Spring 2013: UCHC Premed Training

Transcript

1. PRE-MED VOLUNTEER TRAINING HEALTH CLINIC @ UNIVERSITY CITY HOSPITALITY COALITION JANUARY 2013
2. H E L L O MY NAME IS John E. Nawn
3. JANUARY 1983
4. JANUARY 1983
6. STUDENT-RUN FREE CLINIC 1 2
7. APPROX. 150 PATIENTS OVER 300 VISITS OUR PATIENTS
8. 49 AVERAGE AGE
9. 62% MALE 38% FEMALE GENDER
10. 52% HAVE MEDICAL COVERAGE ACCESS TO CARE
11. 38th Street Sansom Street St. Agatha St. James X LOCATION
12. Wednesdays 5-7:30pm q3 weeks SCHEDULE
13. DRESS CODE ✓ X
14. DRESS CODE ✓
15. MD PharmD Premed (5) MS1 (3-5) MS4 (1-2) CLINICAL TEAM
16. VOLUNTEER ROLE What will I be doing?
18. FORMS!?! Part 1
19. DIANA ROUNDTREE 9/15/1974 38 F X HEALTH PARTNERS X DR. LEE PCPC CLINC, PRESBY. HOSP. JULY 2012 X X METFORMIN
20. DIANA ROUNDTREE DOB: 9/15/1974 3/7/12 4/4/12 4/11/12 6/20/12 8/22/12 9/12/12 250 294 200 242 250 236 8 11:00 AM 10 5 6 8 JEN NS NS DTN JZ NS Should you be concerned by these numbers?
21. DIANA ROUNDTREE DOB: 9/15/1974 THE BIG D
22. ! Type 1 DM: body produces little to no insulin ! Type 2 DM: body does not produce enough insulin for proper function, or the cells in the body do not react to insulin Insulin: necessary for the body to be able to use glucose for energy
23. ! Age >45 ! First degree relative with type 2 ! African-American, Hispanic, Asian, Pacific islander, or Native-American ethnicity ! Overweight, especially abdominally obesity ! Smoker ! Cardiovascular disease, hypertension, dyslipidemia, or other metabolic syndrome features
25. ! Symptoms (compatible with type 2) •  Polyuria •  Polydipsia •  Polyphagia ! Elevated incidental blood glucose levels •  ≥ 126 mg/dL fasting "  Confirmed on repeated testing on another day=current American Diabetes Association preferred criterion for diagnosis •  ≥ 200 mg/dL nonfasting
29. ! Impaired fasting glucose: fasting plasma glucose level 100 to 125 mg/dL
30. ! Diet & Exercise •  Lifestyle intervention: "  Low-calorie, low-fat diet "  ≥150 min moderate exercise/week •  Goal: 7% weight loss •  Results: cumulative incidence of diabetes reduced (29%!14%) ! Medication •  850 mg Metformin 2x daily •  Results: cumulative incidence of diabetes reduced (29%!22%) 3,234 US patients with prediabetes Mean age: 51 years Mean BMI: 34 kg/m2
33. Issue Actions Glycemic Control •  Ask about diet, exercise, results of home monitoring, medications Weight Control •  Weigh patient, measure height, calculate BMI •  Ask about diet & exercise Cardiovascular Complications •  Ask about diet, smoking, & cardiac events in family members •  Measure blood pressure Vision Complications •  Ask about visual acuity (blurred vision?), central vision loss, eye pain Neurologic Complications •  Ask about burning, tingling, numbness in extremities Infectious Complications •  Ask about infections, including skin, dental, foot, genitourinary Patient Education •  Advocate diet, exercise, monitoring, and medication adherence
35. ! Diet •  Moderation •  Avoid saturated fats •  Regular meal schedule •  Frequent, small meals •  Complex carbs>>simple sugars •  Optimization of BMI ! Exercise •  Consider limiting factors •  Practical recommendations, gradual increase "  15 min low impact activity, 3x/wk!30-40 min moderate activity 3-5 d/wk •  Soup cans, books for patients with limited mobility
36. DIABETES MELLITUS SWEED !  Sugar !  Weight !  Eating !  Exercise !  Drinking
37. ! Consider the patient’s challenges and restrictions ! Ask the patient what his/her priorities are ! Suggest small changes that seem more feasible ! Allow for self-management ! Make an action plan ! Take notes in the patient’s chart for future follow up
38. ! Evaluate ! Explain ! Empower
39. DIANA ROUNDTREE 9/15/1974 38 F X HEALTH PARTNERS X DR. LEE PCPC CLINC, PRESBY. HOSP. JULY 2012 X X METFORMIN
40. DIANA ROUNDTREE DOB: 9/15/1974 3/7/12 4/4/12 4/11/12 6/20/12 8/22/12 9/12/12 250 294 200 242 250 236 8 11:00 AM 10 5 6 8 JEN NS NS DTN JZ NS Should you be concerned by these numbers?
41. What fits your schedule better, exercising one hour a day or being dead 24 hours a day?
43. Motivational interviewing is a semi-directive, client- centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. MOTIVATIONAL INTERVIEWING
44. W. Miller S. Rollnick
45. EXPRESS EMPATHY If you don’t start exercising, you’ll be sorry Your schedule sounds crazy. I imagine anyone with a schedule like that would find it hard to make time.
46. EXPRESS EMPATHY If you don’t start exercising, you’ll be sorry Your schedule sounds crazy. I imagine anyone with a schedule like that would find it hard to make time.
47. DEVELOP DISCREPANCY So, sometimes when you drink during the week, you can’t get out of bed to get to work. But you enjoy your work, and doing well in your job is very important to you.
48. ROLL C RESISTANCE I want to quit smoking but everyone around me smokes. What are some reasons you want to quit?
49. HONOR AGENCY It’s great that you’ve thought about quitting smoking. What do you think your first step might be?
50. STAGES OF CHANGE
51. DIANA ROUNDTREE DOB: 9/15/1974 3/7/12 4/4/12 4/11/12 6/20/12 8/22/12 9/12/12 250 294 200 242 250 236 8 11:00 AM 10 5 6 8 JEN VKA VKA DTN JZ VKA How might you motivate Diana to maintain better glycemic control?
52. DIANA ROUNDTREE DOB: 9/15/1974 BEST PRACTICES ‣ Consider the patient’s challenges and restrictions ‣ Ask the patient what his/her priorities are ‣ Suggest small changes that seem more feasible ‣ Allow for self-management ‣ Make an action plan ‣ Take notes in the patient’s chart for future follow up
53. DIANA ROUNDTREE DOB: 9/15/1974 9/22 Counseled on med adherence Goals: (1) will get off 1 block early on bus and walk home (2) will reduce cigarettes from 1 pk to 18 At the end of each session, record progress notes & patient-identified goals
54. JEFFREY KLINE 4/22/1967 45 M X VA BENEFITS X DR. VICTORIA CHANG VA MEDICAL CENTER AUGUST 2012 X 9/19 Y N N QUIT SMOKING
55. JEFFREY KLINE DOB: 4/22/1964 3/7/12 4/4/12 4/11/12 6/20/12 8/22/12 9/12/12 130/85 135/90 132/88 145/90 130/90 135/86 BTR VKA VKA DTN TRS VKA Should we be concerned by these numbers?
56. THE SILENT KILLER Hypertension is persistently high blood pressure JEFFREY KLINE DOB: 4/22/1964
57. WHAT CAUSES HYPERTENSION? JEFFREY KLINE DOB: 4/22/1964
59. RISK FACTORS JEFFREY KLINE DOB: 4/22/1964
60. NORMOTENSIVE 120 80 JEFFREY KLINE DOB: 4/22/1964 WHAT’S NORMAL?
61. jnc7 class I hypertension 140 90 jnc7 class ii hypertension 160 100 JEFFREY KLINE DOB: 4/22/1964 HTN MEDS NEEDED
62. hypertensive crisis/emergency 180 120 JEFFREY KLINE DOB: 4/22/1964 CALL 911!
63. TREATMENT Diet Exercise & Lifestyle Meds JEFFREY KLINE DOB: 4/22/1964
64. DEMO
65. JEFFREY KLINE DOB: 4/22/1964 3/7/12 4/4/12 4/11/12 6/20/12 8/22/12 9/12/12 130/85 135/90 132/88 145/90 130/90 135/86 BTR VKA VKA DTN TRS VKA How would you counsel Jeffrey based on these BP readings?
66. JEFFREY KLINE 4/22/1967 47 M X VA BENEFITS X DR. VICTORIA CHANG VA MEDICAL CENTER AUGUST 2012 X 9/19 Y N N QUIT SMOKING
67. “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” WORLD HEALTH ORGANIZATION JEFFREY KLINE DOB: 4/22/1964
68. HAITIAN PROVERB Giving drugs without food is like washing your hands and drying them in the dirt. JEFFREY KLINE DOB: 4/22/1964
69. SOCIOECONOMIC FACTORS POVERTY, EDUCATION, HOUSING, INEQUALITY CHANGING THE CONTEXT MAKING HEALTHY DECISIONS THE DEFAULT (FLUORIDATION, SMOKING LAWS, ETC...) LONG-LASTING PROTECTIVE INTERVENTIONS IMMUNIZATIONS, COLONOSCOPY, CESSATION TREATMENT CLINICAL INTERVENTIONS RX FOR BLOOD PRESSURE, HIGH CHOLESTEROL, DIABETES COUNSELING & EDUCATION “EAT HEALTHY”, “BE PHYSICALLY ACTIVE” IMPACT centers for disease control & prevention / factors that affect health
70. SOCIOECONOMIC FACTORS POVERTY, EDUCATION, HOUSING, INEQUALITY CHANGING THE CONTEXT MAKING HEALTHY DECISIONS THE DEFAULT (FLUORIDATION, SMOKING LAWS, ETC...) LONG-LASTING PROTECTIVE INTERVENTIONS IMMUNIZATIONS, COLONOSCOPY, CESSATION TREATMENT CLINICAL INTERVENTIONS RX FOR BLOOD PRESSURE, HIGH CHOLESTEROL, DIABETES COUNSELING & EDUCATION “EAT HEALTHY”, “BE PHYSICALLY ACTIVE” IMPACT centers for disease control & prevention / factors that affect health
71. medicare medicaid supplemental nutrition assistance program Low Income Home Energy Assistance Program general assistance select plan for women Free or reduced price school meals child care works pace pacenet Living Independence for the Elderly Emergency Housing Subsidized Housing speciality appointments speciality appointments healthy in philadelphia food trust of philadelphia community legal services lift resume building job search
72. federal poverty income guidelines (FPIG) $2,181 per month 5 $908 per month 1 $1,226 per month 2 $1,544 per month 3 $1,863 per month 4
73. medical assistance
74. medical assistance: what’s covered doctor visits emergency care hospital care vaccinations prescription drugs long-term care preventative care for children
75. medical assistance: providers
76. medical assistance medicare medicaid children’s health insurance plan select plan for women pace & pacenet appointments
77. food access food stamps food pantries soup kitchens
78. supplemental nutrition assistance program “food stamps” up to $200 per individual $500 per family . Can be used to cover any unprepared food
80. HOUSING emergency shelter subsidized housing rent & utility assistance
81. employment job search resume building
82. market-rate housing search food pantries tax preparation (incl. back taxes) tax credit screening education/job training immigration computer literacy online job search & applications resume & cover letter creation/editing interview skills literacy classes dental vision computer literacy
83. wanna help? social services table: commitment of 1 YEAR
84. JEFFREY KLINE 4/22/1967 47 M X VA BENEFITS X DR. VICTORIA CHANG VA MEDICAL CENTER AUGUST 2012 X 9/19 Y N N QUIT SMOKING
85. 9/22 Referred to SS for SNAP & Housing Lifestyle Goals: (1) will not add salt on top of cooked food Remember, at the end of each session, record progress notes & patient- identified goals JEFFREY KLINE DOB: 4/22/1964