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Provider Toolkit

Health Physicals: A health physical is the physical evaluation of an individual, including an age and gender appropriate history, examination and the ordering of laboratory/diagnostic procedures as appropriate. This service is provided by a physician, nurse practitioner or other medical professional acting within scope of practice. (NYS OMH 14 NYCRR Part 599).

Health Screening: Initial gathering and assessing of information concerning the individual's medical history and current physical health status (including physical examination and determination of substance use) for purposes of informing an assessment and determination of its potential impact on a individual's mental health diagnosis and treatment and the need for additional health services or referral. (NYS OMH 14 NYCRR Part 599).

Health Monitoring: Health monitoring is the continued measuring of specific health indicators associated with increased risk of medical illness and early death. For adults, these indicators include, but are not limited to, blood pressure, body mass index (BMI), and smoking status. This service is provided by a physician, nurse or other medical professional acting within scope of practice. (NYS OMH 14 NYCRR Part 599).

  • Adult Preventive Care Guidelines

http://www.mcms.org/community-guidelines

 

Increased morbidity and mortality for individuals with serious mental illness is largely due to risk factors including:

1. Medications; especially a-typical anti-psychotic medication. Selected side effects of commonly used antipsychotic medications: http://www.psychiatryonline.com/popup.aspx?aID=46267

2. Tobacco Use/History

3. Substance Use/History

4. Obesity

5. Sedentary Lifestyle

6. Poor Nutrition

7. High Blood Pressure

8. High Blood Glucose or HbA1C

9. Poor Lipid Profile

10. Personal History of Diabetes, Hypertension, Cardiovascular Disease

11. Family History of Diabetes, Hypertension, Cardiovascular Disease

12. Inadequate access to primary care

13. Lack of social supports

 

The following are best practice guidelines. If an individual falls outside the recommended guidelines, it is recommended that they follow up with their medical provider to determine the appropriate action plan. It is also strongly encouraged that behavioral health providers educate and encourage individuals to self-monitor these indicators. Those indicators with an asterisk * are required by NYS OMH 14 NYCRR Part 599 (Clinic Treatment Programs).

Heart Health Indicators Monitor Frequency Goal/Recommendation Resources

Body Mass Index (BMI)*

BMI should be evaluated at baseline & every 3 months thereafter

Individual may need to be monitored more frequently if they are taking antipsychotic medications; especially when medication is initiated, changed and/or when an individual
experiences significant weight gain

BMI grid (see toolkit):
Desired range between 18.5 and 25

Weight Control Information Network: BMI
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American Dietetic Association (ADA) BMI calculator
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Weight Control Information Network: Talking with Patients about Weight Loss Visit Site

Waist Circumference

BMI should be evaluated at baseline & every 3 months thereafter

Individual may need to be monitored more frequently if they are taking antipsychotic medications; especially when medication is initiated, changed and/or  when an individual experiences significant weight gain

Desired range:
Women:less than 35 inches
Men: less than 40 inches

Weight Control Information Network: BMI
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Blood Pressure*

For individuals without hypertension, blood pressure should be evaluated at baseline & every 3 months thereafter

For individuals with hypertension and/or diabetes, blood pressure should be evaluated at every medical visit

For individuals without high blood pressure, goal is less than 140/90

For individuals with hypertension and/or diabetes, goal is less than 130/80

Monroe County Medical Society Practice Guideline
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Smoking Status*

Smoking status should be evaluated at baseline & at every medical visit (minimum every 3 months)

No tobacco use; even very low levels of tobacco use are harmful to health as is any level of environmental
tobacco

Monroe County Medical Society Practice Guideline
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2008 Update: Clinical Practice Guideline for Treating Tobacco Use & Dependence (Fiore et al.)
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Quit plan template:  USDHHS. (2010)
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Tobacco Dependence Information Center: American Psychiatric Nurses Association
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Tobacco Dependence Intervention Manual for Nurses (Sharp et al.2009)
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Counseling Points: A 3 part series focused on Breaking Barriers & Implementing
Changes when working with those who are tobacco dependent and mentally ill
(published by the American Psychiatric Nurses Association, 2010)

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Smoking Cessation Leadership Center: Mental Health Tool Kit (Morris et al.2009) Read PDF

Glucose/A1C

Testing should include baseline, at 12 weeks and annually.

Individuals taking antipsychotics and/or have glucose elevation, frequency of monitoring may vary. Important to coordinate with primary care physician.

Individuals with diabetes should have their A1C tested every three months. After consultation with their doctor, they may choose to have A1C tested less frequently if levels are consistently in the desired range, but not less often than twice a year.

A1C:
Under 5.7%- normal
5.7%-6.4%- pre-diabetes
Over 6.5%- diabetes

Fasting Blood Glucose:
Under 100mg/dl- normal
100mg/dl-126/mg/dl- pre-diabetes
Over 126mg/dl-diabetes

Oral Glucose Tolerance Test:
Under 140mg/dl-normal
140mg/dl-200mg/dl-pre-diabetes
Over 200mg/dl- diabetes

American Diabetes Association
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Lipids

All adults age 20 or older should have a fasting lipoprotein profile once every five years.

Individual may need to have cholesterol checked more often than every five years if one or more of these situations applies:
  • Total cholesterol is 200 mg/dL or more
  • Man over age 45 or a woman over age 50
  • HDL (good) cholesterol is less than 40 mg/dL.
  • Individual has other risk factors for heart disease and stroke, including taking specific antipsychotic medications.

Important to coordinate with primary care physician.

LDL Cholesterol:
Less than 100- optimal
100-129- near optimal/above optimal
130-159- borderline high
160-189- high
Over 190 -very high

Total Cholesterol:
less than 200- desirable
200-239- borderline high
Over 240- high

HDL Cholesterol:
Under 40 -low
over 60- high

National Cholesterol Education Program
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American Heart Association
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Healthy Self Management Skills

Diet/nutrition

Baseline, every 3 months and annually. If this is a current goal, monitor more frequently.

Individualized based on age, sex and medical needs.

USDA: Food pyramid
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American Dietetic Association:
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American Heart Association
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Cornell Cooperative Extension
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USDA: How to read nutrition labels
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Weight Control Information Network: Better Health and You- Tips for Adults
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Physical Activity

Baseline, every 3 months and annually. If this is a current goal, monitor more frequently.

For those under
age 65:

Moderate intense cardio 30 minutes daily, 5 days a week
OR
Vigorous intense cardio 20 minutes daily, 3 days a week
AND
8-10 strength-training exercises, 8-12 repetitions of each exercise twice a week

American College of Sports Medicine and American Heart Association:
Physical Activity & Public Health Guidelines
:
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Center for Disease Control and Prevention
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Weight Control Information Network: Walking- A step in the right direction
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Tools for Facilitating
Healthy Behavior

   

Changing Habits/Improving Health
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Shared Decision Making
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Read PDF
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Wellness Toolkits

   

NYS Office of Mental Health- Life Span
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NYS Office of Mental Health- Wellness Self-Management Toolkit
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