Incorporating Best Practices through Practice Organization & EMRs in a Residency Practice Mathew...
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Transcript of Incorporating Best Practices through Practice Organization & EMRs in a Residency Practice Mathew...
Incorporating Best Practices
through Practice Organization & EMRs
in a Residency PracticeMathew Devine, D.O.
Associate Medical Director
Highland Family Medicine
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
Chronic Pain and Narcotic Use at Highland Family Medicine
2009
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
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
Peer Review/Audit process and results
Updated information to provided at live presentation
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.
Urine drug screening results from practice
Updated information to provided at live presentation
Helping Patients Whose Pain is Not Relieved Through Group Visits
and Emotional Support
Mathew Devine, D.O.
Associate Medical Director
Highland Family Medicine
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
Group VisitsAvailable at Highland Family Medicine
• Chronic Pain
• Diabetes
• Pediatric Asthma
• Depression
• In the pipeline:
•Prenatal visits
•Tobacco
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)
Why Group Medical Visits?
•PCMH: AAFP; TransforMed
•Growing Literature supports benefits
•Improved clinical outcomes
•Patient satisfaction
•Provider satisfaction
•Cost-neutral
• Education
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
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
PDQ data from Chronic Pain group regarding: Functional assessment
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Initial visit and Last visit data
Chronic Pain Group Functional Assessment
PDQ data from Chronic Pain group regarding: Psychosocial assessment
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PDG Psychosocial Assessment Data
Pre and Post results
Depression Screening data
Information to be provided at session
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
Addiction results
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
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
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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