinicClinic

GMA OverviewGMA Overview

• Why GMA? Support and efficiencyWhy GMA? Support and efficiency

• Started 2004 with diabetics and a Started 2004 with diabetics and a volunteer endocrinologist, pt had to attend volunteer endocrinologist, pt had to attend the education sessions offered by the the education sessions offered by the hospital to take parthospital to take part

• NP led started 2/08 with HTN diagnosis led NP led started 2/08 with HTN diagnosis led with an RN, over 200 pts have participatedwith an RN, over 200 pts have participated

• NP led expanded to diabetes in Feb 2010 – NP led expanded to diabetes in Feb 2010 – led with a DNE, 24 pts to dateled with a DNE, 24 pts to date


HTN GMAHTN GMA

• Monthly HTN GMA Group-elements included-Monthly HTN GMA Group-elements included-definition of high BP, dangers of uncontrolled BP, definition of high BP, dangers of uncontrolled BP, importance of staying on medications life long, how importance of staying on medications life long, how meds work and side effects, smoking cessation meds work and side effects, smoking cessation (referrals), moderate ETOH, eating and activity (referrals), moderate ETOH, eating and activity plans, stress management, also brief physical plans, stress management, also brief physical exam. Labs reviewed and meds refilled. At least 2-exam. Labs reviewed and meds refilled. At least 2-3 hours. Confidentiality form signed.3 hours. Confidentiality form signed.

• Data from 2/08-6/09 gatheredData from 2/08-6/09 gathered• Total 77 pts, pt diagnosed with HTN on meds. Total 77 pts, pt diagnosed with HTN on meds. • Originally looked at BP at baseline and repeat BP Originally looked at BP at baseline and repeat BP

6/12/24 mos, also weight, LDL and dx mental health6/12/24 mos, also weight, LDL and dx mental health


DataData

• 1 year data 40 patients from 2/08-11/081 year data 40 patients from 2/08-11/08• Lost 14 people to follow up (26%)Lost 14 people to follow up (26%)• Of the 40 patients 24 were at goal (below 140/90) Of the 40 patients 24 were at goal (below 140/90)

at first HTN GMA, 16 above goal.at first HTN GMA, 16 above goal.• At 1 year 27 pt were at goal, 13 above goal. At 1 year 27 pt were at goal, 13 above goal. • Of those that started at goal 17 stayed at goal, Of those that started at goal 17 stayed at goal,

(42%) 7 went up (17%), 10 went from above goal (42%) 7 went up (17%), 10 went from above goal to goal (25%), 6 stayed above goal from start to to goal (25%), 6 stayed above goal from start to finish (15%) (failure?? Need to look at finish (15%) (failure?? Need to look at improvement of BP)improvement of BP)

• 67% of pts that went through HTN GMA are at 67% of pts that went through HTN GMA are at goal at 1 year. Need to compare that data to goal at 1 year. Need to compare that data to those that did not attend GMA.those that did not attend GMA.


Other DataOther Data

• Surprising result-53% gained weight Surprising result-53% gained weight from 2-15 lbs in one year. Since then from 2-15 lbs in one year. Since then we have instituted more info on we have instituted more info on weight loss and exercise in the class.weight loss and exercise in the class.

• Of note-LDL went down in 50% of pts Of note-LDL went down in 50% of pts (most placed on statins), only 8 had (most placed on statins), only 8 had mental health diagnosesmental health diagnoses


Successes and ChallengesSuccesses and Challenges

• Successes-started the process! Reported Successes-started the process! Reported pt satisfaction, volunteer RN pt satisfaction, volunteer RN involvement, part of our culture now, involvement, part of our culture now, flexibility-use what you have that day, flexibility-use what you have that day, BPs improvedBPs improved

• Challenges-need more staff, bottlenecks, Challenges-need more staff, bottlenecks, need other providers involved, constant need other providers involved, constant education of front desk, have had all education of front desk, have had all barriers mentionedbarriers mentioned


Final ThoughtsFinal Thoughts

• Collecting data is a lot of work! (even with Collecting data is a lot of work! (even with EMR)EMR)

• I am satisfied that 67% of the pts are at I am satisfied that 67% of the pts are at goal, I would like to have another intern to goal, I would like to have another intern to collect the statistics after 6/09 (another collect the statistics after 6/09 (another 100 pts at least)100 pts at least)

• Don’t focus on those already at goal-just Don’t focus on those already at goal-just make it easy for them to get their medsmake it easy for them to get their meds

• Focus on those that are above goalFocus on those that are above goal• Work on weight lossWork on weight loss

Group Medical Appointments Chesapeake Care Free Clinic Mary Beth Carr, NP.

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