Full Clinical Guidelines - Community First Health Plans.

More documents

Recommendations

Info

Considerations for Prescribing Physical Activity for Type 2 Diabetes Prevention and Treatment Significant health benefits can be obtained by including an accumulated 30 minutes of moderate physical activity on most, if not all, days of the week. Regular physical activity lowers the risk of developing Type 2 diabetes. 1996 Surgeon General’s Report on Physical Activity and <strong>Health</strong> “Regular physical activity” includes all movements in everyday life, including work, recreation, exercise, and sporting activities. Low Intensity/Low Impact Activity - includes activities like walking, housework, light gardening, light yard work, and social dancing Moderate Intensity Activity - includes activities like brisk walking, vigorous gardening, slow cycling, aerobic dancing, doubles tennis, or hard work around the house. . Precautions for Exercise Prescription Retinopathy Patients with proliferative diabetic retinopathy have abnormal hemodynamic responses of the cerebral and ophthalmic circulation both at rest and with exercise. Vigorous physical activity, especially isometric contractions, produces significant increases in blood pressure and can accelerate proliferative diabetic retinopathy with significant risk of retinal and vitreal hemorrhage and detachment. Low impact/low intensity physical activity recommended. Orthopedic Problems Neuropathy and peripheral vascular disease can predict unnoticed foot injury. Footwear that relieves forefoot plantar pressure by up to 50% has been shown to be effective in preventing the recurrence of foot ulcers when worn for more than 60% of the day (Peirce, N. 1999. British Journal of Sports Medicine) <strong>Guidelines</strong> for Exercise Prescription 1. Appropriate attire for physical activity, i.e., footwear - socks, shoes, insoles/orthotics. 2. Do not exercise at peak hypoglycemic times. 3. Monitor blood glucose before and during exercise if symptoms of hypoglycemia occur with exercise. 4. Wear a form of personal identification or medical alert. 5. Carry fast acting carbohydrate, i.e., sucrose and glucose products. 6. Examine feet after exercise. 7. Maintain adequate hydration. 54 H EALTH PLANS www.cfhp.com
Hypertension Algorithm for Diabetes Mellitus in Adults Assess Blood Pressure 1 (BP) Follow-up BP each visit If microalbuminuria or nephropathy present (Table 1) BP 130/80 mmHg Start ACE inhibitor (ACEi) therapy 2-5 If microalbuminuria or nephropathy present (Table 1) If African-American- Start ACEi in combination with diuretic or CCB If SBP >145mmHg and/or DBP>90mmHg 6 Start with combination antihypertensive therapy Reassess therapy in 4-8 weeks-Titrate to at least ½ max dose Encourage self-monitoring of blood pressure 1 (on average > 3 medications will be needed to achieve blood pressure goals) Revised 1-26-06 Table1 Microalbuminuria/Proteinuria 3 • In Type 2 patients, an ACEi or angiotensin receptor blocker (ARB) may be used first line. • In Type 1 patients, an ACEi is recommended to reduce protein excretion • Consider the use of verapamil or diltiazem in patients with proteinuria unable to tolerate ACEi or ARBs. BP130/80 mmHg Continue Therapy BP Check Every Visit Add 6 Diuretic OR Calcium Channel Blocker (CCB) OR Beta Blocker If Diuretic Chosen: (Preferred if no other compelling indications) Creatinine 130/80 mmHg despite above agents or if intolerance/contraindications exist: Refer to Specialist (Endocrinologist or Nephrologist) OR ADD: α blocker, hydralazine, clonidine (caution with β blocker) 9.6 Hypertension Algorithm for DM in Adults H EALTH PLANS www.cfhp.com 55
Page 1 and 2:
Community First Health Plans Qualit
Page 3 and 4: 10.5 ATP III Classification of Chol
Page 5 and 6: Such information is released only t
Page 7 and 8: Non Voting • Martin Jimenez, Dire
Page 9 and 10: The purpose of these guidelines is
Page 11 and 12: Table 1. Adult Preventive Services
Page 13 and 14: Recommended Adult Immunization Sche
Page 15 and 16: Footnotes — Recommended Adult Imm
Page 17 and 18: CFHP has adopted the National Asthm
Page 19 and 20: Patient Name ______________________
Page 21 and 22: Managing Asthma Long Term 41 FIGURE
Page 23 and 24: FIGURE 14. CLASSIFYING ASTHMA SEVER
Page 25 and 26: FIGURE 16. STEPWISE APPROACH FOR MA
Page 27 and 28: FIGURE 20. CLASSIFYING SEVERITY OF
Page 29 and 30: II. Some hyperactive-impulsive or i
Page 31 and 32: COMMUNITY FIRST HEALTH PLANS BEHAVI
Page 33 and 34: Criteria Requirements 33. Release o
Page 35 and 36: The evaluation of breast disease is
Page 37 and 38: Prevent Child Texas, a non-profit o
Page 39 and 40: AMERICAN ACADEMY OF PEDIATRICS: Fai
Page 41 and 42: possible), a careful, complete, and
Page 43 and 44: Examination/Test Oral / Dental Insp
Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 47 and 48: Publication # 45-11647 Targets* A1
Page 49 and 50: WORKSHEET Revised 10-20-05 Advancin
Page 51 and 52: D. Optimizing analog insulin use Re
Page 53: Publication # 45-11266 Age 126 mg/d
Page 57 and 58: Lipid Algorithm For Type 1 and Type
Page 59 and 60: References: Revised 1-24-08 • Col
Page 61 and 62: WEIGHT LOSS ALGORITHM FOR OVERWEIGH
Page 63 and 64: Publication #45-11825 Screening 1 :
Page 65 and 66: Publication #45-12000 DIABETIC FOOT
Page 67 and 68: DIABETIC FOOT CARE/REFERRAL ALGORIT
Page 69 and 70: Publication # 45-12083 WEIGHT MANAG
Page 71 and 72: 9 H EALTH PLANS www.cfhp.com 71
Page 73 and 74: Revised 10-25-07 IV INSULIN INFUSIO
Page 75 and 76: Revised 10-25-07 Publication #: 45-
Page 77 and 78: Revised 2-21-08 Publication #: E45-
Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
Page 81 and 82: Orders for Adults with DKA and Hype
Page 83 and 84: D i a b e t e s t r e a t m e n t a
Page 85 and 86: CFHP has adopted the National Insti
Page 87 and 88: No CHD; 0 to 1, or 2+ Risk Factors
Page 89 and 90: NATIONAL CHOLESTEROL EDUCATION PROG
Page 91 and 92: NATIONAL CHOLESTEROL EDUCATION PROG
Page 93 and 94: Identification, Evaluation, and Tre
Page 95 and 96: 11.3 Treatment of Hypertension H EA
Page 97 and 98: ALGORITHM FOR TREATMENT OF MAJOR DE
Page 99 and 100: CFHP has established guidelines for
Page 101 and 102: A. Documentation ______ B. Continui
Page 103 and 104: CFHP PCP MEDICAL RECORD REVIEW TOOL
Page 105 and 106:
13.3 Specialist Medical Record Docu
Page 107 and 108:
13.4 Specialist Medical Record Revi
Page 109 and 110:
Risk Factors for Osteoporosis Fract
Page 111 and 112:
It is well documented that obesity
Page 113 and 114:
CLASSIFICATION OF OVERWEIGHT AND OB
Page 115 and 116:
16.1.1 Preventive Pediatric Health
Page 117 and 118:
H EALTH PLANS www.cfhp.com 117
Page 119 and 120:
TEXAS MEDICAID PROVIDER PROCEDURES
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
CHILDREN’S SERVICES HANDBOOK P h
Page 127 and 128:
CHILDREN’S SERVICES HANDBOOK P R
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
H EALTH PLANS www.cfhp.com 139
Page 141 and 142:
FIGURE 2: Recommended immunization
Page 143 and 144:
Comprehensive antepartum care is vi
Page 145 and 146:
The following variables should be e
Page 147 and 148:
CRITERIA 19. Unresolved Problems Fr
Page 149 and 150:
CFHP OB/GYN SPECIALTY MEDICAL RECOR
Page 151 and 152:
CFHP OB/GYN SPECIALTY MEDICAL RECOR
Page 153 and 154:
According to the National Institute
Page 155 and 156:
. aminotransferase (AST) and alanin
Page 157 and 158:
PREVENTION RECOMMENDATIONS 1. The E
Page 159 and 160:
2 to 20 years: Boys Body mass index
Page 161 and 162:
AsthmaMatters is an initiative deve
Page 163 and 164:
According to the Centers for Diseas
show all

Full Clinical Guidelines - Community First Health Plans.

Create successful ePaper yourself

Delete template?

Save as template?