Walsenburg Colorado

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WalsenburgColorado
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The Doctors

• Dr. Lori Moll
• Dr. Mike Moll

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Spanish Peaks Hospital

• 25 patient beds, fully staffed
• Emergency Room
• Dialysis
• Diagnostic imaging
• Clinical laboratory
• Physical, occupational and speech therapy
• 7 FPs, and 1 orthopedic surgeon

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Demographics

• Population of Walsenburg 4,182
• Median resident age 37.9 years
• Walsenburg median household income 26,417
• Huerfano County median household income 30,942
• U.S. median household income 49,453
• Consistently one of top 5 poorest counties in
  Colorado

Races in Walsenburg Hispanic (51.0)
White Non-Hispanic (40.8) Other race (12.5)
American Indian (5.2) Black (4.8)
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Health Statistics

• Child abuse rate per 1000 12.8 (5.2 for
  Colorado)
• Child death rate per 100,000 44.7 (22.2 for
  Colorado)
• School based health care 0.0 (7.8 for
  Colorado)
• Births Unintended 57.5 (38.9 for Colorado)
• Source Health Statistics and Vital
  Records, Colorado Department of Public Health and
  Environment - 2002

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Outpatient clinics

• Spanish Peaks Family Clinic Open 5 days a week,
  800am-500pm.
• La Clinica Gardner. Open 2 afternoons a month.
  One MA and Dr. Lori Moll from Spanish Peaks see
  patients.
• Womens Clinic Walsenburg. 1-2
  afternoons/week. Mainly for women, but
  occasionally see men. Run by NP and Dr. Lori
  Moll. Site for community outreach programs and
  specialty clinics.

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Medical Services
Adult and adolescent health care Womens
health care including pap smears, hormone
therapy, menopause care and birth
control.Pediatric care including well child
checks and immunizations Well-man
examinationsGeriatric care Sports and school
examinationsPre-natal care up to the 8th month
of pregnancy CAT and MRI scanning (at
SPRHC)Orthopedic care (at SPRHC) Family
Planning, HIV and STD testing Minor surgical
procedure Dermatology care and specialty consults
(GYN, cardiology, GI, oncology)
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Community Outreach Programs

• Advocates Against Domestic Violence
• Nurse Family Partnership
• Sangre de Cristo Hospice
• Voice Care emergency response system
• Huerfano County Youth Services
• Colorado Womens Cancer Control Initiative
• Bully Prevention Program
• Informed Health Decisions
• KIND (Kids In Need of Dental work)

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Home Visits

• Gardner pop. 535 30 minutes from Walsenburg
• La Veta pop. 1495 20 minutes from Walsenburg

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What they dont have

• Psychiatrists, psychologists
• School Nurses

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Some pictures
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Most commons in clinic

• Well child exams
• Annual adult physicals
• Sore throat, URI
• Headaches
• Pain
• Hypertension, dyslipidemia, NIDDM
• Psychiatric (GAD, MDD, BD)

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The patient

• 46 yo caucasian female recently diagnosed with
  bipolar disorder. Lives in La Veta.
• I saw this patient twice, once for a follow up
  visit in the clinic and once, three days later,
  in the E.R.
• Hx of dependence on narcotics and numerous visits
  to the clinic/E.R.
• Hx of sexual promiscuity and substance abuse.

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The patient

• Clinic visit She has given up her dependence on
  narcotics and we added Lamictal to her Zyprexa
  and Depakote.
• E.R. visit relapse and depressed/suicidal after
  a run in with a guy from town. Sides with me
  after I show her some empathy and swears off E.R.
  physician.
• Any thoughts???

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Borderline Personality Disorder??

• Numerous visits to E.R./clinic
• Substance abuse/dependence
• Sees things as all good or all bad
• Extremely difficult to treat
• She was admitted voluntarily to Pueblo State
  Psychiatric Hospital

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Issue Lack of community resources

• Patient lives 75 minutes from nearest
  psychiatrist/psychologist.
• FPs helped her with her dependency issues.
• May have a bipolar disorder, but I think her main
  problem is BPD.
• Needs a second opinion from a psychiatrist and
  long-term psychotherapy.

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Solution??

• Hire a full-time psychiatrist/psychologist
• Discussed. Between nursing home, hospital and
  community patients, definitely a need. However,
  most likely not an option at this time due to
  cost.

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Solution??

• Refer to Pueblo?
• A viable option for many patients who live close,
  have health insurance, can take time off from
  work and have transportation. Oh yeah, and the
  weather.

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Solution???

• FP centered therapy in Walsenburg
• Good at screening for MDD, GAD and treating with
  pharmacotherapy.
• Not well trained in managing complicated patients
  like the one that I encountered.
• For time being, I think treating uncomplicated
  patients and referring complicated/suicidal
  patients to Pueblo is best option.
• Learning to recognize your limitations is the
  issue with my patient encounter. She should have
  been referred-out a while ago.

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Questions???