GPMP _Item 721_ and TCA _Item 723_

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GPMP _Item 721_ and TCA _Item 723_ Powered By Docstoc
					GPMP (Item 721) and TCA (Item 723)

GPMP Review (Item 725) and TCA Review (Item 727)

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BPTARGETX
National Prescribing Service blood pressure targets
· Below 140/90 > 65 years
· Below 130/85 or 130/80 < 65 years, or those with diabetes or renal impairment or
proteinuria 0.25-1 g/day
· Below 125/75 proteinuria > 1 g/day

TEETHX
Brush teeth twice per day with fluoride toothpaste
Home use of high fluoride toothpastes, gels or mouth rinses for those at high risk
Use sugar free chewing gum for saliva stimulation
Mouthguards for contact sports
Regular dental check ups recommended

BONEX
People over 45 years of age who sustain a low trauma fracture should consider bone
mineral densitometry

EYEX
Patients with a family history of glaucoma, Diabetes and with a history of long term
steroid use should be referred to an ophthalmologist for regular testing

SNAPX
Advised to cease cigarettes
Enjoy a wide variety of vegetables, legumes and fruits
Eat plenty of cereals (including breads, rice, pasta and noodles, preferably whole
grain)
Include lean meat, fish, poultry and/or alternatives
Reduced fat varieties should be chosen where possible
Drink plenty of water and take care to limit saturated fat and moderate total fat intake
Choose foods low in salt
Consume only moderate amounts of sugars and foods containing added sugars
Limit alcohol intake to a maximum of 4 standard drinks (Midi of full strength) usually
confine alcohol to 2 standard drinks per night and abstain from alcohol for 2 nights
per week
Participate in 30 minutes of moderate activity on most, preferably all days of the
week. While moderate physical activity is recommended for health benefit, more
vigorous exercise may confer additional cardiovascular health and cancer prevention
benefits, if carried out for a minimum of 30 minutes 3-4 times a week

PREVENTX
Prevention Plan:
Blood pressure at least each 2 years from 18

Fasting Chol TG HDL each 5 years from 45 (for those at high risk smoker,
hypertension, overweight family history of coronary disease <60 absolute
cardiovascular risk > 15% over the next 5 years screen annually)

Fasting BSL each 3 years from 55 and annually from 45 for those at high risk (IGT,
ATSI, Pacific Island, Indian subcontinent or Chinese origin from 35, BMI>30,
hypertension)
GTT for fasting BSL 5.5-6.9

Consider annual fasting BSL, Chol, TG, HDL, UEC, LFTs

Consider annual CK if on a statin

Urinalysis and blood pressure annually from 50

Consider UEC and calculated GFR annually for those at high risk (hypertension
family history of renal disease)

Consider regular skin check

Patients 13 years and older at high risk of melanoma should be examined for skin
cancer annually (increased risk with family history of melanoma, fair complexion,
>30 years, solar lentigines, previous skin cancer, traumatic sun burn as a child. High
risk multiple dysplastic naevi, personnel or family history of melanoma)

Patients 40 years and older at high risk of non-melanoma skin cancer should be
examined for skin cancer annually (High risk previous skin cancer, past exposure to
arsenic, immunosuppressed)

Pap smear each 2 years to 18-70 who have ever had sex and have not had a
hysterectomy (1-2 years after sexual activity)

Mammogram each 2 years from 50 -70 (consider annually from 40 with a family
history of breast cancer

Consider family cancer clinic or cancer specialist advice for high risk 2 first or second
degree relatives with breast cancer <40 or ovarian cancer < 50 family history of breast
cancer in a male, family history of breast cancer and sarcoma < 45, known family
history of high risk cancer gene mutation)

Faecal occult blood test every 2 years recommended from 50 (by Rotary bowel
screening through your pharmacy around March)

Regular Colonoscopy screening recommended
Consider annual interval faecal occult blood test
Colonoscopy each 5 years with family history of colon cancer < 55
Consider family cancer clinic or cancer specialist advice for high risk (2-3 first or
second degree relatives on the same side with colon cancer, multiple colonic cancers
in the same person, family history of colon cancer << 50, family history of hereditary
non-polyposis colorectal cancer, first or second degree relative with a large number of
colon adenoma or a known family history of high risk cancer gene mutation)

Consider regular PSA and rectal examination screening

Inform of risks, uncertainties and benefits of annual PSA and rectal examination from
50-70 (From 40 with family history of prostate cancer < 60). Routine screening
currently not recommended by RACGP or NHMRC.

Consider annual Influenza vaccination from 65 years of age

Consider Pneumococcal vaccination from 65 years of age

GPMPX
General Practice Management Plan: (item 721)
Note a rebate will not be paid within 3 months of item 725,727,729 or 731
General Practice Management Plan (GPMP) prepared including:
• Assessment to identify health care needs and problems
• Agreed management goals
• Actions to be taken by patient identified
• Treatments and services likely to be needed documented
• Arrangements for these services made
• General Practice Management Plan Documented with copy prepared for patient

A separate consultation was clinically required to be provided on the same day

Team Care Arrangements (item 723)
Note a rebate will not be paid within 3 months of item 727 (TCA review)
Collaboration with

TCAX
Team Care Arrangements (TCA) indicated by complex health care needs and one or
more of the following:
•      A need to see other providers on regular, frequent and ongoing basis to
manage the chronic condition
•      An unstable or deteriorating condition
•      Increasing frailty and dependence
•      Increasing incidence and complexity of health problems
•      significant change in social circumstances
•      two or more hospital admissions for their chronic condition in the past six
months
•      inability to comply with required treatment without ongoing management and
coordination
Management goals agreed
•      Actions to be taken identified
•      Treatments and services likely to be needed documented
•      Arrangements for these services made
•      Consent to share information with other care providers
•      Collaboration with other care providers
•      Goals of care documented
•      Review dates documented

GPMPRU
General Practice Management Plan Review (item 725)
Note a rebate will not be paid within 3 months of item 721 or 725
General Practice Management Plan (GPMP) prepared including:
• Assessment to identify health care needs and problems
• Agreed management goals
• Actions to be taken by patient identified
• Treatments and services likely to be needed documented
• Arrangements for these services made
• General Practice Management Plan Documented with copy prepared for patient

A separate consultation was clinically required to be provided on the same day

TCARU
Team Care Arrangements Review (item 727)
Note a rebate will not be paid within 3 months of item 723 or 727
Collaboration with


Management goals agreed
•     Actions to be taken identified
•     Treatments and services likely to be needed documented
•     Arrangements for these services made
•     Consent to share information with other care providers
•     Collaboration with other care providers
•     Goals of care documented
•     Review dates documented

A separate consultation was clinically required to be provided on the same day

EPCX
Enhanced Primary Care Program Referral
Enhanced Primary Care Program Referral Form completed for Allied Health Services
under Medicare

REDBOOKX
My health record:
"My health record" explained to patient
Health summary filed
General Practice Management Plan (GPMP) filed
Health Assessment filed
Advanced Health Directive filed
Advised to take "My health record" when attending any health service, doctor or
hospital
EPCXX
General Practice Management Plan (item 721)
Team Care Arrangements (item 723)
General Practice Management Plan Review (item 725)
Team Care Arrangements Review (item 727)

GP Mental Health Care Plan (item 2710)
GP Mental Health Care Plan Review (item 2712)

Health Assessment (item 700)
Home Medicines Review Referral (item 900)
Has an EPC referral
Has a Red Book
Has an Advanced Health Directive
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Immunosupression shortcuts for letter writer
Specific goals:

Osteoporosis prevention
Consider measurement of bone density before treatment and yearly while on treatment.
Start Calcium and Vitamin D supplements.
Bisphosphonates may reduce bone loss associated with the chronic use of steroids

Peptic ulcer protection
Consider Helicobacter screening and prophylactic treatment with proton pump inhibitors with a history of previous
ulceration or if NSAIDs are being used

Infection prophylaxis
Avoid live vaccines.
Consider a Chest Xray prior to treatment with more specific TB testing depending on history and Xray changes

Malignancy prevention
Annual skin survey recommended Eye protection may limit cataract development
(reference Australian Prescriber Dec 2007)

COPD/CAL shortcuts for letter writer
General Practice Management Plan
Consider annual FBC to exclude polycythaemia
Consider annual ECG looking for evidence of pulmonary hypertension
Consider annual spirometry

Team Care Arrangements and frequency of review
Consider Pulmonary Rehabilitation with multidisciplinary education and rehabilitation if available including:
Education about lung disease in a group setting
Effective Breathing Exercises
Skeletal muscle training

Confirmation of Diagnosis
Spirometry performed to confirm diagnosis

Specific goals
Documentation of severity of COPD with spirometry
Determination and documentation of reversibility and steroid responsiveness (esp if FEV1<1.6)

Domiciliary Oxygen
Appropriate use of Domiciliary Oxygen with confirmed PaO2 of 55 mm Hg or less in a non smoker with all
reversible factors (such as anaemia) remediate. Polycythaemia (Hb > 170 gm/L), clinical or ECG evidence of
pulmonary hypertension, as well as episodes of right heart failure, strengthen the case for use of oxygen. Oxygen is
required for 15 hours a day, including sleep with flow rates ranging from 1-5 L/min, at the lowest rate needed to
maintain a resting PaO2 of 60 mm Hg (in practice, most often 2 L/min). Concentrators are the most appropriate
mode of supply for continuous oxygen, E cylinders last around 30 hours D cylinders around 11 hours and C
cylinders around 3 hours at 2L/min. Concentrators are cheaper than cylinders if use is equivalent to three E-size
cylinders per month. Benefits of oxygen use should be confirmed at one month an then annually.

Avoid
Beta-blockers (including Carvedilol), Benzodiazepines relatively contraindicated, Narcotics especially with
hypercapnia relatively contraindicated.

Action Plans
Add or increase bronchodilator therapy
Amoxycillin or Doxycycline for 5-12 days with increased cough and dyspnoea together with increased sputum
volume and/or purulence and/or fever. Short course of oral steroids if no improvement in 48 hours or if wheeze
present from the beginning of the exacerbation. Possible role for mucolytics in consultation with General
Practitioner
In an emergency dial 000 for ambulance

Patient support organisations
The Australian Lung Foundation supports people who have
been diagnosed with lung disease and their families
Web site: www.lungnet.org.au/psych-conseq-rd.html

Warfarin shortcuts for letter writer
Team Care Arrangements and frequency of review
Comprehensive Warfarin education and dietary education
Warfarin care by pathology staff

Specific goals
INR target
Usual INR target for Atrial Fibrillation 2-3
Usual INR target for mechanical prosthetic heart valve 3-4.5
Usual INR target for DVT and PE 2-3

INR monitoring at least 6 weekly with more frequent testing if results unstable
Twice weekly testing with the introduction of new medications or a change in the diet

Action Plans
Seek advice prior to any surgery or dental work
Increase frequency of testing to at least twice weekly during hospitalization surgery or change medication or diet

				
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