CORONARY ARTERY DISEASE

Transcription

1 CORONARY ARTERY DISEASE Background In late 2010, Jean Rosenthawn, a clerical assistant, began experiencing increasing episodes of substernal chest pain and shortness of breath climbing stairs at her work. After a short time these symptoms were not always precipitated by physical exertion and sometimes occurred after heavy meals. Jean s GP ordered an exercise stress test where the ECG demonstrated sinus cardiac rhythm with infrequent premature ventricular contractions. Cardiac catheterisation then performed which revealed triple vessel disease with left ventricular hypokinesis and an ejection fraction of 40%. Coronary artery bypass graft surgery was performed were Jean was referred to cardiac rehabilitation for 12 weeks. After completing cardiac rehabilitation, Jean moved in with her daughter and family. During her last visit to her GP, team care plan was developed that included an Exercise Physiologist to support assist Jean better manage her health. Her father died from an acute myocardial infarction at age 57 years and her two older sisters have coronary artery stents. She has a 40 year history of smoking and leads a relatively sedentary lifestyle. Page 1

2 Enhanced Primary Care (EPC) Program Referral form for Allied Health Services under Medicare To be completed by referring GP: Please tick the relevant box below: Patient has a GP Management Plan and Team Care Arrangements in place (new CDM MBS items 721 AND 723) OR Patient has an EPC Multidisciplinary Care Plan in place (former MBS items 720, 722 or 730; or new CDM item 731) Note: GPs are encouraged to attach a copy of the relevant part of the patient's care plan to this form. Medicare rebates and Private Health Insurance benefits cannot both be claimed for these. Patients should be advised that they must choose whether to access one or the other. GP details NOTE: Relevant MBS item(s) above must be BILLED by GP prior to patient receiving their first referred allied health service for Medicare rebate to be payable for that service. Provider X Name Dr W Jones Address 101 My Street, Mytown 2999 Postcode 2999 Patient details Medicare X X X X X X X X X A Patient s ref no. 1 First Name Jean Surname ROSENTHAWN Address 14 Some Street, Someothertown Postcode 2998 Allied Health Professional (AHP) patient referred to: (Please specify name or type of AHP) Name Accredited Exercise Physiologist Address Exercise Physiology Clinic Postcode 2000 Referral details Please use a separate copy of the referral form for each type of service Eligible patients may access Medicare rebates for up to 5 allied health (total) in a calendar year. Please indicate the number of required by writing the number in the No. of column next to the relevant AHP. Aboriginal Health Worker Dietitian Physiotherapist Audiologist Exercise Physiologist Podiatrist Chiropractor Mental Health Worker Psychologist Chiropodist Occupational Therapist Speech Pathologist Diabetes Educator Osteopath Referring General Practitioner s signature Dr. William Jones Date signed 18/05/2010 AHP must provide a written report to patient s GP after each service except where the AHP provides multiple to a patient under the one referral. In this case, the AHP must provide a written report to the patient s GP after the first and last service, and more often if clinically necessary. Allied health professionals should retain this referral form for record keeping and Medicare Australia audit purposes. Allied health funded by other Commonwealth or State/Territory programs are not eligible for Medicare rebates under this initiative. This form may be downloaded from the Department of Health and Ageing website at or ordered by faxing (02) THIS FORM DOES NOT HAVE TO ACCOMPANY MEDICARE CLAIMS EPCAHS 0806

3 Dr Bill Jones Good Health Medical Practice MB.BS, MD, PhD, DSc, FRACGP 101 My Street, Mytown 2999 Provider No: X PO Box 101, Mytown 2999 Phone: (02) Fax: (02) CHRONIC DISEASE MANAGEMENT GP Management Plan (721) and/or Team Care Arrangement (723) PATIENT DETAILS: Ms Jean Rosenthawn 14 Some Street Someothertown, 2998 Phone: (02) DOB: 16/08/1946 Medicare : / 1 DETAILS OF PATIENT S CARER (IF APPLICABLE): None recorded. DETAILS OF PATIENT S USUAL GP: Dr David Garber Provider No: X 101 Some Street, Someothertown 2999 Phone: (02) Date of Last GP Management Plan / Team Care Arrangements (if done): None recorded. Other notes or comments relevant to the patient s Team Care Arrangements: None recorded. MEDICAL HISTORY: FAMILY/SOCIAL HISTORY / Date Condition SUPPORTS: 3/11/2009 CABGS None recorded. 16/10/2007 Anxiety 11/10/2006 Myocardial Infarction 8/04/2001 Hypertension 11/10/1994 PAP Smear 11/10/1993 Overweight LIFESTYLE HISTORY: Smoking: YES NO Alcohol: YES NO Exercise: Sedentary Diet: Normal CURRENT MEDICATIONS: Medications Strength Dose / Frequency Astrix tablet 100mg 1 daily Captopril Sandoz tablet 50mg 1 b.i.d Betaloc tablet 100mg 1 b.i.d Lipitor tablet 30mg 1 daily Efexor-XR tablet 75mg 1 daily Somac tablet 40mg 1 nocte VITALS: Age: 64 years Height: 162 cm Weight: 84 kg BMI: 31 kg.m -2 BP: 138/88 mmhg Pulse: 82 bpm Waist: 94 cm Hip: 86 cm WHR: 1.09 BLOOD CHEMISTRY: Total Cholesterol: 5.1 mmol/l LDL-C: 3.1 mmol/l HDL-C: 0.6 mmol/l Triglycerides: 3.7 mmol/l Random BGL: 8.7 mmol/l Fasting BGL: 6.1 mmol/l hs-crp: 3.7 mmol/l OTHER INFORMATION: Allergies: No known allergies. Immunisations: None recorded. Copy of Team Care Arrangements offered to patient? YES NO Team Care Arrangements added to the patient s records? YES NO Copy / relevant parts of the Team Care Arrangements supplied to other providers? YES NO Referral forms for Medicare allied health and dental care completed? YES NO Date TCA was completed: 12/06/2012 Proposed TCA Review Date: 12/06/2012 Page 2

4 Patient: Ms Jean Rosenthawn Address: 14 Some Street Sometown, 2998 DOB: 16/08/1946 Phone: (02) Medicare No: / 1 GP MANAGEMENT PLAN (721) AND/OR TEAM CARE ARRANGEMENT (723) DETAILS Relevant conditions managed under this GP management plan (721) and/or team care arrangement (723): 1. CABGS; 2. Weight management. PATIENT PROBLEMS / NEEDS GOALS TO BE ACHIEVED (IF POSSIBLE) REQUIRED TREATMENTS INCLUDING PATIENT ACTIONS 1. GENERAL Patient's understanding of coronary heart disease Patient to have a clear understanding of coronary heart disease and CABGS and the patient's role in managing the condition. Chest pain action plan Develop action plan. and patient agree on written action plan on use of anti-anginals and when to ring the ambulance 2. BIOMEDICAL Cholesterol / Lipids Blood pressure 3. MEDICATION Medication review Cholesterol 4.0 mmol/l Triglycerides 2.0 mmol/l LDL-C 2.5 mmol/l HDL-C 0.9 mmol/l 140/90 mmhg Correct use of medications, minimise side effects Check every 6 months Check every 6 months Review medications 4. Lifestyle Nutrition Healthy eating pattern, low fat diet Monitor Weight management BMI 30 kg.m Waist 85 cm -2 Monitor Review 6 monthly ARRANGEMENTS FOR TREATMENTS Patient to review and provide education Patient to implement Dietician Patient to manage to monitor Dietician Page 3

5 Patient: Ms Jean Rosenthawn Address: 14 Some Street Sometown, 2998 DOB: 16/08/1946 Phone: (02) Medicare No: / 1 Physical activity Increase habitual physical activity levels Increase exercise capacity Increase functional ability Patient exercise program Patient to implement to review Smoking Complete cessation QUIT Patient to manage to monitor Alcohol 1 standard drink per day Reduce alcohol intake Patient to manage to monitor GP DECLARATION: I have explained the steps and any costs involved, and the patient has agreed to proceed with the Team Care Arrangements. YES NO The patient also agrees to the involvement of other health providers and to share their clinical information without restrictions. YES NO GP s Signature: William J. Jones Date: 12/06/2012 Page 4