1. Group Medical Appointments Chesapeake Care Free Clinic Mary Beth Carr, NP

2. Chesapeake Care Free Clinic GMA Overview Why GMA? Support and efficiency Why GMA? Support and efficiency Started 2004 with diabetics and a volunteer endocrinologist, pt had to attend the education sessions offered by the hospital to take part Started 2004 with diabetics and a volunteer endocrinologist, pt had to attend the education sessions offered by the hospital to take part NP led started 2/08 with HTN diagnosis led with an RN, over 200 pts have participated NP led started 2/08 with HTN diagnosis led with an RN, over 200 pts have participated NP led expanded to diabetes in Feb 2010 – led with a DNE, 24 pts to date NP led expanded to diabetes in Feb 2010 – led with a DNE, 24 pts to date

3. Chesapeake Care Free Clinic HTN GMA Monthly HTN GMA Group-elements included-definition of high BP, dangers of uncontrolled BP, importance of staying on medications life long, how meds work and side effects, smoking cessation (referrals), moderate ETOH, eating and activity plans, stress management, also brief physical exam. Labs reviewed and meds refilled. At least 2-3 hours. Confidentiality form signed. Monthly HTN GMA Group-elements included-definition of high BP, dangers of uncontrolled BP, importance of staying on medications life long, how meds work and side effects, smoking cessation (referrals), moderate ETOH, eating and activity plans, stress management, also brief physical exam. Labs reviewed and meds refilled. At least 2-3 hours. Confidentiality form signed. Data from 2/08-6/09 gathered Data from 2/08-6/09 gathered Total 77 pts, pt diagnosed with HTN on meds. Total 77 pts, pt diagnosed with HTN on meds. Originally looked at BP at baseline and repeat BP 6/12/24 mos, also weight, LDL and dx mental health Originally looked at BP at baseline and repeat BP 6/12/24 mos, also weight, LDL and dx mental health

4. Chesapeake Care Free Clinic Data 1 year data 40 patients from 2/08-11/08 1 year data 40 patients from 2/08-11/08 Lost 14 people to follow up (26%) Lost 14 people to follow up (26%) Of the 40 patients 24 were at goal (below 140/90) at first HTN GMA, 16 above goal. Of the 40 patients 24 were at goal (below 140/90) at first HTN GMA, 16 above goal. At 1 year 27 pt were at goal, 13 above goal. At 1 year 27 pt were at goal, 13 above goal. Of those that started at goal 17 stayed at goal, (42%) 7 went up (17%), 10 went from above goal to goal (25%), 6 stayed above goal from start to finish (15%) (failure?? Need to look at improvement of BP) Of those that started at goal 17 stayed at goal, (42%) 7 went up (17%), 10 went from above goal to goal (25%), 6 stayed above goal from start to finish (15%) (failure?? Need to look at improvement of BP) 67% of pts that went through HTN GMA are at goal at 1 year. Need to compare that data to those that did not attend GMA. 67% of pts that went through HTN GMA are at goal at 1 year. Need to compare that data to those that did not attend GMA.

5. Chesapeake Care Free Clinic Other Data Surprising result-53% gained weight from 2-15 lbs in one year. Since then we have instituted more info on weight loss and exercise in the class. Surprising result-53% gained weight from 2-15 lbs in one year. Since then we have instituted more info on weight loss and exercise in the class. Of note-LDL went down in 50% of pts (most placed on statins), only 8 had mental health diagnoses Of note-LDL went down in 50% of pts (most placed on statins), only 8 had mental health diagnoses

6. Chesapeake Care Free Clinic Successes and Challenges Successes-started the process! Reported pt satisfaction, volunteer RN involvement, part of our culture now, flexibility-use what you have that day, BPs improved Successes-started the process! Reported pt satisfaction, volunteer RN involvement, part of our culture now, flexibility-use what you have that day, BPs improved Challenges-need more staff, bottlenecks, need other providers involved, constant education of front desk, have had all barriers mentioned Challenges-need more staff, bottlenecks, need other providers involved, constant education of front desk, have had all barriers mentioned

7. Chesapeake Care Free Clinic Final Thoughts Collecting data is a lot of work! (even with EMR) Collecting data is a lot of work! (even with EMR) I am satisfied that 67% of the pts are at goal, I would like to have another intern to collect the statistics after 6/09 (another 100 pts at least) I am satisfied that 67% of the pts are at goal, I would like to have another intern to collect the statistics after 6/09 (another 100 pts at least) Don’t focus on those already at goal-just make it easy for them to get their meds Don’t focus on those already at goal-just make it easy for them to get their meds Focus on those that are above goal Focus on those that are above goal Work on weight loss Work on weight loss