Family Medicine

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Family Medicine

• Mark Mawhinney
• December 15, 2006

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What movie?

• What's your problem, Kazanski?
• Youre everyones problem. That's because every
  time you go up in the air, you're unsafe. I don't
  like you because you're dangerous.
• That's right! Ice... man. I am dangerous.

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Top Gun (1986)
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2 main items to be covered

• 1- Where was I the last 5 weeks?
• 2- Who is an interesting patient I worked with
  who has a chronic disease?

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Question 1
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Where was I?
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MCPN- Hoffman Heights

• Metro Community Providers Network
• - Began in 1989 to aid the underserved
• - A network of 14 clinics and health centers
• - Designed to provide primary care to those with
  no other access to care

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Who MCPN Serves

                                    
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Insurances Accepted

• Colorado Indigent Care Program (CICP)
• Colorado Child Health Plan Plus (CHP)
• Emergency Medicaid
• Medicaid
• Medicare
• CHP
• Sliding Fee Scale
• Self Pay

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Hoffman Heights Clinic

• - Staff of 2 physicians and 4 PAs on the primary
  care side of the clinic
• - Staff of 2 physicians and 3 PAs on the OB side
  of the clinic
• - Majority of patients Hispanic and
  Spanish-speaking only
• - Typical Day is around 30 patients

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Most Common things seen

• 1- Prenatal Care
• 2- Well-child exams
• 3- Diabetes
• 4- Acute Illnesses
• 5- Obesity/Hyperlipidemia/Hypertension
• 6- Mental Health

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Services Available

• - AmeriCorps service learning Programs for Adults
• - Health Education Classes Diabetes, Asthma,
  Childbirth, Smoking Cessation, Family Planning
  and Healthy Living.
• - Healthy Start Project, providing care
  coordination for pregnant women and families
• - Perinatal Services
• - Services for Auroras Homeless/Indigent
  Populations
• - Services for Pregnant and Parenting Teens,
  working with pregnant and parenting youth in
  Aurora ages 11 19 years. Resource information,
  help returning to school or getting a GED,
  support, advocacy, home visits, case management
  and the teen clinic. 

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Unique Difficulties

• - Language barrier!!!
• - Patients lost to follow-up
• - Specialist referrals
• - Overbooked/understaffed

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Question 2
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Who is my Chronic Disease Patient?

• Patient M.L.
• - 60 yo female
• - Hispanic
• - Spanish-speaking only
• - Diabetes Mellitus Type 2

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History of her disease

• - Diagnosed 3 years ago after not having been to
  a doctor for more than 10 years
• - Prescribed medication, given diet/exercise
  instructions, NON-COMPLIANT
• - Did not have regular follow-up

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THEN

• - Husband was diagnosed with diabetes two years
  later
• - She became motivated/scared towards controlling
  her diabetes and her husbands
• - Attended diabetes education classes sponsored
  by MCPN

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M.Ls tx plan

• - Avoid foods rich in carbohydrates
• - Exercise 30 min/day
• - Metformin 1000mg bid
• - Have regular follow-up with physician

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M.L.s progress

• - Weight 1 year ago 204
• Weight now 180
• - HA1C 1 year ago 8.8
• HA1C now 6.9
• - BP 1 year ago 138/85
• BP now 120/73

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Reasons for success?

• - Patient-doctor relationship established
• - Could work as a team with her husband
• - Was motivated/scared into action
• - Knew she had resources available to her
• - Able to see her results and take pride in them

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Thank you!!!