Providing Coordinated Care

1. Providing Coordinated Care Jessica Peacock, health behavior counselor Amy Blackshire, health behavior counselor

2. The Database • Effectiveness of Health Behavior Counseling often relies on information from the database • Monthly measurements • Site visits • Fitness assessments • Dietary assessments

3. Health Behavior Counselor (HBC) Note • Relevant Nutrition Information • Info regarding nutrition that will be helpful for RD to know when meeting with client • Relevant Exercise Information • Info regarding exercise that will be helpful for trainers and Ex Phys to know when meeting with client • Reported Barriers • Client-specific barriers that keep WMPs from moving forward to their potential • Overall Suggestions for working with this patient • HBC suggestions based on participant reports, questions asked by the participant, etc. for helping the participant to move forward

4. HBC note EXample Relevant dietary information: Jane very much has a “diet” mentality. Remind her that she will do better if she focuses on making small changes she can stick with long-term. Also, encourage her not to eliminate foods she enjoys, but rather to learn to eat them in a different way. She said she hates cooking, but admitted that she really doesn’t know how to cook – she would benefit from more education or lessons on how to cook easy, healthy meals. Relevant exercise information: Jane said she does not like exercise much, so encourage her to focus on how exercise makes her feel – she agreed that she feels proud and accomplished, so help her also recognize having more energy and improved self-esteem. Reported barriers: dislike of exercise, lack of time, lack of education Overall suggestions for working with this patient: Jane may not feel entirely comfortable in the gym, so remind her to practice staying positive on a daily basis – what she tells herself will be crucial to her success! She will work better with female staff, so a female trainer who can work with and check in with her frequently would be helpful.

5. EP Effective notes • Participant is a 61 yo female family court judge. MEDS Zestoretic, Zocor, ASA, Multivitamin. HEALTH HX positive for HTN, high cholesterol, arthritis in knee & back, discomfort with exertion. GOALS increase regular exercise to 4 x wk; maintain mobility, wt loss of 100#. LIKES walking & being outdoors DISLIKES elliptical (hurt knee) and group classes. Coworkers and friends are supportive of lifestyle change. CHALLENGES sedentary job, work hours unpredictable. PRIOR fitness levels walk 3xwk, track at around 2 mph 4-5yrs. TEST cardio WBA, flex F, muscular endurance good -excellent. It is noted that she informed me late into our visit that her elderly father passed away this morning. His health had been declining and she wanted to complete this visit before travelling to his services. Will schedule FU following her return from his funeral in the midwest.

6. EP Ineffective notes • Participant was seen and evaluated today. • Participant is starting with a 20-30 minutes walking schedule.

7. EP Structured template • History • Medical, weight loss, exercise • Assessment • Name of test, result, score • Plan • Exercise prescription, follow-up, etc.

9. Monthly Personal training notes

10. Rd Structured Template • History • Medical conditions, nutrition habits (e.g. fast food, skipping meals, carb heavy, etc) • Education • Points of discussion based on basic nutrition guidelines plus individual-specific education delivered • Assessment • Level of risk, barriers, what will need to happen for this client to move forward • Plan • Individual prescription such as goals for daily calorie intake, macronutrient intake, water consumption, and other RD recommendations such as incorporating healthy snacks between meals for eating every 3-4 hours and pairing protein with carbs

11. RD Effective Note • H: Client is young male. Starting weight is 275.6# per ex phys note. Ht is self reported 5’11”. Ideal body weight for height: 172# +/- 10%. BMI of 38.4 classified as obese class 2. Client has elevated blood sugar levels; presents insulin resistance; and is hypertensive. He reports being on medications for both conditions. He reports that he lives alone and that he does not prepare many foods at home. He eats out at restaurants everyday and frequently visits the fast food places close to workplace. He related this to lack of time and the expense of healthy foods. Client drinks regular soda throughout the day consuming 4 or 5 cans of soda daily. • E: Education was based on client history. Compared cost of a week of healthy foods at grocery store vs meals at fast food restaurants. Educated client on the three macronutrients in foods and what the food groups fall into. Worked with client on diet plan to help maintain and stabilize blood sugar levels. Focused on lean sources of protein, high fiber fruits and vegetables, and heart healthy fat choices. Suggested client decrease the amount of regular soda a day to one or switch to a diet version and to not drink his calories. Encouraged low glycemic vegetable consumption and fruits with the skin on. Provided some easy ways to prepare healthy meals quickly using his George Foreman Grill and microwave. Educated client on importance of planning ahead of time to make healthy choices easy. Discussed the healthier options when eating fast food. Encouraged grilled proteins over fried, swapping side salad for French fries and avoiding the dessert items. Suggested omega 3 supplementation and downloading fitness pal app to track food and physical activity. • A: Client seems to want the results, but is unwilling to give up the fast food habit. Client is addicted to fried foods. He is motivated to get to the gym, but is reluctant to change diet. Encouraged client to follow the 80/20 rule: 80% strict diet, 20% have something you want. He seems willing to make some switches I suggested to him including: preparing some fast, healthier meals at home and eating more regularly. Overall, client hopes to gain self confidence through weight loss and decrease his medications. Barriers: spending money wisely, lack of motivation. • P: 1400-1800 kcal/day; 100-120 grams protein/day; </= 120 grams carbohydrate/day. Recommended 3g omega-3 supplementation/day. 6-8 cups of water/day. Eat small snack/meal every 4 hours. Provided contact information to client for further questions and assistance. Will follow per program protocol.

12. RD Ineffective Note • Met with Mrs. M for Month 3 for nutrition visit. She has been successful with losing 16# over the past 6 months. She is a little upset that she has not lost enough weight. She states that she has been feeling so much better with more energy. Encouraged her to be positive and continue efforts with weight loss. Reviewed traveling and continuing to lose weight.