Thanks again to all of you for volunteering. We are needed more than ever, with our total patients up 14% from this time last year!

Transcription

1 Lunch & Learn Minutes May 5, 2017 Thanks again t all f yu fr vlunteering. We are needed mre than ever, with ur ttal patients up 14% frm this time last year! 1. CVIM Vlunteer Plicy n Criminal Checks Reminder t all vlunteer staff: As required by the PA Child Prtective Services law, all clinical and supprt vlunteers must cmplete a PA Criminal Check and a PA Child Abuse Clearance. All vlunteers need t prvide the certificates prduced by these clearances fr their persnnel file, and the prcess must be repeated every 5 years. All vlunteers wh have been residents f PA cntinuusly fr the past 10 years must als sign a PA Disclsure Statement ( Attestatin ). If yu have resided utside f PA in the past 10 years, and d nt have clinical cntact with children at CVIM, yu d nthing further. Vlunteers wh see children as patients must als cmplete the FBI Criminal Check. Please be aware that these clearances are required in rder t (re-)credential vlunteers at CVIM. We really appreciate yur understanding and cperatin! Instructins and paperwrk are available n ur website, cvim.rg. Click n Vlunteers then Vlunteer Lgin username: Vlunteer passwrd: cvim300 Infrmatin can als be btained frm Jane Orner at jrner@cvim.rg. Yu are welcme t sit with her and walk thrugh the steps tgether; her desk is at the entrance t the business ( west ) wing f the clinic. She can tell yu what yu need t update r prvide. 2. Develpment Update Strategic Plan Gal #5: Strengthen the Financial Future FY17 Develpment Gal = $2,865,000 Yield t Date = $2,275,000 Amunt t Gal = $590,000; may nt hit gal but cntinuing t encurage dnrs and spreading the wrd Strategic Plan Gal # 4: Burnish the Brand Nn-prfit f the year Chester Cunty Chamber f Business & Industry CBS Brtherly Lve segment Facebk: 15,757 peple reached, 689 reactins Twitter: 11 new fllwers, 21 mentins, 1,212 prfile visits Vide link in staff signature SPW/Main Line Chamber highlighted nnprfit Upcming: Main Line Tday - CVIM feature in June issue May 15th CVIM Mnday Night Receptin; pprtunity t be mre visible, encurage supprt

2 3. The Harrisn Sciety was intrduced, it was launched at a recent Mnday Night Harrisn Receptin hnring Dr. Harrisn s 10 years f CVIM service Over 50 peple in attendance including Mrs. Harrisn & daughters Sciety will recgnize and hnr thse wh make a gift f $1,000 r mre n an annual basis The Harrisn family kicked ff Sciety with a $10,000 dnatin Hpe many friends f CVIM will becme members 4. CVIM PAIN PROGRAM Opiate abuse has becme a natinal crisis. CVIM has develped and frmalized ur Pain Management Prgram t treat patients with bth acute and chrnic pain. At CVIM, we d nt prescribe piates, but we want ur patients t knw that we will treat their pain using a cmbinatin f treatment mdalities that acknwledge the multi-faceted cmplexity f chrnic pain. One-third f CVIM s pain management prgram is medicatin. Nn-pharmaclgic treatments and self-care management techniques cmprise tw-thirds f ur prgram. Specialties such as rthpedics, chirpractic, acupuncture, neurlgy, rheumatlgy, and therapeutic massage are imprtant aspects f ur pain team. Our Behaviral Health Prgram wrks in cnjunctin with ur Pain Management, as many f ur chrnic pain patients, nt surprisingly, struggle with depressin and anxiety. Additinally, many patients wh present with medical cnditins such as headaches r abdminal pain are actually diagnsed with depressin as the etilgy f their cncern. The imprtant discussin is t set realistic gals with the patient. Patients must understand that we will wrk with them t help decrease their chrnic (r acute) pain but may nt cmpletely alleviate it. Realistic expectatins can imprve their utlk and thus their quality f life. Finally, CVIM s gal is fr every patient t knw we are here t help, we are here t listen, and each patient can leave with HOPE fr a better utcme. See the Pain Prgram belw in picture frm. Anticnvulsants Tramadl Antidepressants Exercise Pharmaclgic Treatments ASA Tpical Agents Nutritin Heat/Cld Self Care NSAIDs Acetaminphen Sleep Hygiene Acupuncture Prcedures Chirpractr Physical Therapy Cunseling Trigger Pint Epidural Nn-Pharmaclgic Appraches

3 a. What is Pain? The Internatinal Assciatin fr the Study f Pain defines pain as an unpleasant sensry and emtinal experience assciated with actual r ptential tissue damage Pain is the mst cmmn reasn fr physician cnsultatin in the US Our patients may have increased pain (and ther cnditins) due t limited access t care; they are ften mre critical when they get t us Pain is present in >50% ED visits, 30% f family practice visits After 3 mnths it is cnsidered Chrnic Pain b. Pain Panel Nt all the members f ur pain prgram culd attend but I am very grateful t thse wh presented. Neursurgen Dr. James Kenning He runs ur pain clinic. He specializes in evaluating patients with pain, especially cervical and lumbar pain issues. Please refer t him befre rdering an MRI and he will triage if needed (unless patient emergency) Orthpedics Dr. Jhn Caggian Dr. Caggian evaluates and treats all rthpedic issues and never hesitates t give an injectin if needed. Acupuncture Dr. Michael Gravely - He sees a vast array f pain issues and has had great success; he has written a bk called Tame Yur Pain. Dr. Peg Strz is anther acupuncturist nce a mnth. Rheumatlgy - Dr. Gerge McLaughlin discussed treatments and medicatins fr rheumatlgy cnditins. Massage Therapy Marigld Bernstein Marigld is the newest member f the team and we are grateful fr massage therapy. She discussed the inter-cnnectedness f emtinal stress and physical pain. c. Dr. Wirshup presented ur new Pain Self-Assessment Survey (attached) We are asking all patients wh have pain t fill this ut befre the physician, NP r Pa sees the patient. It is a great tl t understand hw pain is affecting the patient and t see if ur treatments are helping. Then we will be asked t fill ut the diagnsis f Pain n the face sheet and put the pain scre n the face sheet. Finally all the patients with chrnic pain shuld have a PHQ-9 t lk fr depressin and GAD-7 t lk fr anxiety filled ut every 3-4 mnths. Many patient with pain have secndary anxiety r depressin and need cunseling. d. Pain Medicatins Reviewed Pain Medicatins in the Dispensary: Acetaminphen (Tylenl) Aspirin NSAIDS Ibuprfen (Mtrin) Naprxen (Naprsyn) Melxicam (Mbic) Nabumetne (Relafen) Celebrex Cntrlled substances Tramadl (Ultram) Muscle relaxants Cyclbenzaprine (Flexeril) Lidcaine patches Gabapentin (Neurntin) Tricyclic Antidepressants Amitriptyline Nrtriptyline SNRI/SSRI Cymbalta Effexr Injectins

4 5. Behaviral Health Behaviral Health Services are available t CVIM Medical patients. Miriam manages referrals, schedules and waitlists. Miriam is CVIM s nly Spanish speaking cunselr. Miriam refers many Spanish speaking patients t cmmunity services fr cunseling at a sliding scale rate. Current Vlunteers: 4 cunselrs (plus 1 wh is n a medical leave), 3 adult psychiatrists and 1 pediatric psychiatrist Recruiting cunselrs, bth English and Spanish speaking shuld speak with Miriam if interested Discussed inter-cnnectedness f emtinal stress and physical pain; ften patient presents with pain (r weight/diabetes r ther symptms/illnesses) and cnsult reveals depressin and/r anxiety. Facesheet has places fr PHQ9, GAD7, ACE, range sheet (mre belw in Facesheet) ACE (Adverse Childhd Events): 10 questins abut experiences under age 18; hw many times fear f vilence, parent in prisn, divrce, etc. There is a direct link between childhd trauma and adult nset f chrnic disease (heart disease, lung cancer, diabetes and many autimmune diseases), as well as depressin, suicide, being vilent and a victim f vilence: mre types f trauma increased the risk f health, scial and emtinal prblems. 6. Patient Educatin Arkel Grdn has patient educatin literature and vides that can be viewed befre the patient visit r while waiting fr prescriptins; clinician shuld tell him any tpics they want the patient t be educated n and he will arrange it. There are green papers in each examining rm t indicate which vide(s) we want the patient t watch while they are waiting fr their meds. These are given t the patient, wh shuld give them t Arkel. 7. Cllabratins: Expand the Reach Prgrams & Partnerships Chester Cunty Hspital Weight Management Chester Cunty Fd Bank/ CSA Eagles Eye Van Bryn Mawr Rehab Hspital Diabetes Educatin Series Kennett Area Cmmunity Services Pre-Diabetes Classes Anxiety & OCD Center Zm Transprtatin Is nw available n Wed t pick up ur patients. Cntact ur scial wrker Sam Artze. 8. Updated Facesheet (attached) a. New facesheet infrmatin: Fx Chase Mammgram Van Literacy Cnferences > Next ne at CVIM: May 31 West Chester University >Public Health students >Athletic Training students >Nutritin >Nurses Added places fr PHQ9, GAD7, ACE (Adverse Childhd Events), range sheet (CVIM patient questinnaire), Pain scale, and Diabetes scale at the bttm Added pain as a diagnsis Added pediatric BMI and nutritin/exercise discussin Added lcatins fr mre vaccine, injectin, A1c, lipids, and PPD infrmatin

5 b. Three areas f facesheet are smetimes incmplete/missing and are critical fr grant reprting (as well as fr prper patient care): During this visit: Patient Educatin: [ ] Discussed smking Gal: percent f tbacc users ver age 18 wh have received cessatin advice r medicatin (see Tbacc belw) During this visit: Patient Educatin: [ ] Discussed asthma plan Gal: percent f patients aged 5-40 diagnsed with persistent asthma wh have an acceptable pharmaclgical treatment plan During this visit: Pediatrics: [ ] BMI Percentile [ ] Discussed nutritin & exercise Gal: percent f children and adlescents age 3-17 with a BMI percentile and cunseling n nutritin and physical activity dcumented 9. Tbacc Dependence a. The percentage f CVIM patients age 13 years and lder wh were screened fr tbacc use at least nce a year is high - cnsistently 97-99% f ur patients in 2016 and Keep up the gd wrk! b. Of the patients age 13 years and lder wh smke, the percentage received cunseling interventin and/r pharmactherapy has been less cnsistent at 28-40% mnth t mnth ( %) Please remember t refer patients t ur Tbacc Dependence prgram. We talked abut that yu d nt need t be ready t quit. We are nw using Mtivatinal interviewing s the cunselr will help them get t that pint. c. Check ff [ ] Discussed smking if clinician talked t patient abut smking and cessatin readiness; nt if they just asked if they smke/hw much. d. In each rm are patient educatin flders that patients can take with them, in English and Spanish.. 9. Cardiac Risk Assist app Discussed access t and use f the ASCVD Risk Algrithm app (place n all phnes, nurse r dctr can use it; als available nline) Calculates the lifetime risk f Athersclertic Cardivascular Disease using input n: Gender, race age Chlesterl, HDL, Systlic Bld Pressure, BP medicatin, diabetes, smker