ADAPT Level One Detailed Course Outline

Transcription

1 ADAPT Level One Detailed Course Outline I. ADAPT FOUNDATIONS A. Welcome B. Course overview 1. Course overview and learning objectives a) Clinician handout: Learning Objectives 2. Learning theory: why course is structured how it is 3. How to get the most out of the course a) Time commitment b) Study tips c) Getting support C. The Future of Medicine 1. The epidemic of modern disease 2. A new approach to medicine a) Recognizes exposome and epigenetics as primary drivers of disease b) Embraces an evolutionary/ancestral perspective c) Applies a functional medicine approach to care 3. How functional and conventional medicine differ a) Patient handout: Functional vs. Conventional Medicine 4. The ADAPT functional medicine systems model D. Patient Care 1. Where do you start? Where do you go from there? a) Clinician handout: FM Systems Model and the Order of Things 2. How do you layer and structure the treatment? a) Clinician infographic: Structuring a Treatment II. OPTIMIZING THE EXPOSOME A. Introduction and overview B. Nutrition 1. Introduction 2. Starting clients on Paleo a) Three options: (1) 30-Day Reset (2) 14-Four with 2-week on-ramp b) What if your clients won t go Paleo? kresserinstitute.com 1

2 (1) Common objections and solutions (a) Patient handout: Resources for Getting Started (b) Patient handout: Healthy Living on a Budget (2) Paleo for vegetarians (a) Patient handout: Paleo for Vegetarians (3) The 3 most important changes c) The Paleo Reset diet (1) Patient handout: Paleo Reset Guidelines 3. Diet/lifestyle protocols for particular needs a) The importance of personalization b) Macronutrient ratios (1) Patient handout: Macronutrient Targets (2) Patient handout: Monitoring Ketones (3) Patient handout: Blood Sugar Tracking Form c) Meal frequency and timing d) Intermittent fasting e) Carbohydrate backloading f) Athletes: protein, post-workout meals, carbs (1) Patient handout: Paleo for Athletes g) Women: hormones, carbs, other tips (1) Patient handout: Paleo for Women h) Paleo pitfalls and solutions i) Case studies j) Homework: Case assignments 4. How to customize diet/lifestyle for common health conditions a) Introduction b) Weight loss (1) Patient handout: Six Strategies for Successful Weight Loss c) High cholesterol and heart disease (1) Patient handout: High Cholesterol and Heart Disease (3) Homework: Case Assignments d) High blood pressure (1) Patient handout: 10 Tips for Lowering Your Blood Pressure Naturally e) GERD, IBS, IBD, and other digestive problems (1) Patient handout: Digestive Problems f) Anxiety, depression, and cognitive disorders (1) Patient handout: Boost Your Mood Without Medications kresserinstitute.com 2

3 (3) Homework: Case Assignments g) Diabetes and other blood sugar disorders (1) Patient handout: Diet and Lifestyle Recommendations for Blood Sugar Disorders h) Thyroid disorders (1) Patient handout: Diet and Lifestyle Changes for Good Thyroid Health i) Autoimmune disorders (1) Patient handout: Diet and Lifestyle Recommendations for Autoimmune Disorders j) HPA Axis dysregulation (1) Patient handout: Diet and Lifestyle Recommendations for HPA-D (3) Homework: Case Assignments k) Acne, eczema, psoriasis, and other skin conditions (1) Patient handout: Diet and Lifestyle Changes for Healthy Skin l) Fertility, pregnancy, and breastfeeding (1) Patient handout: Diet and Lifestyle Changes for Fertility, Pregnancy and Breastfeeding (3) Homework: Case assignments C. Basic supplementation 1. Introduction 2. Maintenance supplementation a) Vitamin A (1) Food sources (2) Recommended supplements b) Vitamin D (1) Food sources (2) UV exposure (3) Recommended supplements c) Magnesium (1) Food sources (2) Recommended supplements d) Vitamin K2 kresserinstitute.com 3

4 (1) Food sources (2) Recommended supplements e) Vitamin C (1) Food sources (2) Recommended supplements f) Iodine (1) Food sources (2) Recommended supplements g) Patient handout: Food Sources of Key Nutrients 3. Nutrients to be cautious of supplementing with a) Iron b) Calcium c) Vitamin E (alpha-tocopherol) d) Beta-carotene e) Folic acid 4. Summary of supplement recommendations a) Patient handout: Maintenance Supplementation D. Lifestyle 1. Introduction 2. Physical activity a) Introduction b) Core concepts (1) Physical activity-disease connection (2) Move like your ancestors (3) Overtraining (a) Patient handout: Are You Overtraining? c) Recommendations (1) SWAP (2) Apps, tools and resources (3) Patient handout: SWAP Your Way to Health d) Homework: Case assignments 3. Sleep a) Introduction b) Core concepts (1) Sleep-disease connection (2) The role of artificial light (3) Determining how much sleep you need (4) Sleep quality: factors that interfere, improving c) Basic recommendations (1) Sleep hygiene (2) Sleep nutrition (3) Light control kresserinstitute.com 4

5 (4) Movement (5) Apps, tools and resources (6) Patient handout: Sleep More Deeply d) Homework: Case assignments 4. Stress management a) Introduction b) Core concepts (1) Stress-disease connection (2) Definition of stress (3) HPA axis dysregulation (4) Benefits of stress management c) Basic recommendations (1) Reduce stress you experience (2) Manage stress you can t avoid (3) Tips for getting started with stress management (4) Apps, tools and resources (5) Patient handout: Manage Your Stress d) Homework: Case assignments 5. Environmental toxins a) Introduction b) Core concepts (1) Toxins-disease connection (2) Most harmful toxins and where to find them c) Basic recommendations (1) Minimizing toxic exposure (2) Supporting natural detoxification systems (3) Apps, tools and resources (4) Patient handout: Living Clean and Green d) Homework: Case assignments E. Additional resources 1. Introduction 2. Hardware tools (e.g. Fitbit, iwatch, Withings scale, etc.) a) Patient handout: Tools for Getting Healthy 3. Websites and apps a) Food/diet tracking b) Physical activity c) Sleep d) Stress management/meditation e) Behavior change f) Food/products g) Patient handout: Apps for Getting Healthy 4. 14Four kresserinstitute.com 5

6 a) 14Four overview b) 14Four affiliate program III. GUT A. Introduction and overview B. Basic physiology 1. Review of digestive tract anatomy and physiology 2. Microbiome in health and disease 3. The role of the gut barrier C. Pathology 1. Risk factors 2. Difference between syndrome/symptom and pathology 3. Pathologies a) Hypochlorhydria and impaired bile/enzyme production b) SIBO (1) Patient handout: Understanding SIBO (2) Clinician handout: SIBO test options c) Infections d) Dysbiosis and fungal overgrowth e) Food intolerances f) Intestinal permeability g) Autoimmunity D. Diagnosis 1. Identifying and working with food intolerances a) Introduction (part of slide presentation) b) Is food intolerance testing legitimate? c) Signs and symptoms d) Recommended labs (1) Cyrex Array 3 (a) Case studies (b) Homework: Case assignments (c) Clinician handout: Array 3 Interpretation Guide (d) Clinician handout: Interpretation of Antibodies Against Wheat, Gluten and Enzyme Antigens (2) Cyrex Array 4 (a) Case studies (b) Homework: Case assignments (c) Clinician handout: Array 4 Interpretation Guide (d) Patient handout: Preparing for Array 4 (3) Cyrex Array 10 (a) Case studies kresserinstitute.com 6

7 (b) Homework: Case assignments (c) Clinician handout: Array 10 Interpretation Guide (d) Patient handout: Preparing for Array 10 e) Elimination/provocation f) Follow-up testing 2. Gut pathologies a) DD CSAP + BioHealth 401H (2) Homework: Case assignments (3) Clinician handout: CSAP Interpretation Guide (4) Patient handout: Preparing for the CSAP b) NCNM SIBO Breath (2) Homework: Case assignments (3) Clinician handout: SIBO Breath Interpretation Guide (4) Patient handout: Preparing for SIBO Breath c) Genova Organix Dysbiosis (2) Homework: Case assignments (3) Clinician handout: Organix Dysbiosis Interpretation Guide (4) Patient handout: Preparing for Organix Dysbiosis d) Cyrex Array 2 (2) Clinician handout: Array 2 Interpretation Guide (3) Patient handout: Preparing for Array 2 e) Doctor s Data Intestinal Permeability Assessment (2) Clinician handout: IPA Interpretation Guide (3) Patient handout: Preparing for Intestinal Permeability Assessment f) ubiome and American Gut (1) Pros and cons (2) Clinical relevance E. Treatment protocols 1. General considerations a) Two stages of treating the gut (1) Remove (2) Rebuild b) General guidelines and tips for antimicrobial protocols 2. SIBO a) Diet b) Antimicrobials kresserinstitute.com 7

8 c) Prokinetics d) Other supplements e) 3-stage SIBO protocol f) Patient handout: Anti-Microbial Protocols g) Clinician handout: SIBO Treatment Duration h) Clinician handout: Prescription Medications for SIBO Treatment i) Clinician handout: Pediatric SIBO and Gut Dysbiosis Treatment Protocols j) Clinician handout: Elemental Diet 3. Dysbiosis and fungal overgrowth a) Diet b) Antimicrobials c) Other supplements d) Clinician handout: Botanical Protocol for Dysbiosis 4. Parasites & H. pylori a) Diet b) Antiparasitics c) Other supplements d) Clinician handout: H. Pylori Botanical Treatment 5. Low stomach acid/gerd a) Diet b) Supplements c) Other considerations d) Clinician Handout: GERD Treatment Summary 6. IBD/IBS-D a) Diet b) Supplements c) Medications d) Patient handout: Paleo Low-FODMAP Diet e) Patient handout: GAPS Diet f) Patient Handout: How to Manage Your Stress g) Clinician Handout: IBD Remission and Maintenance Treatment 7. IBS-C/constipation a) Diet b) Supplements c) Other considerations d) Clinician Handout: Probiotics and Gut Symptom Treatment 8. Leaky gut a) Diet b) Supplements c) Other considerations d) Clinician handout: Gut Barrier Interventions kresserinstitute.com 8

9 F. Probiotics and prebiotics 1. Fermented foods 2. Fermentable fiber 3. Commercial products 4. Patient handout: Fermented Foods Guide 5. Patient handout: Rebuilding a Healthy Gut G. Lifestyle and behavior 1. Stress management 2. Mindful eating 3. Meal timing and frequency 4. Clinician handout: Gut Lifestyle & Behavior Recommendations H. Advanced treatments 1. Probiotic and prebiotic implants 2. Fecal transplants I. Bringing it all together 1. Case studies 2. Homework: Case assignments J. Wrap-up IV. HPA AXIS DYSREGULATION (HPA-D) A. Introduction B. Basic physiology 1. HPA axis and Adrenomedullary Hormone System (AHS) 2. Stress hormones and hormone metabolism C. Etiology 1. 4 categories of HPA axis stressors 2. Diet and lifestyle factors 3. Caffeine, steroids, and other drugs D. HPA-D vs. Adrenal Fatigue 1. Does Adrenal Fatigue exist? 2. Problems with the 3-stage model 3. How to discuss HPA-D with clients and other medical professionals a) Patient handout: What is HPA Axis Dysregulation? E. Pathology 1. Allostatic load and depletion of metabolic reserve 2. Genomics, epigenetics and HPA-D 3. Conditions related to HPA-D F. Diagnosis 1. Categories of assessment a) Signs, symptoms & history (1) HPA-D is clinical diagnosis kresserinstitute.com 9

10 b) Lab tests: allostatic load battery : what to measure? (1) Cortisol (2) DHEA (3) Cortisol awakening response (4) Cortisol: DHEA ratio (5) Optional: aldosterone, melatonin, ACTH, inflammatory markers c) Assessment tools for perceived stress (1) Patient handout: Perceived Stress Scale (2) Patient handout: Holmes and Rahe Stress Scale 2. Comparison of available tests a) Serum vs. saliva vs. urine vs. hair b) Saliva vs. DUTCH test c) Recommended test protocol G. DUTCH Adrenal Profile 1. PH Adrenal Profile 2. Case studies / specific patterns of dysfunction 3. Clinician Handout: Adrenal Profile Interpretation Guide H. Treatment of HPA-D 1. Diet a) Macronutrients (1) Protein (timing, total amount) (2) Carbs (timing, total amount) b) Meal frequency and timing c) Specific nutrients d) Patient handout: Diet for HPA-D 2. Behavior and lifestyle a) Light exposure b) Exercise c) Stress management d) Patient handout: HPA-D Behavior and Lifestyle Strategies 3. Adjunctive therapies a) Acupuncture b) Massage c) MBCT 4. Supplemental nutrients, botanicals & hormones a) Basic nutrients b) Adaptogens and licorice c) Glandulars d) Hormones 5. Building a protocol a) High free and total cortisol kresserinstitute.com 10

11 b) Low free and total cortisol c) Disrupted diurnal rhythm / high nighttime cortisol d) High free cortisol with low total e) Low free cortisol with high total f) Impaired cortisol metabolism g) Low/high DHEA h) Low melatonin i) Clinician handout: HPA-D Protocol Matrix j) Homework: Case assignments I. Bringing it all together 1. Case studies 2. Homework: Case assignments J. Wrap-up V. FUNCTIONAL BLOOD CHEMISTRY A. Introduction and overview B. Blood chemistry basics 1. Principles of functional blood chemistry 2. Functional vs. conventional ranges a) Clinician handout: Functional Blood Chemistry Ranges b) Clinician handout: Functional Blood Chemistry Template 3. Recommended panel a) Clinician handout: Professional Co-op Case Review Panel 4. Options for ordering the panel 5. Where to find additional info C. Blood chemistry patterns 1. Blood sugar imbalances a) Hyperglycemia / MetSyn (a) Clinician handout: Post-Meal Blood Sugar Template (b) Patient handout: Post-Meal Blood Sugar Testing Instructions (a) Patient handout: Intermittent Fasting (b) Patient handout: The Potato Hack Diet (c) Patient handout: Protein-Sparing Modified Fast Guidelines b) Hypoglycemia / reactive hypoglycemia kresserinstitute.com 11

12 (a) Clinician handout: Interpretation of Hypoglycemia Follow-up Tests 2. Nutrient imbalances a) Iron deficiency (a) Patient handout: Iron Repletion Protocol (b) Clinician handout: Functional Ranges for Iron Markers b) Iron overload (a) Patient handout: Iron Reduction Protocol (b) Patient handout: FeGGT Score Questionnaire (c) Clinician handout: FeGGT Score Assessment (d) Patient handout: How to Determine HFE Status c) B12 deficiency (a) Patient handout: B12 Repletion Protocol d) Vitamin D imbalance (a) Patient handout: Optimizing Vitamin D Levels e) Zinc-copper imbalance (a) Patient handout: Optimizing Copper and Zinc Levels f) Magnesium deficiency 3. Thyroid imbalances a) Thyroid hypofunction kresserinstitute.com 12

13 (a) Clinician handout: THEA Score Assessment (b) Patient handout: THEA Score Questionnaire (c) Patient handout: Dietary Nutrients for Thyroid Health b) Thyroid hyperfunction (a) Clinician handout: Finding Low Thyrotropin Level 4. Other blood chemistry patterns a) Impaired kidney function b) Other metabolic patterns (dehydration, gout, edema, changes in muscle mass) c) Impaired liver function d) Impaired gallbladder function e) Anemia (iron deficiency) (4) Clinician handout: ACD and IDA Iron Marker Comparison f) Anemia (B12/folate/B6 deficiency) g) Anemia (of chronic disease) h) Dyslipidemia kresserinstitute.com 13

14 VI. i) Chronic infection & immune dysregulation j) Impaired methylation (a) Patient handout: Methylation Nutrients and Foods D. Bringing it all together 1. Full case studies with blood panels and history 2. Case assignments 3. Clinician manual: Functional Blood Chemistry Interpretation Guide E. Wrap-up Case Reviews A. Introduction and overview B. Full case studies C. Full case assignments D. Final thoughts VII. PRACTICE MANAGEMENT A. Healthcare business models 1. Distributed/virtual practice 2. The Case Review process a) Patient handout: What is a Case Review? 3. Patient flow a) Initial Consult b) Case Review appointment c) Follow-ups B. Operations and procedures 1. Staffing a) Key staff positions and roles (1) Start-up (2) Growth (3) Clinician handout: CCFM organization chart 2. Onboarding new clients a) Introduction b) Overview of steps kresserinstitute.com 14

15 c) Initial application & follow-up d) autoresponder e) Scheduling the Initial Consult (1) Clinician Handout: Authorization for Services (2) Clinician Handout: Chart Prep Case Reviews (3) Clinician Handout: Chart Prep Initial Consults (4) Clinician Handout: Create BC Reports (5) Clinician Handout: Create Superbills (6) Clinician Handout: Estimate Additions (7) Clinician Handout: Estimate Approvals (8) Clinician Handout: Estimate Modifications (9) Clinician Handout: Lab Ordering Procedures (10)Clinician Handout: Onboarding AR Outline (11)Clinician Handout: Onboarding Case Review Clinician (12)Clinician Handout: Onboarding Case Review Follow-up Call (13)Clinician Handout: Onboarding Case Review Follow-up (14)Clinician Handout: Onboarding EHR Registration (15)Clinician Handout: Onboarding from Initial Consult through Case Review (16)Clinician Handout: Onboarding Initial Consult Follow-up Call (17)Clinician Handout: Onboarding Initial Consult Follow-up (18)Clinician Handout: Onboarding Initial Consult for Clinician (19)Clinician Handout: Onboarding Initial Inquiry Follow-Up (20)Clinician Handout: Onboarding Process Registration Form (21)Clinician Handout: Onboarding Schedule Initial Consult Follow Up (22)Clinician Handout: Onboarding Schedule Initial Consult (23)Clinician Handout: Onboarding through Booking Initial Consult (24)Clinician Handout: Outline of NP Onboarding Procedure (25)Clinician Handout: Patient Guide (26)Clinician Handout: Process Appointment Encounter Case Reviews (27)Clinician Handout: Process Appointment Encounter Initial Consults (28)Clinician Handout: Schedule CR (29)Clinician Handout: Send Messages (30)Clinician Handout: Tag Questionnaires (31)Clinician Handout: Update CC Info (32)Clinician Handout: Upload Lab Results into the EHR (33)Clinician Handout: Using Ring Central 3. Utilizing allied providers to improve care and increase revenue 1. Why use allied providers? kresserinstitute.com 15

16 2. The role of various allied providers: health coaches/nutritionists, nurse practitioners/physician assistants 3. Incorporating allied providers into the case review model 4. Additional ways to utilize allied providers to improve patient care 5. Scope of practice considerations for licensed clinicians and allied providers 4. The Initial Consult a) Overview b) Key points to cover (1) Clinician handout: Initial Consult Script c) Follow-up (1) Sending intake paperwork, lab requisitions, and kits (2) Scheduling the Case Review d) Clinician handout: Patient Guide & Informed Consent e) Working procedure: Initial Consult f) Clinician handout: Initial Consult Overview and Tips 5. The Case Review a) Overview b) New patient intake (1) Chief complaints (2) Body systems assessment (3) Diet survey and one-day diary (4) History (5) Supplement and medication list (6) Case Review questionnaire (7) Patient handout: Case Review Questionnaire (8) Patient handout: Dietary Habits Questionnaire (9) Patient handout: Environmental Exposure Survey (10)Patient handout: Food Survey (11)Patient handout: Metabolic Assessment Form c) The Report of Findings (1) Clinician Handout: Report of Findings Template d) How to structure the appointment e) Managing expectations for treatment f) Follow-up (1) Delivering the Report of Findings (2) Delivering patient instructions g) Working procedure: Case Review 6. Follow-up appointments a) Overview b) Pre-appointment questionnaire: tracking progress over time c) How to structure the appointment d) Follow-up kresserinstitute.com 16

17 e) Working procedure: Follow-up Appointments f) Patient handout: Follow-Up Appointment Questionnaire 7. Processing patient charts a) Processing initial consult appointments (1) Overview of steps (2) Preparing invoice and getting patient approval (3) Ordering supplements (4) Ordering labs (5) Delivering clinician instructions and handouts (6) Billing (7) Working procedure: Processing Patient Charts b) Processing case review appointments c) Processing existing patient appointments 8. Billing, insurance and reimbursement a) Relevant issues for functional medicine practice b) Billing policies for cash practices c) ICD-10 diagnosis codes d) Clinician handout: Registration and Agreement Form Example 9. Patient communication a) Providing first-class service while protecting your time b) Phone vs. electronic communication c) Patient communication policy and procedures (1) Clinician handout: Patient Communication Policy Example (2) Clinician handout: Privacy Policy Example C. Back-end systems 1. EHR and Accounting a) Overview b) Accounting (1) Quickbooks introduction c) EHR (1) Using the EHR (a) Process Appt Encounters - Lab Ordering (b) Navigate the PPQ - Quest & Comm for Clinicians (2 parts) (c) Create, Manage, and Use Chart Parts (d) Send Medical Records (e) Order Supplements (f) Order Prescriptions (g) Create BC reports (h) Add CPT Options to the Database (i) Add Supplements to the Database (j) Patient handout: How to Use Your Patient Portal 2. Legal / Phone/ File management kresserinstitute.com 17

18 3. Scheduling a) Overview b) Case review and initial consult appointments c) Existing patient appointments 4. Collaboration & Video conferencing a) Basecamp b) Teamweek c) Perch.co d) Clinician handout: Hosting a Zoom Webinar e) Clinician handout: Webinar Best Practices 5. Getting help 6. Documentation (Work The System) kresserinstitute.com 18