Byron L. Haney, MD Family Physician-Ellensburg WA Consultant-Shared Medical Appointments Family Health Care of Ellensburg PNWU Associate Professor bhaney@fhcoe.com www.fhcoe.com
TRIPLE AIM + 1
Family Health Care • HIGH VALUE HEALTH CARE • TRIPLE AIM ACHIEVED • REDUCING COST OF CARE • IMPROVING POPULATION HEALTH • IMPROVED PATIENT EXPERIENCE • EMPLOYEES LOVE THEIR WORK ENVIRONMENT, MAKE LIFESTYLE CHANGES THEMSELVES
CHANGE IN PATIENT SATISFACTION WITH PRIMARY CARE PHYSICIAN 3.8 SMA 3.7 3.6 Individual 3.5 Baseline 24 Months Scale: 1 to 4. Higher Score = Greater Satisfaction. p = .003 -Scott JC.
RETURN THE JOY TO MEDICINE OR TALK FASTER WALK FASTER DON’T EAT DON’T MICTURATE NEGLECT SELF/LOVED ONES JUST BURNOUT
CO$T OF DIABETES DIABETE TES 201 012 2 EST. COST : $245,000,000,000 $69 BILLION IS REDUCED PRODUCTIVITY. HEALTH TH CARE RE COST T PER R CAPI PITA : (ANNUAL) NON DIABETI TIC: $5,800 DIABETI TICS: $13,700 $7,900 ATTRIBUTED TO DIABETES (2.3 X)
DIABETES PREVENTION LITERATURE REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN • N ENGL J MED FEBRUARY 7, 2002 • DIABETES PREVENTION PROGRAM RESEARCH GROUP (DPRRG)
SHARED MEDICAL APPOINTMENTS SMA S ARE P URE J OY
WHY GROUPS WORK? • INSTILLATION OF HOPE • UNIVERSALITY • IMPARTING INFORMATION • IMITATIVE BEHAVIOR • INTERPERSONAL LEARNING • ALTRUISM • GROUP COHESIVENESS • CATHARSIS • CORRECTIVE RECAPITULATION OF THE PRIMARY FAMILY GROUP • EXISTENTIAL FACTORS -Yalom I.
WHY GROUPS WORK? INSTILLATION OF HOPE: ENCOURAGEMENT THAT RECOVERY IS POSSIBLE UNIVERSALITY: FEELING OF HAVING PROBLEMS SIMILAR TO OTHERS, NOT ALONE IMPARTING INFORMATION: HELPFUL TO LEARN FACTUAL INFORMATION FROM OTHERS IMITATIVE BEHAVIOR: MODELING ANOTHER’S MANNERS AND RECOVERY SKILLS -Yalom I.
INT NTERP RPERSONAL RSONAL LEARNING ARNING: ACHIEVING GREATER SELF-AWARENESS THROUGH GROUP FEEDBACK ON THEIR BEHAVIOR AND IMPACT ON OTHERS. ALTRUIS TRUISM: : HELPING AND SUPPORTING OTHERS GROUP UP CO COHES ESIVE IVENES ESS: : FEELING OF BELONGING TO AND VALUING THEIR GROUP. CA CATHA HARSIS RSIS: RELIEF OF EMOTIONAL TENSION BY TELLING THEIR STORY TO A SUPPORTIVE AUDIENCE, GAINING RELIEF FROM CHRONIC FEELINGS OF SHAME AND GUILT. CO CORRECTIV CTIVE REC ECAPITUL APITULATION TION OF T F THE E PRIMAR RIMARY Y FAMIL ILY Y EX EXPE PERIE RIENC NCE: IDENTIFYING AND CHANGING DYSFUNCTIONAL PATTERNS AND ROLES ONE CARRIES OUT IN THEIR FAMILY. EXISTEN STENTIA TIAL FACTO CTORS RS: : LEARNING ONE MUST TAKE RESPONSIBILITY FOR ONE’S OWN LIFE AND THE CONSEQUENCES OF ONE’S DECISIONS. -Yalom I.
Paradigm Change CAREGIVERS: • DEPART FROM PATERNALISTIC CARE • MOTIVATIONAL INTERVIEWING • BECOME A FACILITATOR • TALK LESS--USE YOUR PATIENTS AS YOUR EXPERTS (FACILITATE, DIRECT AND EDUCATE THEM TO BE EXPERTS) • CARE DECISION MAKING STEPS • PATIENT FIRST • GROUP MEMBERS SECOND • PROVIDER LAST
DPPRG VS SMA’S ( FHC)
Long-Term Success Rate of Diets 45 Million Americans plan to go on a diet this year and most will lose some ? % weight, but then the chance of keeping it off for 5 or more years is….
Long-Term Success Rate of Diets 5%
The Ideal Protein Weight Loss Method An evidence-based medical protocol that addresses improving long-term patient outcomes and results through education delivered by healthcare provider partners.
Ideal Protein Protocol Outcomes at FHCOE • >45,000 # & 32,000” LOST OVER THE LAST 5+ YEARS • WEIGHT LOSS WITH BMI OF: • 30-39.9 57.6# AVG • 40+ 100.6# AVG • PATIENTS WITH STARTING BMI >30: • 60% ARE MAINTAINING THEIR WEIGHT LOSS • HALF WITH OUR HELP • 40% STRUGGLE (95% NOT FOLLOWING OUR FREE MAINTENANCE PLAN) • ALCOHOL ABUSE • INCREASED SUCCESS IF: • REACHED NORMAL BMI (89% MAINTAINING) • SET 2 WEEK WEIGHT GAIN MARGIN • MEN • SMA INVOLVED (80% MAINTAINING) • ELIMINATED MEDICATION OR CPAP • ATTENDING FREE MAINTENANCE PROGRAM
58 y.o. May �1� June �17 Aug �1� (9 mo) 148# 252# 156# 104#
Diabetes Type II, Uncontrolled Medications 58 Years Old August, 2014: May, 2015 • Metformin 850 TID • Aspirin 81mg • Glyburide 10mg BID • Lisinopril 2.5mg QD • Simvastatin 80mg QD • Lisinopril 20mg QD • Bupropion HCl XL 150mg QD • Aspirin 81mg QD
Diabetes Type II, Uncontrolled 58 Years Old Vitals August, 2014: May, 2015: On meds Off meds • Blood Pressure: 155/87 • Blood Pressure: 105/74 • Weight: 252 • Weight: 148 • BMI: 37.2 • BMI: 21.9
Diabetes Type II, Uncontrolled Labs 58 Years Old August, 2014: April, 2015: Aug, 2016: • A1c: 14.7 • A1c: 6.2 • A1c: 6.0 Off meds On meds • FBS: 362 • FBS: 118 • FBS:111 • Trig: 737 • Trig: 81 • Trig: 83 • LDL: (not reported) • LDL: 168 • LDL: 96 • HDL: 38 • HDL: 83 • HDL: 54 • Total Chol: 250 • Total Chol: 267 • Total Chol: 167 • Creatinine: 0.66 • Creatinine: 0.58 • Creatinine: 0.65 • Micro/Creat Ratio: 723 • Micro/Creat Ratio: 447 • Micro/Creat Ratio: 859
Diabetes Type II, Uncontrolled Cardiac Risk 58 Years Old August, 2014: April, 2015:
Larry 68 y.o. 9/26/17 Mar, �17 (6 mo) 255# 340# 85#
Diabetes Type II, Uncontrolled Medications 68 Years Old March, 2017: Sept, 2017: • Tresiba 70 units/day • Tresiba 16 units/day • Humalog 120 units/day • Humalog (gone) • Lisinopril 2.5mg/day • Lisinopril 2.5mg/day • Atorvastatin 20mg/day • Atorvastatin 5 mg/day • Clopidogrel 150mg/day • Clopidogrel 75 mg/day • Terrazosin 0.4mg/day • Terrazosin 0.4mg/day • Metoprolol 200mg/day • Metoprolol 50 mg/day • Digoxin .125mg/day • Digoxin .125mg/day • Furosemide 40mg/day • Furosemide – 10 mg/day 5 day/wk – 20 mg/day 2 day/wk
Diabetes Type II, Uncontrolled 68 Years Old Vitals March, 2017: Sept, 2017: On meds Medication reduction • Blood Pressure: 142/70 • Blood Pressure: 134/74 (8/9) • Weight: 340 • Weight: 255 • BMI: 41 • BMI: 31
Diabetes Type II, Uncontrolled Labs 68 Years Old Pre March, 2017: May, 2017: Sept, 2017: • A1c: 10.1 • A1c: 7.5 • A1c: 6.1 • FBS: 260 • FBS: 137 • FBS: ?? Less meds Further Med On meds • Trig: 251 • Trig: 74 • Trig: 85 reduction • LDL: 55 • LDL: 38 • LDL: 33 • HDL: ?? • HDL: 33 • HDL: 37 • Total Chol: (not reported) • Total Chol: • Total Chol: • Creatinine: 1.67 • Creatinine: 1.38 • Creatinine: ?? • Micro/Creat Ratio: ?? • Micro/Creat Ratio: 208 • Micro/Creat Ratio: 261 • GFR: 44 • GFR: 55 • GFR: ?? • Ejection Fract: <35 • Ejection Fract: >40 • Ejection Fract: 40
Three Step Process 1. Weight Loss • Until healthy weight achieved 2. Stabilization • Learn a New Healthy Lifestyle – 12 months 3. Maintenance • For life Our Coaches are there to offer the tools, education and support necessary to achieve and maintain weight loss goals!
The Ideal Protein Weight Loss Method Reduces Calories Maintains Vitamin, Mineral, and Electrolyte Balance Maintains Muscle Mass by Ensuring Adequate Protein Intake
Why the Ideal Protein Weight Loss Method? Ideal Protein Hypocaloric Diet Phase 1 “Balanced” Diet Vitamins Vitamins & Minerals & Minerals 2000 Calorie Diet Vitamins & Minerals 1200 – 1400 Calorie Diet 850 Calorie Diet 2000 Calorie Diet 850 – 1000 1200 – 1400 Calorie Diet Calorie Diet
FHCOE providers also see improvements in: High Uric Acid PCOS, Infertility • • Fatty Liver (NASH) Abnormal Periods • • Heart Burn/Reflux CVD • • Obstructive Sleep Apnea Depression • • COPD Fibromyalgia • • Joint Pain Fatigue • •
The choice is yours?
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