Family Physician-Ellensburg WA Consultant-Shared Medical - - PowerPoint PPT Presentation

Byron L. Haney, MD Family Physician-Ellensburg WA Consultant-Shared Medical Appointments Family Health Care of Ellensburg PNWU Associate Professor

bhaney@fhcoe.com www.fhcoe.com

TRIPLE AIM

+ 1

• HIGH VALUE HEALTH CARE
• TRIPLE AIM ACHIEVED
• REDUCING COST OF CARE
• IMPROVING POPULATION HEALTH
• IMPROVED PATIENT EXPERIENCE
• EMPLOYEES LOVE THEIR WORK ENVIRONMENT,

MAKE LIFESTYLE CHANGES THEMSELVES

Family Health Care

CHANGE IN PATIENT SATISFACTION WITH PRIMARY CARE PHYSICIAN

3.5 3.6 3.7 3.8 Baseline 24 Months

SMA Individual

Scale: 1 to 4. Higher Score = Greater Satisfaction. p = .003

• Scott JC.

RETURN THE JOY TO MEDICINE

OR

TALK FASTER WALK FASTER DON’T EAT DON’T MICTURATE NEGLECT SELF/LOVED ONES

JUST BURNOUT

CO$T OF DIABETES

DIABETE TES 201 012 2 EST. COST : $245,000,000,000 $69 BILLION IS REDUCED PRODUCTIVITY. HEALTH TH CARE RE COST T PER R CAPI PITA : (ANNUAL) NON DIABETI TIC: $5,800 DIABETI TICS: $13,700 $7,900 ATTRIBUTED TO DIABETES (2.3 X)

DIABETES PREVENTION LITERATURE

REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN

• N ENGL J MED FEBRUARY 7, 2002
• DIABETES PREVENTION PROGRAM RESEARCH GROUP (DPRRG)

SHARED MEDICAL APPOINTMENTS SMAS ARE PURE JOY

WHY GROUPS WORK?

• INSTILLATION OF HOPE
• UNIVERSALITY
• IMPARTING INFORMATION
• IMITATIVE BEHAVIOR
• INTERPERSONAL LEARNING
• ALTRUISM
• GROUP COHESIVENESS
• CATHARSIS
• CORRECTIVE RECAPITULATION OF THE

PRIMARY FAMILY GROUP

• EXISTENTIAL FACTORS
• Yalom I.

WHY GROUPS WORK?

INSTILLATION OF HOPE: ENCOURAGEMENT THAT RECOVERY IS POSSIBLE UNIVERSALITY: FEELING OF HAVING PROBLEMS SIMILAR TO OTHERS, NOT ALONE IMPARTING INFORMATION: HELPFUL TO LEARN FACTUAL INFORMATION FROM OTHERS IMITATIVE BEHAVIOR: MODELING ANOTHER’S MANNERS AND RECOVERY SKILLS

• Yalom I.

INT NTERP RPERSONAL RSONAL LEARNING ARNING: ACHIEVING GREATER SELF-AWARENESS THROUGH GROUP FEEDBACK ON THEIR BEHAVIOR AND IMPACT ON OTHERS. ALTRUIS TRUISM: : HELPING AND SUPPORTING OTHERS GROUP UP CO COHES ESIVE IVENES ESS: : FEELING OF BELONGING TO AND VALUING THEIR GROUP. CA CATHA HARSIS RSIS: RELIEF OF EMOTIONAL TENSION BY TELLING THEIR STORY TO A SUPPORTIVE AUDIENCE, GAINING RELIEF FROM CHRONIC FEELINGS OF SHAME AND GUILT. CO CORRECTIV CTIVE REC ECAPITUL APITULATION TION OF T F THE E PRIMAR RIMARY Y FAMIL ILY Y EX EXPE PERIE RIENC NCE: IDENTIFYING AND CHANGING DYSFUNCTIONAL PATTERNS AND ROLES ONE CARRIES OUT IN THEIR FAMILY. EXISTEN STENTIA TIAL FACTO CTORS RS: : LEARNING ONE MUST TAKE RESPONSIBILITY FOR ONE’S OWN LIFE AND THE CONSEQUENCES OF ONE’S DECISIONS.

• Yalom I.

CAREGIVERS:

• DEPART FROM PATERNALISTIC CARE
• MOTIVATIONAL INTERVIEWING
• BECOME A FACILITATOR
• TALK LESS--USE YOUR PATIENTS AS YOUR EXPERTS (FACILITATE, DIRECT AND

EDUCATE THEM TO BE EXPERTS)

• CARE DECISION MAKING STEPS
• PATIENT FIRST
• GROUP MEMBERS SECOND
• PROVIDER LAST

Paradigm Change

DPPRG VS SMA’S (FHC)

Long-Term Success Rate of Diets 45 Million Americans plan to go on a diet this year and most will lose some weight, but then the chance of keeping it

• ff for 5 or more

years is….

? %

Long-Term Success Rate of Diets

5%

The Ideal Protein Weight Loss Method

An evidence-based medical protocol that addresses improving long-term patient

• utcomes and results through education delivered by healthcare provider partners.

Ideal Protein Protocol Outcomes at FHCOE

• >45,000 # & 32,000” LOST OVER THE LAST 5+ YEARS
• WEIGHT LOSS WITH BMI OF:
• 30-39.9 57.6# AVG
• 40+ 100.6# AVG
• PATIENTS WITH STARTING BMI >30:
• 60% ARE MAINTAINING THEIR WEIGHT LOSS
• HALF WITH OUR HELP
• 40% STRUGGLE (95% NOT FOLLOWING OUR FREE MAINTENANCE PLAN)
• ALCOHOL ABUSE
• INCREASED SUCCESS IF:
• REACHED NORMAL BMI (89% MAINTAINING)
• SET 2 WEEK WEIGHT GAIN MARGIN
• MEN
• SMA INVOLVED (80% MAINTAINING)
• ELIMINATED MEDICATION OR CPAP
• ATTENDING FREE MAINTENANCE PROGRAM

58 y.o.

Aug 1 252# May 1 148# 104# June 17 156#

(9 mo)

Diabetes Type II, Uncontrolled 58 Years Old

August, 2014:

• Metformin 850 TID
• Glyburide 10mg BID
• Simvastatin 80mg QD
• Lisinopril 20mg QD
• Bupropion HCl XL 150mg

QD

• Aspirin 81mg QD

May, 2015

• Aspirin 81mg
• Lisinopril 2.5mg QD

Medications

Diabetes Type II, Uncontrolled 58 Years Old

Vitals

August, 2014:

• Blood Pressure: 155/87
• Weight: 252
• BMI: 37.2

May, 2015:

• Blood Pressure: 105/74
• Weight: 148
• BMI: 21.9

On meds Off meds

Diabetes Type II, Uncontrolled 58 Years Old August, 2014:

• A1c: 14.7
• FBS: 362
• Trig: 737
• LDL: (not reported)
• HDL: 38
• Total Chol: 250
• Creatinine: 0.66
• Micro/Creat Ratio: 723

April, 2015:

• A1c: 6.2
• FBS:118
• Trig: 81
• LDL: 168
• HDL: 83
• Total Chol: 267
• Creatinine: 0.58
• Micro/Creat Ratio: 447

Labs

Aug, 2016:

• A1c: 6.0
• FBS:111
• Trig: 83
• LDL: 96
• HDL: 54
• Total Chol: 167
• Creatinine: 0.65
• Micro/Creat Ratio: 859

On meds Off meds

Diabetes Type II, Uncontrolled 58 Years Old

Cardiac Risk

August, 2014: April, 2015:

Larry 68 y.o.

Mar, 17 340# 85#

9/26/17 255#

(6 mo)

Diabetes Type II, Uncontrolled 68 Years Old

March, 2017:

• Tresiba 70 units/day
• Humalog 120 units/day
• Lisinopril 2.5mg/day
• Atorvastatin 20mg/day
• Clopidogrel 150mg/day
• Terrazosin 0.4mg/day
• Metoprolol 200mg/day
• Digoxin .125mg/day
• Furosemide 40mg/day

Sept, 2017:

• Tresiba 16 units/day
• Humalog (gone)
• Lisinopril 2.5mg/day
• Atorvastatin 5 mg/day
• Clopidogrel 75 mg/day
• Terrazosin 0.4mg/day
• Metoprolol 50 mg/day
• Digoxin .125mg/day
• Furosemide

– 10 mg/day 5 day/wk – 20 mg/day 2 day/wk

Medications

Diabetes Type II, Uncontrolled 68 Years Old

Vitals

March, 2017:

• Blood Pressure: 142/70
• Weight: 340
• BMI: 41

Sept, 2017:

• Blood Pressure: 134/74 (8/9)
• Weight: 255
• BMI: 31

On meds Medication reduction

Diabetes Type II, Uncontrolled 68 Years Old Pre March, 2017:

• A1c: 10.1
• FBS: 260
• Trig: 251
• LDL: 55
• HDL: ??
• Total Chol: (not reported)
• Creatinine: 1.67
• Micro/Creat Ratio: ??
• GFR: 44
• Ejection Fract: <35

May, 2017:

• A1c: 7.5
• FBS: 137
• Trig: 74
• LDL: 38
• HDL: 33
• Total Chol:
• Creatinine: 1.38
• Micro/Creat Ratio: 208
• GFR: 55
• Ejection Fract: >40

Labs

Sept, 2017:

• A1c: 6.1
• FBS: ??
• Trig: 85
• LDL: 33
• HDL: 37
• Total Chol:
• Creatinine: ??
• Micro/Creat Ratio: 261
• GFR: ??
• Ejection Fract: 40

On meds Further Med reduction Less meds

Three Step Process

1. Weight Loss

• Until healthy weight achieved
• 2. Stabilization
• Learn a New Healthy Lifestyle – 12 months
• 3. Maintenance
• For life

Our Coaches are there to offer the tools, education and support necessary to achieve and maintain weight loss goals!

The Ideal Protein Weight Loss Method

Reduces Calories Maintains Vitamin, Mineral, and Electrolyte Balance Maintains Muscle Mass by Ensuring Adequate Protein Intake

2000 Calorie Diet

1200 – 1400 Calorie Diet 850 Calorie Diet “Balanced” Diet Hypocaloric Diet Ideal Protein Phase 1 2000 Calorie Diet 1200 – 1400 Calorie Diet 850 – 1000 Calorie Diet

Vitamins & Minerals Vitamins & Minerals Vitamins & Minerals

Why the Ideal Protein Weight Loss Method?

FHCOE providers also see improvements in:

• PCOS, Infertility
• Abnormal Periods
• CVD
• Depression
• Fibromyalgia
• Fatigue
• High Uric Acid
• Fatty Liver (NASH)
• Heart Burn/Reflux
• Obstructive Sleep Apnea
• COPD
• Joint Pain

The choice is yours?