Family Practice Residency Training Programs Capitation & Special Programs Funding Webinar
Incorporating Best Practices through Practice Organization & EMRs in a Residency Practice
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Transcript of Incorporating Best Practices through Practice Organization & EMRs in a Residency Practice
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Incorporating Best Practices
through Practice Organization & EMRs
in a Residency PracticeMathew Devine, D.O.
Associate Medical Director
Highland Family Medicine
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Highland Family Medicine – Urban Family Medicine Residency
History
• Founded 1967
• Recent expansion to 12:12:12
• Urban Health Clinic
• 261 bed Critical care hospital
• P4 Residency program 2007
• 60 providers in practice
• Total patient population over 19, 000
• > 55,000 visits per year
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Chronic Pain and Narcotic Use at Highland Family Medicine
2009
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Objectives of this section
• Discuss contract and narcotics policy use in resident practices
• Identify importance of patient databases to support chronic pain
management in residency practices
• Review audit document used for peer review in residency practices
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Use of EMR for tracking of Chronic Pain
• Use of Patient lists in EMR to create Chronic Pain Database
• Placing identifier on medication list for those on chronic
narcotics, “1-pain management agreement”
• Implementing peer review to audit charts of patients with
chronic pain
• Collaboration through EMR with Pain management clinic in
system, placing and tracking referrals
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Peer Review/Audit process and results
Updated information to provided at live presentation
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Use of urine toxicology in monitoring
Urine should contain the prescribed drug/s:
• If not, the patient may be diverting or providing a fake sample to cover
other substances, make sure you know what your UDS is capable of
detecting
Urine should be free of non-prescribed substances:
• If the patient is unable to relinquish alcohol / recreational drugs in order
to receive treatment, either treatment is not very important or the
other drugs are overly important, and addiction assessment/RX is
needed.
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Urine drug screening results from practice
Updated information to provided at live presentation
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Helping Patients Whose Pain is Not Relieved Through Group Visits
and Emotional Support
Mathew Devine, D.O.
Associate Medical Director
Highland Family Medicine
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Objectives of this section
• Review the curriculum, patient selection, and data collection performed
for chronic pain group visit
• interpret the data from chronic pain group visits in regards to
improvement of functional status, depression, and identification of
addiction
•Discuss the tenets of creating a successful group visit format in residency
practices
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Group VisitsAvailable at Highland Family Medicine
• Chronic Pain
• Diabetes
• Pediatric Asthma
• Depression
• In the pipeline:
•Prenatal visits
•Tobacco
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Group Visit Format
Referrals from PCP/CCP to group
Closed group of 8 sessions over 6 months
Group size goal of 8-12 patients
Team consists of 2 providers, psychologist, nurse, and
resident(s)
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Why Group Medical Visits?
•PCMH: AAFP; TransforMed
•Growing Literature supports benefits
•Improved clinical outcomes
•Patient satisfaction
•Provider satisfaction
•Cost-neutral
• Education
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Group Visit Data
1. REALM
2. PHQ-9
3. DAST
4. AUDIT
5. PDQ – Functional assessment tool
6. Smoking and Anxiety history
7. Re-sign pain contract
8. Urine Drug Screen
9. Domestic Violence screen
10. How’s Your Health online survey
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Functional Assessment - Data Review
• Used an evidence based assessment survey that
checks functional and psychosocial components of
the patient
• The higher functioning and emotional stable the
individual is the lower the scores
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PDQ data from Chronic Pain group regarding: Functional assessment
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Initial visit and Last visit data
Chronic Pain Group Functional Assessment
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PDQ data from Chronic Pain group regarding: Psychosocial assessment
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PDG Psychosocial Assessment Data
Pre and Post results
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Depression Screening data
Information to be provided at session
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Addiction
• Regardless of referral source – resident, nurse practitioner, or
attending, addiction was found to be heavily present in sample
of patients selected
• Majority of patients coming to group female
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Addiction results
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Resident involvement in Group process
• Get to observe them in group setting in motivation interviewing
and teaching to patients
• Work closely with them on EBM evidence for pain management
• Can follow their prescription habits
• Can provide more structure and an organized plan and
improved historical information of patients for further individual
management by providers using annual pain review assessment
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Downsides of Group visit
• Billing
• If applicable patient has to be for each co-pay
• Increased time of session, planning, and calling/mailing to patients
• Patient difficulty with being on time to visit
• Identification of addiction early in process and losing individual from
group due to treatment or patient refusal to return
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What other services are available to patients with chronic pain?
•Physical therapy
• Adjunct treatment
• Acupuncture
• Chiropractor
• Osteopathic Manipulation
• Massage therapy
• Hypnosis
• Behavioral health therapy
• Family therapy
• Pain management evaluation
• Support groups
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