Retrospective chart review of metabolic syndrome at the Regina by alextt

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									Retrospective chart review of
 metabolic syndrome at the
 Regina Community Clinic

     Roseann Nasser MSc RD CNSD
           Research Dietitian
      Nutrition and Food Services
Outline
 • What is the Regina Community Clinic
 • What is metabolic syndrome
 • Purpose
 • Methods
 • Discussion/Recommendations
 • Strengths/Limitations
 • Implications for practice
 • Questions
What is the Regina Community Clinic (RCC)?
 • Cooperative primary health service provider
 • Diverse clientele
 • Staff: physicians, nurses, counsellors,
   dietitian, optometrist, exercise specialist,
   x-ray and lab technicians, support staff
 • Minimum of 15 minutes with each client
Metabolic Syndrome (metsyn)
 Metsyn:
   – Obesity
   – Dyslipidemia
   – Hypertension
   – Type II Diabetes
Purpose

The purpose of the study was two-fold:
  1) to determine the number of clients admitted to
    RCC with metsyn, and
  2) what were the treatment options offered to clients
Methods
• Retrospective chart review
   – September 2006
   – 530 charts
• Data collection:
   – Height, weight, waist circumference
   – Age, gender
   – Serum triglycerides, HDL, fasting glucose
   – Dyslipidemia, hypertension, diabetes, obesity
   – Medication, lifestyle treatments
Methods – continued
 • Modified National Cholesterol Education Program
   Adult Treatment Panel III (NCEP ATP III)
 • Any 3 or more of the following 5 features:

Risk Factor               Defining Level

Abdominal Obesity         Waist circumference
                          Men        >102 cm (>40 inch)
                          Women      >88 cm (>35 inch)
                          Or          BMI > 30



Triglycerides                         ≥ 7.1 mmol/L

HDL cholesterol           Men         < 1.03 mmol/L
                          Women       < 1.29 mmol/L


Blood Pressure                        ≥ 130/85 mm Hg

Fasting Glucose                       ≥ 6.1 mmol/L
 Results
• 289/424 charts met criteria
   – mean age 55 years
   – All clients had risk factors
       • (HTN,  BMI, TG,  fasting glucose, HDL)
   – 42/289 clients identified with metsyn
Results
Classification of Clients with metsyn by age (n=42)



               35
                                     29
               30
  Percentage




                                              26
               25
                                                       19
               20
               15
                             10                               9.5
               10
                     5
               5
               0
                    18-39   40-49   50-59    60-69    70-79   80+

                                          Age Group
Results
Treatments offered by Physicians and Nurse Practitioner (n=40)
  Number of Clients



                      50
                      40
                      30
                      20
                      10
                      0
                           Medication Referral to   Referral to   Dietary   Physical     Weight
                                          RD           ES         Advice    Activity   loss advice
                                                                            Advice

                                       Treatments Offered
Results
Registered Dietitian (n= 24) and Exercise Specialist (ES) (n=11)


                      30
                      25
  Number of Clients




                      20
                                                                         Dietitian
                      15
                                                                         ES
                      10
                       5
                       0
                           Weight   Lipids   Diabetes    Pre-      HTN
                           Loss                         Diabetes


                                    Type of Referrals
Discussion
• The purpose of this study was to determine the number of clients
  at RCC with metsyn?
   – 42/289 (14%) identified with metsyn


• What treatment options were provided to clients?
   – 40 offered treatments
       • Medication 83%
       • Registered Dietitian 48%
       • Exercise Specialist 24%
Recommendations to RCC
 • Metsyn – obesity, hypertension, dyslipidemia, type
   II Diabetes
    – Lifestyle therapies are integral to the treatment
    – Have BP and waist circumference checked at every visit
    – List risk factors for metsyn on RCC screening tool
    – Regular follow-up needed
 Acknowledgements
Students
    – Ka Man Cheung, Dietitian Candidate
    – Nicole Pulvermacher, Dietitian Candidate
    – James Smetaniuk , Dietitian Candidate
Advisors
    – Heather Dzioba, Regina Community Clinic
    – Jean Coleman, Internship Coordinator
RCC staff
    –   Dr. Jerry Danielson
    –   Dr. Robin McMaster
    –   Myrna Williams
    –   Melanie Schipper and Russ Down
    –   the Medical Records staff
Research and Development
    – Ali Bell
    – Dr. Elan Paluck
    – Research Showcase

								
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