Criteria 21

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Criteria 21 22 Delivery Methods
Involvement in LearningThe incorporation of
live patient encounters into disease
managementcertificate programs

• Michael Vinson, Pharm.D., M.S.
• Director of the Bureau of Pharmaceutical Services
• University of Mississippi

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Disease Management Certificate Programs at the
University of Mississippi

• Programs have been offered since 1996
• Four areas of concentration
• Anticoagulation
• Asthma
• Diabetes
• Dyslipidemia

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Patient Encounter Workshop

• Begun in 1999
• Jackson Medical Mall

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Jackson Medical Mall
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Jackson Medical Mall

• Conference Center
• Pharmaceutical Care Clinic

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Patient Encounter Workshop

• Usually the first workshop of each program
• Participants divided into groups of 3-5
• Each group has a facilitator
• A patient is assigned to each group to interview
• Patients sign a standard release and are paid
  50.00

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Patient Encounter Workshop

• Experienced facilitator guides interview
• Patient interviewed by the entire group
• Interview lasts approximately 30 minutes
• Group discusses the case and develops a care plan
  for the patient
• Cases and care plans are presented and discussed
  in plenary session the next day

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Why a Patient Encounter Workshop?

• Not to teach interviewing skills
• Although some basic concepts can be conveyed
• To
• Let the pharmacists see that they are NEEDED
• Show that they can contribute to patient care
• Energize the participants
• Provide an experience from which they can develop
  basic care plans

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An Example
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Example of a Groups Presentation

• The following slides were produced by a group to
  report their case and care plan
• The presentation mode (i.e. slides) is NOT
  typical
• The content of the report IS typical

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Diabetes Certificate ProgramPatient Care Plan

• Group 1
• Thomas Casey, Dennis Read, Jill Barrett
• March 15, 2001

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Patient Presentation

• A.H. is a 27 y/o WF with Type 1 DM
• Diagnosed 1988 at age 14
• Symptoms Blurry vision, frequent urination and
  thirst
• 2 week hospital stay with BG 500
• Started on insulin and sent to educator

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Past Medical History

• Type 1 DM x 14 yrs
• No hypertension or dyslipidemia
• Allergic to PCN and sulfa
• C-section male, 6 pounds (3 weeks early) no
  problems during pregnancy but did require more
  insulin

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Family History

• Maternal grandparents had diabetes
• Mother and father do not have DM
• Mom has HTN
• All of moms brothers and sisters (9) are
  diabetic some have CAD

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Social History

• No ETOH
• Quit smoking 5 years ago (1/2 ppd)
• On disability - Medicaid

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Medications

• Aciphex 20mg as needed for heartburn
• Celexa 20mg QAM and noon
• Vistaril 25mg TID for anxiety
• Desryl 150mg HS prn sleep
• Detrol 2 mg BID

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Insulin Regimen

• Novolin N 25 units AM 33 units HS
• Humalog 2 units/carb TID AC SS
• Sliding scale (Humalog)
• 150-2001 unit 201-2502 units
• 251-3004 units 301-3506 units
• 351-4008 units

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Current Status

• 54 218 lbs
• Last HbA1c 7
• BGM up to 5 or 6 times a day
• Eye exam yearly diabetic clinic Q 3 mo.
• Sick days BG increases and usually is
  hospitalized
• C/O constipation, gas pain, and frequent yeast
  infections

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Diary entry
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Log History

• AM fasting average 160 (goal
  80-120)
• HS average 154 (goal 100-140)
• Noon average 115
• Supper average 154
• 2 episodes lt 60 (took glucose tabs)

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Objective notes

• 27 y/o WF, Type 1 DM, obese
• Upbeat, well-educated on diabetes with positive
  outlook
• Compliant with BGM and insulin
• Fairly good glycemic control
• Early signs of gastroparesis
• Otherwise no complications

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Patient Needs

• Diet education stress compliance
• Exercise training
• Address early signs of gastroparesis
• Review insulin regimen to lower AM and HS blood
  sugar and decrease hypoglycemic episodes
• Review financial status for diabetic supplies
  indigent programs??
• Sick day control
• Educate family members

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Patient Goals

• Weight management
• Eat healthier foods
• Regular exercise ( 5x week)
• Control AM glucose
• Increase water and fiber intake
• Stricter monitoring on sick days use diabetic
  clinic for support

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Plan for Glycemic Control
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Patient Care Plan

• Diet and exercise plan
• Review carb counting
• Increase fluid intake
• Increase fiber intake
• Educate family and friends on glucagon kit,
  hypoglycemia, and sick day control

• BGM and HS insulin adjustment
• Aciphex 20mg QD
• ASA 81 mg QD
• MVI QD
• Diflucan refills

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Monitoring

• FBG - log book
• HbA1c - every 3 months
• Blood chemistry (every 3 to 6 months)
• Urinalysis each visit
• Yearly eye exams
• Foot exam each visit (and at home)
• Insulin administration technique

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Follow-up Questions

• Injection technique
• How does she pay for diabetic supplies?
• How many DKA episodes?
• Family support

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• Questions?