General Practice BILLING GUIDE - British Columbia Medical ...

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APPENDIX i FORMS FOR THE GPSC INITIATIVES Chronic Disease Management NAME OF PATIENT RISK FACTORS AND CO-MORBID CONDITIONS DIABETES PATIENT CARE FLOW SHEET CARE OBJECTIVES Obesity (Measure BMI and waist circumference annually) DATE This Flow Sheet is based on the Guideline, Diabetes Care Web site: http://www.bcguidelines.ca SEX M F DIABETES Hypertension (Target: ≤130/80) Dyslipidemia (risk, see back) CVD VISITS (3 TO 6 MONTHS) Renal (microalbuminuria) • ACR (Target: M:
APPENDIX i FORMS FOR THE GPSC INITIATIVES Chronic Disease Management E/2 BRITISH COLUMBIA MEDICAL ASSOCIATION SUMMARY OF GUIDELINE Guideline Effective Date: November 1, 2003 Heart Failure Care For full Guideline please go to website: http://www.bcguidelines.ca Diagnosis • Distinguish systolic (more fully researched treatment; poorer prognosis) and diastolic heart failure. • For systolic, ejection fraction (EF) ≤ 40%; for diastolic, EF > 40%. • Both types display heart failure signs and symptoms (fatigue, fluid retention, dyspnea). Evaluation (beyond thorough history and physical examination) • Assess volume status. • Assess vascular risk factors and comorbid conditions. • Lab: Bloodwork (CBC, serum albumin, AST, BUN, creatinine/eGFR, electrolytes, FBS, TSH); urinalysis; ECG. • Imaging: CXR; 2D Doppler echocardiography (less desirable is radionuclide ventriculography). Drug Therapy Refer to full Guideline (Appendices) for detailed drug dosage information YES: Class III-IV Spironolactone 25 mg OD Therapy for Underlying/Contributing causes • Hypertension • Ischemic heart disease • Atrial fibrillation • Hypertrophic cardiomyopathy (consider referral) Diuretic for NYHA Classes II-IV* (usually furosemide 20 mg OD; decrease dose or discontinue when symptoms are controlled) ACE to maximum trial dose or ARB if ACE intolerant ß-blocker to maximum trial dose Symptomatic YES: Class II-Ill Digoxin 0.125-0.25mg OD +/- nitrates Follow-up • Patient self-management is important (e.g., goal setting, salt restriction, weight monitoring, rehab). • Immunize for influenza and Pneumococcus. • Monitor electrolytes, BUN and creatinine/eGFR if condition or medications change and at least q6months. • Monitor digoxin levels only if there are concerns about toxicity or compliance. • End-of-life care is important at that stage. Continue current treatment GENERAL PRACTICE BILLING GUIDE NO *The New York Heart Association (NYHA) classification of heart failure. Class Severity Class I No symptoms Class II Symptoms with ordinary activity Class III Symptoms with less than ordinary activity Class IV Symptoms at rest
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CONTENTS 4. Prevention Fees A/39 El
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GENERAL PRACTICE BILLING GUIDE
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A GP SERVICES COMMITTEE INCENTIVES
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Page 29 and 30: A GP SERVICES COMMITTEE INCENTIVES
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Page 75 and 76: C UNINSURED SERVICES A00073 A Medic
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