IMPLEMENTING PREVENTIVE
SERVICES

Ambulatory Care Block Rotation Spring 2004

Perry
Pong, MD

                                                                                   

 

 

ORGANIZATION
OF THE SESSION:

1 Questionnaire

2 Examining Barriers

3 Continuous Quality
Improvement

4 Interventions

 

PART I    ATTITUDES

 

1.                 
I recommend the influenza vaccine to patients.

 

            Strongly
disagree                  Neutral                                   Strongly
agree

                                    1          2          3          4          5          6          7

 

 

2.                 
I received the influenza vaccine this past winter.

 

            1  Yes                                     2  No

 

 

3.                 
Studies show that the most effective influenza prevention
strategy in a nursing home is to:

 

            1
Vaccinate all residents      2 Vaccinate
all staff  3. Vaccinate all staff and
residents

 

 

 

PART II    THE PATIENT ENCOUNTER

 

1.  Your first patient today is
a 54-year-old nurse’s aide with hypertension, obesity and low back pain. She is
your regular patient and says nothing is new, her back pain is the same.  She takes hydrochlorothiazide, calcium
carbonate and an occasional ibuprofen. You glance at her chart, BP 135/85 P 72;
no Pap smear or mammogram in years, no advance directive, no immunizations
since childhood, no colonoscopy and menopausal since 2002.

 

CHECK THE THINGS YOU CHOOSE TO DISCUSS TODAY:

Issue		Issue
Advance Directives		Low Back Pain
Cholesterol – Lipid Panel screen		Mammogram
Colonoscopy		Obesity
Depression		Osteoporosis / Bone Densitometry
Diabetes – Hba1c screen		Pneumococcal Vaccination
Domestic Violence		PAP Smear
Hepatitis B Vaccination		Stool Guaiac Cards
Hypertension		Tetanus Booster Vaccination
Influenza Vaccination

 

What is your strategy to
accomplish the prevention issues selected?

 

2. Your next patient  is a new
patient: 23 year old female needing a physical exam for graduate school.

 

 

CHECK THE PREVENTION AREAS YOU CHOOSE TO DISCUSS TODAY:

Issue		Issue
AIDS / HIV testing		GC/Chlamydia/RPR Screen
Alcohol		Guns/Firearms safety
Cholesterol		Immunizations
Contraception		Nutrition and Diet
Depression		PAP Smear
Domestic Violence		PPD
Drugs		Seat Belts
Exercise		Sexual History
Folate Supplements		Smoking

 

 

How did you make your choices?

 

 

How do you remember to do all that
you checked?

 

 

 

PART III:           THE PRACTICE

After graduation, you find a job in
a group of 10 physicians and nurse practitioners in Brooklyn. Your patients are
diverse: young, old, with many immigrants from the Caribbean and Latin America,
and some older Italian American and African American patients. Most have
Medicare or Medicaid, some have commercial insurance and about 10% are
self-pay.

 

Because you are the newest hire,
the medical director assigns you to improve mammogram performance. The current
percentage of patients over age 50 having a yearly mammogram is 34%. Your
target is 50%. The radiology office is in the same building.

 

Outline your strategy (include
resources needed, personnel involved, timeline for implementation, and how you
will get the staff and doctors to “comply” with your recommendations):

 

 

 

                       

 

POINTS TO
MAKE:

 

Major:

1.         Physician
factors

            Pt
factors

            Organizational
Factors

 

2.         What
can the physician do?

            What
does the physician want to do?

 

3.         Look
at processes, more than individuals

 

FACTS TO BRING UP

1.         Time
not really the determining factor

Mayo clinic
study- time not related to prevention performance

 

2.         Patient
factors are complex

 

3.         Organization
is the key

Make it routine!

 

4.         You will be audited by insurance
companies, outside agencies,

Boards! on how well you do. Might
as well excel at it.

           

WHAT TO DO?

Example: Vaccines

1.         Standing
orders: example Flu vaccine

2.         Reminders
to Providers

            Assessment
and Feedback to Providers on Performance

3.         Reminder notices to Patients

Educational
brochure was more useful than just reminder letter

4.         Flow
Charts

Critical to have flow chart to
keep track of patient’s

5.         Enhance Access: Financial incentives, reducing out of pocket
costs

 

Others:

1.         Community
Involvement:  Involve the patients in
planning

2.         Flow
Charts

3.         Get
all the staff involved

4.         Continuous
Quality Improvement

5.         Audit
yourself

6.         Disease Management Trend

 

Community Control: Smoking
Cessation

Ban, Increasing price of tobacco,
media campaigns, quitter telephone support with interventions