Annals of Family Medicine

NOVEMBER 20, 2024

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. The pre-intervention no-show rate of TCM appointments at Wellstar MCG Health was 44% per month.

Appointment 130

Appointment Hospital Management Family Medicine 130

Annals of Family Medicine

NOVEMBER 20, 2024

A recent review of national diabetes treatment guidelines recommended adjustments to DM to reduce financial strain (eg, selecting lower cost medications), as well as directly intervening in response to an identified social need (eg, referral to a community-based service). Setting: Ambulatory clinics (e.g.,

Primary Care 130

Primary Care Diabetes Management Provider 130

Dr. Zaar

JUNE 1, 2025

Certified Diabetes Educators (CDE): While not doctors, they play a key role in diabetes education and lifestyle support. Firsthand referrals often lead to trusted and patient-focused providers. A difficult-to-reach provider could lead to skipped appointments and poorly managed blood sugar.

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

Physician's Weekly

JUNE 25, 2025

Many of these patients are clinically complex and receive care from multiple professionals—which creates unique management hurdles. Have clinical indicators of disease complexity or advancement. Communicate clearly with appropriate non-clinical staff. Have open gaps in care or medications not filled.

Chronic Condition 59

Chronic Condition Patients Management Primary Care Physician 59

Minnesota Academy of Family Physicians

FEBRUARY 20, 2025

Streamline Referrals: Utilize technology like the Hunger Vital Signs tool and the Minnesota Food Helpline to connect patients directly to mobile food units, emergency food programs or Supplemental Nutrition Assistance Program (SNAP) enrollment services. Park Nicollet Health Services combines nutrition education with SNAP referrals.

Family Physician 52

Family Physician Community Family Families 52

Tiny Physician

FEBRUARY 15, 2022

There is an increasing trend in the number of medico-legal cases filed against doctors and doctors have started practicing defensive medicine (the ordering of tests, procedures, referrals, or avoidance of high-risk patients or procedures, to reduce medico-legal cases) for the sake of their safety. patients show their frustration at doctors.

Patient-Centered 52

Patient-Centered Government Referral Hospital 52

GeriPal

JANUARY 18, 2024

In particular, we talk about Katie’s and Jesica’s paper in NEJM titled “ Juggling Two Full-Time Jobs — Methadone Clinic Engagement and Cancer Care ,” which described the difficulty in managing cancer pain and methadone for opioid use disorder. AMA PRA Category 1 credit(s) ™. Who do we have with us today? Katie, welcome back to GeriPal.

Illness 137

Illness Patient-Centered Screening Clinic 137