Full Clinical Guidelines - Community First Health Plans.

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DIABETIC FOOT EXAM** **Performed Initially at Diagnosis, Annually In Primary Care FOOT HISTORY 1. Ulcers: location, time to heal, wound care necessary for healing 2. Infections: type, bacteria involved, medical treatment necessary 3. Amputations: type, time to heal, modalities used in healing process 4. Surgeries/Injuries: type, location FOOT EXAM Vascular (Vasc) Neurologic (Neuro) 1. Palpate DP, PT pulses (present or absent) 2. Temperature gradient: from ankle to toes, focal “hot spots” 3. General Color: pink, palor, rubor on dependency 4. Digital Capillary refill time: in seconds 5. ABI: for both DP & PT arteries (abnl if 10 secs) OR Biothesiometer (>25 volts)—tested at hallux 3. Tactile sensation (light touch): via cotton wool (dorsum of foot) 4. Reflexes: Achilles tendon Dermatologic (Derm) 1. General skin turgor/texture 2. Focal lesions: calluses (debride to fully assess), cracks, pigmentation 3. Interdigital: calluses, maceration 4. Nails: incurvated, nail plate thickness, coloration, inappropriate self-care Musculoskeletal (Msk) 1. General Range of Motion: ankle, subtalar, midtarsal, metarsophalangeal 2. Foot type: rectus, pes planus, pes cavus, Charcot foot 3. Digits: hammertoes, claw toes, mallet toes, bunion/hallux abductovalgus 4. Bony prominences Footwear 1. Type 2. Wear pattern: outsole and upper counter distortion 3. Insole inspection: foreign bodies, staining, excessive wear 4. Socks: foreign bodies, staining, excessive wear Social 1. Tobacco/alcohol/drug use 2. Work environment/foot demands/footwear requirements 3. Physical activities: footwear used 4. Family support: marital status, spouse/family involvement in health 5. Education: diabetes self-management Page 2 66 H EALTH PLANS www.cfhp.com
DIABETIC FOOT CARE/REFERRAL ALGORITHM Complete Diabetic Foot Exam** (see page 2) NORMAL (NL) EXAM NL vasc NL neuro NL msk NL derm MD/DO/DPM (or physician extender) DM FOOT EDUCATION -patient/family (Diabetes Self- Management Education) -verbal/written -websites -clinic phone #s ABBREVIATIONS: MD = medical doctor DO = doctor of osteopathy DPM = doctor of podiatric medicine (Podiatrist) NL = normal ABNL = abnormal ABI = ankle/brachial index TCPO2 = transcutaneous oxygen pressure NCV = nerve conduction velocities PSSD = pressure specified sensory device REPEAT Diabetic Foot Screen* -per MD, DO, physician extender visits or DPM exam REPEAT EVERY VISIT ABNORMAL (ABNL) EXAMS NORMAL testing-repeat per change in exam or onset symptoms A ABNL VASC NL neuro NL msk NL derm VASCULAR CONSULT/TESTING Consider : PVR, Seg.pres., ABI, TCPO2 -peripheral arteriogram as indicated -intervention as indicated to re-establish blood flow Documentation of vascular disease OR Post intervention with improvement -EDUCATION: signs/symptoms -HIGH RISK foot status -Foot screen every MD/DO/DPM, or physician extender visit B NL vasc ABNL NEURO NL msk NL derm NEURO or PM&R CONSULT Consider: NCV, PSSD -other causes: consider and rule out as indicated -if painful consider pharmaceutical vs. surgical treatment -EDUCATION: signs/symptoms -HIGH RISK foot status -Foot screen every MD/DO/DPM, or physician extender visit, PRN C NL vasc NL neuro ABNL MSK NL derm COMPLETE BIOMECHANICAL EXAM (Podiatrist, Orthopedist) -discuss clinical significance -Treatment options: surgical, non-surgical -EDUCATION: signs/symptoms -Intervention: surgery→healed = low risk -Biomech: shoes, orthoses, phys.medicine -Follow up DPM per modality needed -Foot screen: every MD/DO/physician extender visit D NL vasc NL neuro NL msk ABNL DERM Dystrophic (thick, discolored) toenails -Debride/reduce -Culture as needed -Educate on condition management -Referral as needed (podiatrist, dermatologist) Dry skin, fissures -Diagnostic tests as indicated, e.g. for fungus -Topicals as indicated -referral as indicated Ingrown toenail -Instruct on proper nail care -Matrixectomy if NL vasc exam Page 3 H EALTH PLANS www.cfhp.com 67
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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TEXAS MEDICAID PROVIDER PROCEDURES
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CHILDREN’S SERVICES HANDBOOK P h
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CHILDREN’S SERVICES HANDBOOK P R
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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