Developing and Utilizing CHD Resources by Q2CgqLD

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									Developing and Utilizing
   CHD Resources

       Dr Irene Fruzynski
  Reynolds Road Medical Centre,
           Applecross
Practice Background
   8 GPs ( 5 FTE)
   3 nurses (1 per day)
   Fully computerized – Med Director
   Mixed billing
   Fairly young practice – 4 yrs old
   Includes skin clinic
Wave 1 Experience
   Dr Irene as „driver‟
   Practice Principal in „backseat‟
   3 different staff at workshops
   Staff turnover issues
Change Principle 2
Be systematic and proactive in managing
  care:
 PDSA cycle on CHD management principles
 Obtained NHF guidelines – incorporates
  NPCC aims but also others
 Distribute to doctors and continue to remind
 Keep handy
Change Principle 3
Involve patients in delivering and developing
  care:
 PDSA cycle on Acute Chest Pain
  Management
 Review of existing protocols, review by
  doctors, endorsement, distribution to patients
  via doctors rather than mailout.
 Incorporate into GPMPs
Change Principle 4
Develop effective links with key local partners
 PDSA cycle on devising database of Allied
  Health Professionals
 Nurse developed list from GP knowledge,
  Yellow Pages and Division website
 Check if registered with Medicare Plus

 Keep adding to list as new AHPs establish
Change Principle 4 and 5
Develop effective links with key local partners
  and analyse your secondary care interface:
 PDSA cycle on available local physical
  activity resources
 Division happened to be researching this at
  the time
 Laminated A4 resource brochure adopted for
  each room
          Utilizing HMRs: Item 900
          Change Principle 5
   CHD patients are ideal candidates.
   Optimizes medication regime, better care of
    patients in the community
   There is a range of risk factors for medication
    misadventure
            HMR criteria

   There is only one criterion for a
    patient to receive an HMR.
       The GP thinks that the patient (who is living in
        the community) would benefit from this
        service
     HMR 10 Point Process
                  2. GP\Patient      3. GP
1. Potential
                  consultation       initiates
HMR patient       and informed       HMR with
identified        consent            patient

   4. Sends              5. Pharmacy makes
   referral to           appointment -
   patient’s chosen
   community             interviews patient
   pharmacy              and conducts Home
                         Medicines Review
  HMR 10 Point Process

                  7. Two way       8. Consultation
6. Pharmacist                      with patient
                  communication    using
sends report to
                  between          pharmacist’s
GP                                 report to
                  pharmacist
                  and GP           complete
                                   medication
                                   review
    9. Copy of action and
    plan to patient,          10. Claim:
    community pharmacy
    and inpatient notes       Item 900
Alternative ways of doing HMRs
   By hand
   Electronically - eg Medical Director
   Combination (letter/fax)
   Some tasks can be delegated eg to practice
    nurse
Medical Director Process

As easy as                  1, 2, 3
1.    Click the Letter Writer on the MD toolbar
2.    File menu - Choose “New”
3.    Click the Template: eg “HMR Referral
     Template”
1   - Click the “Letter Writer” icon
        on the MD toolbar
2-   Click „file‟ – „new‟
      (or use „Ctrl+N‟)
3 - Click the Template
              or use the „supplied‟ template
4 - Click or type the Pharmacist
5 - Click “Progress Notes” you wish to include




           1
           2
                           3
6 - Click “Investigations” for inclusion




            1

                             2
7 – Type/select in the minimum data set




          
          

          

          


                         
The referral is 95% complete
     Complete HMR referral

   Simply fill in any extra box
   It is not necessary to keep a hard copy
   Send copy to pharmacist
       Email (from MD) – if you have encryption
       Fax
       Letter
   Patient doesn't need to sign
Click email and send (if secure in md3)
    or print - then fax/letter
    Completing the plan

   Second consultation;
   GP cannot claim item 900 until plan has been
    completed:
   Take time to gain informed consent and
    produce the referral or the plan cannot be
    claimed as consultation time;
On receipt of pharmacy advice
Use Letter Writer “Action Plan” Template
- then follow the same process as for the referral
HMR example
   Mrs KL 81 yo, PH CABG, Atrial fib,
    Diabetes type 2-diet
   Problem – multiple medications and INR
    fluctuating
   Pharmacist identified intermittent use of
    glucosamine, possible missed doses and
    highlighted risk of myopathy with statins with
    increasing age
Action and plan
   Regulate dose of glucosamine, continue only
    if helpful after adequate trial. Monitor INR
    closely
   Organize webster pack
   Reduce statin from 40mg to 20mg as present
    chol <4 and monitor response
Future PDSA cycles
   Identify CHD patients needing HMRs
   Nurse led clinics
Questions?

								
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