Transcript HIV/AIDS Prevention, Diagnosis, and Treatment in Older Patients

HIV/AIDS Prevention, Diagnosis,
and Treatment in Older Patients
An Interactive Online CME
Program for Primary Care
Providers
NIA 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
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Health care providers less likely to discuss
HIV/AIDS with older patients (Skiest & Kaiser, 1997).
Providers less likely to recognize HIVassociated 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 presentation
 Live lectures
 Online offerings
- mostly linear, few interactive
opportunities
Transformation of CME

Growth of online CME offerings
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13 sites in 1997
135 sites in 2000
Increase in number of users of eCME
–
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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.
Our Challenge
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Address practice problems
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Utilize principles of adult learning
when designing the program
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Help physicians realize their own
deficiencies
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Match 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 events
 Use of multiple stimuli
 Relevant/practical information
 Problem-based experiences
 Transference of learning to real life

Help Physicians Realize
Deficiencies
Needs assessment
 Compare responses to peers
(online CME has unique advantage)
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Match Learning Objective to
Appropriate Educational Format

Objectives: To increase
1. awareness of the epidemiology of HIV/AIDS
in adults over age 50
2. ability to conduct an age-sensitive risk
assessment
3. ability to discuss risk reduction strategies
with at-risk midlife and older patients
4. knowledge/recognition of the clinical
manifestations of HIV in older adults
5. 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)
-
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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
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Library
- written articles on various topics that can be
printed
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File Cabinet
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assessment tools, patient handouts, etc.
Activities
- Q & A, mini-cases, etc.
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Internet Resources
Waiting Room
62-year old retired chiropractor
complains of fatigue,
sleeplessness, weight loss
Bill Watson
Conference Room
Conference Room
SCREENING FOR HIV/AIDS
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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
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PSYCHOSOCIAL NEEDS
END-OF-LIFE CONSIDERATIONS
WELLNESS COUNSELING
HEPATITIS C
MANAGEMENT OF HIV
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THE AGING IMMUNE SYSTEM
TREATING OLDER ADULTS
STRATEGIES FOR INCREASING ADHERENCE TO
ANTIRETROVIRAL THERAPY
DEALING WITH PSYCHIATRIC ISSUES
Library
Library/Articles
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DIAGNOSTIC ISSUES
HIV DISEASE PROGRESSION IN OLDER ADULTS
– BEFORE HAART
HIV DISEASE IN OLDER ADULTS –RESPONSE TO
HAART
GUIDELINES FOR THE TREATMENT OF HIVINFECTED ADULTS
ADVERSE EVENTS ASSOCIATED WITH
ANTIRETROVIRAL THERAPY IN OLDER PATIENTS
DRUG INTERACTIONS
PRESENCE OF COMORBIDITIES IN OLDER HIVINFECTED ADULTS
PSYCHIATRIC DISORDERS
HIV-ASSOCIATED DEMENTIA AND OLDER
PATIENTS
COMPLEMENTARY AND ALTERNATIVE THERAPY
Virtual Clinic/map
Evaluation
Immediate Effects
 Comparison to a Traditional CME
Group
 Satisfaction
 Long-Term Follow-up (6 months)
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The degree to which information
provided in CME program is
incorporated into practice
More Information

HealthCare Education Associates
– www.hceassoc.com
–
[email protected]
Program Available in Fall 2004
 The
Virtual Lecture Hall
www.vlh.com