MD Template GP Management Plan Coronary Heart Disease

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MD Template GP Management Plan Coronary Heart Disease Powered By Docstoc
					                                       <<Miscellaneous:Practice Letterhead>>

                           GP MANAGEMENT PLAN (Coronary Heart Disease)

Patient’s Name: <<Patient Demographics:Full Name>>                Date of Birth: <<Patient Demographics:DOB>>

Contact Details:                                                  Medicare or Private Health Insurance Details:
<<Patient Demographics:Full Address>>                             <<Patient Demographics:Medicare Number>>
                                                                  <<Patient Demographics:Health Insurance>>

Details of Patient’s Usual GP:                                    Details of Patient’s Carer (if applicable):
<<Doctor:Name>>
<<Doctor:Full Address>>



Date of last Care Plan/GP Management Plan (if done): <<Date of last Care Plan/GPMP>>

Other notes or comments relevant to the patient’s management plan:




PAST MEDICAL HISTORY

<<Clinical Details:History List>>

MEDICATIONS

<<Clinical Details:Medication List>>

ALLERGIES




Original template compiled by Monash Division of General Practice, August 2005
Patient’s Name: <<Patient Demographics:Full Name>>

                       GP MANAGEMENT PLAN (Coronary Heart Disease CHD)
  Applies to acute coronary syndromes, myocardial infarction, coronary angioplasty with/without stenting, and
         bypass surgery. Similar guideline for other vascular disease (peripheral and cerebrovascular)
Patient problems /        Goals - changes to be                   Required treatments and         Arrangements for
needs / relevant          achieved (if possible)                  services including patient      treatments/services
conditions                                                        actions                         (when, who, and
                                                                                                  contact details)
1. General
Patient's understanding Patient to have a clear           Patient education                       GP/nurse
of coronary heart       understanding of coronary heart
disease                 disease and the patient's role in
                        managing the condition
Chest pain action         Develop action plan                     GP and patient agree on         GP
plan                                                              written action plan on use of   Patient
                                                                  anti-anginals and when to
                                                                  ring the ambulance
2. Lifestyle
Nutrition                 Healthy eating pattern, low fat diet Patient education                  GP/nurse to advise
                                                                                                  Patient to implement
Weight                    Your target:                            Monitor                         Patient to monitor
                            BMI  __                              Review 6 monthly                GP/nurse to review
                            Waist  __ cm
                          Ideal:
                            BMI  25
                            Men waist 94 cm
                            Women waist  80 cm
Physical Activity         Your target:                            Patient exercise routine        Patient to implement

                          Ideal:
                            At least 30 minutes walking or
                            equivalent 5 or more days per
                            week
Smoking                   Zero                                    Smoking cessation               Patient to manage
                                                                                                  GP/nurse to monitor
Alcohol                   Your target:                        Reduce alcohol intake               Patient to manage
                             __ standard drinks per day      Patient education                   GP to monitor
                          Ideal:
                             2 standard drinks per day (men)
                             1 standard drinks per day
                            (women)
2. Biomedical
Cholesterol / Lipids      Your target:                            Annual check                    GP
                             Cholesterol  __ mmols/L
                             Triglycerides  __ mmol/L
                             LDL-C  __ mmol/L
                             HDL-C  __ mmol/L
                           Ideal:
                             Cholesterol  4.0 mmols/L
                             Triglycerides  2.0 mmol/L
                             LDL-C  2.5 mmol/L
                             HDL-C  1.0 mmol/L
Blood pressure            Your target: <                          Check every 6 months            GP / nurse
                          Ideal: < 140/90
Diabetes                  Your target:                            Patient education               GP / nurse
                             HbA1C  __%                          Review every 6 months           Diabetes educator
                             Fasting glucose  __
                             2hr post prandial glucose  __
                          Ideal:
                            HbA1C  7%
                            Fasting glucose  6
                            2hr post prandial glucose  8




Original template compiled by Monash Division of General Practice, August 2005
3. Medication
Medication review         Correct use of medications,             Patient education                  GP to review and provide
                          minimise side effects                   Review medications                 education
Medication                Use of antiplatelet agents              Aspirin (unless contraindicated)   GP to monitor
management
                           Use of ACE inhibitors                  Consider in all patients           GP to monitor
                                                                  (angiotension II receptor
                                                                  antagonists if develop side
                                                                  effects)
                          Use of Beta-blockers                    Consider in all post-acute         GP to monitor
                                                                  coronary syndromes
                          Use of Statins                          In all unless contraindicated      GP to monitor
                          Use of Anticoagulants                   Warfarin if high risk of           GP to monitor
                                                                  thromboembolism post-
                                                                  myocardial infarction
4. Psychosocial
Depression                Manage depression                       Assessment.                        GP to assess and initiate
                                                                  Medication or cognitive            management
                                                                  behaviour therapy
Social isolation          Reduce social isolation                 Improve social support             GP to advise and monitor
                                                                  eg referral to support group

Copy of GP Management Plan offered to patient? <<Copy of GPMP offered to patient?>>

Copy / relevant parts of the GP Management Plan supplied to other providers? <<Copy of GPMP supplied to
other providers?>>

GP Management Plan added to the patient’s records? <<GPMP added to patient's records?>>

Date service was completed: <<Date service                        Proposed Review Date: <<Proposed review date
completed>>                                                       (recommended 6 months)>>


I have explained the steps and any costs involved, and the patient has agreed to proceed with the plan. <<Steps
and costs explained, patient agreed>>

 GP’s Signature: ________________________________________________                      Date:___________________




Original template compiled by Monash Division of General Practice, August 2005

				
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