hiv/aids prevention, diagnosis, and treatment in older patients an interactive online cme program...
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HIV/AIDS Prevention, Diagnosis, and Treatment in Older Patients
An Interactive Online CME Program for Primary Care ProvidersNIA Grant # R44AG019518
Rita Strombeck, Ph.D. HealthCare Education Associates
Study Goals
“…to develop a cost-effective Internet-based education program that will improve the performance of physicians and other health professionals in preventing, diagnosing, and managing HIV/AIDS in persons over age 50.”
Study Features
2 1/2 years– Phase 1: define learning objectives,
develop and review curriculum, (6 months)
– Phase 2: refine & develop online program format, validate curriculum in clinical setting, compare online education to traditional written format (2 years)
Need
Health care providers less likely to discuss HIV/AIDS with older patients (Skiest & Kaiser, 1997).
Providers less likely to recognize HIV-associated diagnoses and symptoms in older adults (Alpert et al. 1996; Justice Y Weissman, 1998).
Timely diagnosis of HIV/AIDS in older adults frequently delayed (CDC 1996; Vanhems et al. 1999).
Treatment difficulties in older patients due to multiple comorbidities, potential drug interactions, and altered pharmacokinetics (Gegeny 2000).
Current CME Programs on HIV/AIDS
Linear, text-based presentationLive lecturesOnline offerings
- mostly linear, few interactive opportunities
Transformation of CME
Growth of online CME offerings– 13 sites in 1997– 135 sites in 2000
Increase in number of users of eCME– 204,000 physicians in 2000– 363,000 physicians in 2003
Source: Manhattan Research August, 2003
What is Needed
To be effective, CME models need to incorporate interactive CME sessions that enhance participant activity and provide the opportunity to practice skills .
Davis DA, Thomson O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282:867-874.
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Our Challenge
Address practice problems Utilize principles of adult learning when
designing the programHelp physicians realize their own
deficienciesMatch the desired learning objective with
an appropriate education format
Address Practice Problems
Link specific educational interventions to specific practice problems
Problem- “not enough time to screen all patients for
HIV”
Possible Solutions - Patient self-assessment questionnaire- Staff Training Guide - Train staff members to
conduct screening and counseling
Utilize Adult Learning Principles
Self-directed learning eventsUse of multiple stimuli Relevant/practical informationProblem-based experiencesTransference of learning to real life
Help Physicians Realize Deficiencies
Needs assessment Compare responses to peers
(online CME has unique advantage)
Match Learning Objective to Appropriate Educational Format
Objectives: To increase1. awareness of the epidemiology of HIV/AIDS in adults over age 502. ability to conduct an age-sensitive risk assessment3. ability to discuss risk reduction strategies with at-risk midlife and older patients4. knowledge/recognition of the clinical manifestations of HIV in older adults5. ability to conduct age-sensitive pre- and post-test counseling 6. ability to provide age-appropriate care
Program Overview Needs Assessment Virtual Patient Encounters (8-10)
- screening/counseling (2-4)- testing (2-4)- pre- and post-test counseling (2-4)- care management (6)
Conference Room- audio/visual lectures on select topics
Library- written articles on various topics that can be printed
File Cabinet- assessment tools, patient handouts, etc.
Activities- Q & A, mini-cases, etc.
Internet Resources
Waiting Room
62-year old retired chiropractor Bill Watson complains of fatigue, sleeplessness, weight loss
Conference Room
Conference RoomSCREENING FOR HIV/AIDS
HOW TO CONDUCT A ONE-ON-ONE RISK ASSESSMENT SYMPTOMS OF HIV/AIDS IN OLDER ADULTS THE INCIDENCE OF HIV/AIDS IN LATER LIFE HIV/AIDS RISK FACTORS FOR OLDER ADULTS
POST-TEST COUNSELING/EVALUATION PSYCHOSOCIAL NEEDS END-OF-LIFE CONSIDERATIONS WELLNESS COUNSELING HEPATITIS C
MANAGEMENT OF HIV THE AGING IMMUNE SYSTEM TREATING OLDER ADULTS STRATEGIES FOR INCREASING ADHERENCE TO ANTIRETROVIRAL THERAPY DEALING WITH PSYCHIATRIC ISSUES
Library
Library/Articles DIAGNOSTIC ISSUES HIV DISEASE PROGRESSION IN OLDER ADULTS – BEFORE HAART HIV DISEASE IN OLDER ADULTS –RESPONSE TO HAART GUIDELINES FOR THE TREATMENT OF HIV-INFECTED ADULTS ADVERSE EVENTS ASSOCIATED WITH ANTIRETROVIRAL THERAPY IN
OLDER PATIENTS DRUG INTERACTIONS PRESENCE OF COMORBIDITIES IN OLDER HIV-INFECTED ADULTS PSYCHIATRIC DISORDERS HIV-ASSOCIATED DEMENTIA AND OLDER PATIENTS COMPLEMENTARY AND ALTERNATIVE THERAPY
Virtual Clinic/map
Evaluation
Immediate EffectsComparison to a Traditional CME GroupSatisfactionLong-Term Follow-up (6 months)
– The degree to which information provided in CME program is incorporated into practice
Program Available in Fall 2004
The Virtual Lecture Hallwww.vlh.com