Wray Community District Hospital and The Wray Clinic

1
Wray Community District Hospital and The Wray
Clinic

• Family Medicine 7000
• July 2006

2
(No Transcript)
3
(No Transcript)
4
Wray The Town

• Estimated population of Wray in July 2005 2,147
• Estimated population of Yuma county in 2005
  9,841
• Median resident age 39.4 years
• In Yuma county
• Median household income in 2005 39,814
• 94.2 white, 0.1 African American, 12.9 Latino

5
(No Transcript)
6
Wray The Town

• For population 25 years and over in Wray
• High school or higher 78.7
• Bachelor's degree or higher 14.2
• Graduate or professional degree 3.5
• Unemployed 3.0
• Mean travel time to work 11.1 minutes

7
Wray Community District Hospital

• 3 Family Practice Physicians
• 2 Physician Assistants
• 1-2 Residents from the FM program in Greeley
• All see clinic patients and ER patients
• Rotating call schedule with the PAs and residents
  being backed-up by a physician as needed
• On-site lab, x-ray, CT, ultrasound
• MRI, sleep studies available once or twice a week

8
(No Transcript)
9
(No Transcript)
10
The Patients

• Peds, OB, adults, geriatric
• What do they do?
• Farm
• Ranch
• Factory Work
• Raise huge families!!!

11
The Patients

• What did I do for them?
• Delivered babies
• Incisional biopsies
• Well child/adult physicals
• Cryotherapy of skin lesions
• Injected joints
• Sutures/suture removal
• Provided lots of reassurance

12
(No Transcript)
13
The Patients

• Leading causes of death in Yuma County
  (1999-2003)
• Cardiovascular disease
• Cancer
• Respiratory disease
• Unintentional injuries
• Diabetes
• Alzheimers
• This follows the same trend as CO as a whole but
  with slightly higher numbers dying from CV dx,
  Ca, and accidents.

14
B.K.

• 64 year old man
• Visited the clinic for knee pain
• Hx of everything Lyme disease, hypertension,
  hypothyroid, Type 2 Diabetes, GERD, chronic pain

15
B.K.

• Medications
• Toprol XL (Metoprolol) HTN (Beta-blocker)
• Lotensin (Benazepril) HTN (ACE-I)
• Coumadin (Warfarin) - Anticoagulation
• ASA
• Cymbalta (Duloxetine) Depression and chronic
  pain
• Cytomel (Liothyronine) - Hypothyroid
• Synthroid (Levothyroxine) - Hypothyroid
• Serax (Oxazepam) - Anxiety
• Lantus Diabetes (long-acting insulin)

16
B.K.

• Humalog Diabetes (short-acting insulin)
• Glipizide - Diabetes
• Protonix (Pantoprazole) GERD (PPI)
• Tramadol Pain (central opioid agonist)
• Flexeril (Cylopenzaprine) Pain (muscle
  relaxant)
• Vicodin Pain (Narcotic)
• Methadone Pain (Narcotic)
• Prednisone - Inflammation
• Moxifloxacin Low-dose for Lyme Dx
• Flomax (Tamsulosin) - BPH

17
B.K.

• Approximately 25 pills per day plus insulin
  injections.
• But thats not all.

18
B.K.

• BMI 46
• One year ago he had lost 50 lbs
• Was on fewer meds, had fewer complaints, fewer
  visits
• Has now gained back 20 lbs
• What happened?
• He got new doctors for his Lyme disease
• He stopped going to the WRAC (my community
  resource)

19
THE WRAC

• Wray Rehabilitation and Athletic Center
• An amazing community resource
• Walking track
• Basketball and racket ball courts
• Nautilus equipment
• Weight room
• Pool
• Hot tubs
• Free blood pressure screening

20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
The WRAC

• Also a place to socialize
• Dances
• Group workout
• Classes
• Show artwork

27
(No Transcript)
28
Back to B.K.

• For his knee we sent him for an MRI
• We discussed the problem of having multiple
  doctors prescribing medications
• We listened to a long list of he and his wifes
  concerns

29
Back to B.K.

• Our biggest recommendation was getting back to
  the WRAC for these reasons
• Weight loss
• Help with diabetes control
• HTN control
• Chronic pain?
• Fewer medications????
• Social support
• Encouragement
• Ideas from other people doing the same thing
• Friendship
• It can be lonely out there

30
(No Transcript)
31
B.K.

• Will he do it?
• I hope so.

32
(No Transcript)