{"id":1203,"date":"2013-10-10T19:27:17","date_gmt":"2013-10-10T19:27:17","guid":{"rendered":"http:\/\/jacobimed.org\/NS\/?page_id=1203"},"modified":"2013-10-10T19:27:17","modified_gmt":"2013-10-10T19:27:17","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/jacobimed.org\/old\/ambulatory\/mlove\/curriculumprevention\/implementation-of-preventive-measures\/implementation-menu\/questionnaire\/","title":{"rendered":"Questionnaire"},"content":{"rendered":"

 <\/p>\n

\n

IMPLEMENTING PREVENTIVE
\nSERVICES<\/span><\/h2>\n

Ambulatory Care Block Rotation Spring 2004<\/h3>\n

Perry
\nPong, MD<\/p>\n

                                                                                    <\/span><\/p>\n

 <\/h1>\n
\n

   <\/span>LEARNER’s GOALS
\n<\/em><\/span><\/strong><\/p>\n

   <\/span>At the end of the session, the learner will
\nbe able to recognize his\/her own attitudes towards preventive services and how
\nthey impact on performance. The learner will begin to recognize barriers to
\npreventive services that exist for the patient, provider and society. The
\nlearner will be able to select a preventive service and draft a plan to improve
\nthe delivery of that service, utilizing either the barriers to care model or
\nthe continuous quality improvement model.<\/em><\/p>\n

 <\/span><\/p>\n<\/div>\n

 <\/span><\/p>\n

ORGANIZATION
\nOF THE SESSION:<\/strong><\/p>\n

1 Questionnaire<\/p>\n

2 Examining Barriers<\/p>\n

3 Continuous Quality
\nImprovement<\/p>\n

4 Interventions<\/p>\n

 <\/p>\n

PART I    <\/span>ATTITUDES<\/span><\/h2>\n

 <\/p>\n

1.                 
\n<\/span>I recommend the influenza vaccine to patients.<\/p>\n

 <\/p>\n

            <\/span>Strongly
\ndisagree                  <\/span> Neutral                                   <\/span>Strongly
\nagree<\/span><\/p>\n

                                    <\/span>1          <\/span>2          <\/span>3          <\/span>4          <\/span>5          <\/span>6          <\/span>7<\/span><\/p>\n

 <\/span><\/p>\n

 <\/span><\/p>\n

2.                 
\n<\/span>I received the influenza vaccine this past winter.<\/p>\n

 <\/span><\/p>\n

            <\/span>1  <\/span>Yes                                     <\/span>2  <\/span>No<\/span><\/p>\n

 <\/p>\n

 <\/p>\n

3.                 
\n<\/span>Studies show that the most effective influenza prevention
\nstrategy in a nursing home is to:<\/p>\n

 <\/span><\/p>\n

            <\/span>1
\nVaccinate all residents      <\/span>2 Vaccinate
\nall staff  <\/span>3. Vaccinate all staff and
\nresidents<\/span><\/p>\n

 <\/span><\/p>\n

 <\/span><\/h1>\n

 <\/span><\/h1>\n

PART II    <\/span>THE PATIENT ENCOUNTER
\n
\n<\/span><\/h1>\n

 <\/span><\/p>\n

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

 <\/strong><\/p>\n

CHECK THE THINGS YOU CHOOSE TO DISCUSS TODAY:<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Issue<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Issue<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Advance
\n Directives<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Low
\n Back Pain<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Cholesterol
\n – Lipid Panel screen<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Mammogram<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Colonoscopy<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Obesity<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Depression<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Osteoporosis
\n \/ Bone Densitometry<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Diabetes
\n – Hba1c screen<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Pneumococcal
\n Vaccination<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Domestic
\n Violence<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

PAP
\n Smear<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Hepatitis
\n B Vaccination<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Stool
\n Guaiac Cards<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Hypertension<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Tetanus
\n Booster Vaccination<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Influenza
\n Vaccination<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/span><\/p>\n

What is your strategy to
\naccomplish the prevention issues selected?<\/p>\n

 <\/p>\n



\n<\/span><\/p>\n

2. Your next patient  <\/span>is a new
\npatient: 23 year old female needing a physical exam for graduate school.<\/em><\/p>\n

 <\/span><\/p>\n

 <\/strong><\/p>\n

CHECK THE PREVENTION AREAS YOU CHOOSE TO DISCUSS TODAY:<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Issue<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Issue<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

AIDS
\n \/ HIV testing<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

GC\/Chlamydia\/RPR
\n Screen<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Alcohol<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Guns\/Firearms
\n safety<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Cholesterol<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Immunizations<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Contraception<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Nutrition
\n and Diet<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Depression<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

PAP
\n Smear<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Domestic
\n Violence<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

PPD<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Drugs
\n <\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Seat
\n Belts<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Exercise<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Sexual
\n History<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Folate
\n Supplements<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n

\n

Smoking<\/span><\/p>\n<\/td>\n

\n

 <\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/span><\/p>\n

 <\/p>\n

How did you make your choices? <\/p>\n

 <\/p>\n

 <\/p>\n

How do you remember to do all that
\nyou checked?<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

PART III:           <\/span>THE PRACTICE
\n
\n<\/span><\/h4>\n

After graduation, you find a job in
\na group of 10 physicians and nurse practitioners in Brooklyn. Your patients are
\ndiverse: young, old, with many immigrants from the Caribbean and Latin America,
\nand some older Italian American and African American patients. Most have
\nMedicare or Medicaid, some have commercial insurance and about 10% are
\nself-pay.<\/p>\n

 <\/p>\n

Because you are the newest hire,
\nthe medical director assigns you to improve mammogram performance. The current
\npercentage of patients over age 50 having a yearly mammogram is 34%. Your
\ntarget is 50%. The radiology office is in the same building. <\/p>\n

 <\/p>\n

Outline your strategy (include
\nresources needed, personnel involved, timeline for implementation, and how you
\nwill get the staff and doctors to “comply” with your recommendations):<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

                        <\/span>
\n<\/p>\n

 <\/p>\n

POINTS TO
\nMAKE:<\/span><\/strong><\/p>\n

 <\/p>\n

Major: <\/strong><\/p>\n

1.         <\/span>Physician
\nfactors<\/p>\n

            <\/span>Pt
\nfactors<\/p>\n

            <\/span>Organizational
\nFactors<\/p>\n

 <\/p>\n

2.         <\/span>What
\ncan the physician do?<\/p>\n

            <\/span>What
\ndoes the physician want to do?<\/p>\n

 <\/p>\n

3.         <\/span>Look
\nat processes, more than individuals<\/p>\n

 <\/p>\n

FACTS TO BRING UP<\/h2>\n

1.         <\/span>Time
\nnot really the determining factor<\/p>\n

Mayo clinic
\nstudy- time not related to prevention performance<\/p>\n

 <\/p>\n

2.         <\/span>Patient
\nfactors are complex<\/p>\n

 <\/p>\n

3.         <\/span>Organization
\nis the key<\/p>\n

Make it routine!<\/p>\n

 <\/p>\n

4.         <\/span>You will be audited by insurance
\ncompanies, outside agencies, <\/p>\n

Boards! on how well you do. Might
\nas well excel at it.<\/p>\n

            <\/span><\/p>\n

WHAT TO DO?<\/h2>\n

Example: Vaccines<\/p>\n

1.         <\/span>Standing
\norders: example Flu vaccine<\/p>\n

2.         <\/span>Reminders
\nto Providers <\/p>\n

            <\/span>Assessment
\nand Feedback to Providers on Performance<\/p>\n

3.         <\/span>Reminder notices to Patients<\/p>\n

Educational
\nbrochure was more useful than just reminder letter<\/p>\n

4.         <\/span>Flow
\nCharts<\/p>\n

Critical to have flow chart to
\nkeep track of patient’s<\/p>\n

5.         <\/span>Enhance Access: Financial incentives, reducing out of pocket
\ncosts<\/p>\n

 <\/p>\n

Others: <\/p>\n

1.         <\/span>Community
\nInvolvement:  <\/span>Involve the patients in
\nplanning<\/p>\n

2.         <\/span>Flow
\nCharts<\/p>\n

3.         <\/span>Get
\nall the staff involved<\/p>\n

4.         <\/span>Continuous
\nQuality Improvement <\/p>\n

5.         <\/span>Audit
\nyourself<\/p>\n

6.         <\/span>Disease Management Trend<\/p>\n

 <\/p>\n

Community Control: Smoking
\nCessation<\/p>\n

Ban, Increasing price of tobacco,
\nmedia campaigns, quitter telephone support with interventions<\/p>\n

 <\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

  IMPLEMENTING PREVENTIVE SERVICES Ambulatory Care Block Rotation Spring 2004 Perry Pong, MD                                                                                          LEARNER’s GOALS    At the end of the session, the learner will be able to recognize his\/her own attitudes towards preventive services and how they impact on performance. The learner will begin to recognize barriers to preventive services that….<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1198,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-1203","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1203","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/comments?post=1203"}],"version-history":[{"count":2,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1203\/revisions"}],"predecessor-version":[{"id":1211,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1203\/revisions\/1211"}],"up":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1198"}],"wp:attachment":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/media?parent=1203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}