GLP‑1s in your practice: build it right or refer well

Decide first: will you offer GLP‑1s or refer to trusted partners? Both are good answers.

If you offer them, stand up safety, operations, and documentation on day one.

If you refer, keep co‑monitoring mood, sleep, and meds and send brief updates.

If you DO add GLP‑1s

1. Start with reputable CME/CE so the team is aligned

   • AACE overview; PracticalCME; NPACE; ACP obesity management modules

2. Core operations to stand up

   • Eligibility checklist: BMI or cardiometabolic risk; pancreatitis/gallbladder history; pregnancy plans; MEN2 risk; severe GI disease

   • Informed consent bundle: risks, expected course, off‑label disclosures when applicable, nutrition/fitness co‑plan, discontinuation expectations

   • Baseline orders: weight, BMI, waist, BP/HR, A1C or fasting glucose, lipids; pregnancy test when appropriate; consider CMP by risk

   • Titration protocols: nausea first aid, dose‑hold rules, sick‑day rules, when to down‑titrate or switch

   • Adverse event playbooks: N/V/GERD and constipation; suspected pancreatitis or gallbladder events; hypoglycemia in T2D on secretagogues/insulin

   • Drug notes: oral contraceptive efficacy changes with tirzepatide at initiation/escalation; levothyroxine timing; psychiatric side effects with GI effects

   • Supply strategy: covered brands vs prior auth; transparent cash pricing; policy for compounded products (503A/503B only when justified by shortages, with documentation)

   • Clinic ops: refrigerator logs (if storing), sharps policy, injection teaching, refill timing, lost dose policy

   • Documentation templates: baseline note, 4–6 week check‑in, 12‑week review, outcomes tracker

   • Coverage/billing: ICD‑10 pairing, prior auth packet, letter of medical necessity, self‑pay bundle with clear deliverables

   • KPIs: percent at 5%/10% weight loss by 12/24/52 weeks; discontinuation reasons; AE rates; A1C change

3. Team training

   • MA/RN triage trees, nutrition and resistance‑training quick guides, front‑desk scripting for expectations and no‑surprise billing

   • Equity guardrails: screen for eating disorders; set weight floor rules; escalate for red‑flags (syncope, severe vomiting, suicidal ideation)

If you DON’T add GLP‑1s

• Refer smart: maintain a “preferred partners” list (endocrinology, obesity‑medicine clinics, health‑system programs)

• Stay helpful: normalize plateaus; monitor GI effects that stack with psych meds; protect sleep/mood; keep co‑monitoring and send brief updates to the prescriber

Patient education snapshot

• “GLP‑1s are one tool; nutrition, resistance training, sleep, and stress management remain essential.”

• “Expect dose adjustments and occasional pauses; report severe abdominal pain or signs of dehydration.”

References (web‑friendly)

• AACE, NPACE, ACP, PracticalCME, and Elite NP course pages

If you’re launching a GLP‑1 service, I can share templates for eligibility, consent, titration, and AEs.

Prefer to refer? I’ll help build a local partner list and a co‑monitoring checklist.