Primary Care Program Office PCS May 2011 PC Rural Health Series PC Rural Health Series in LMS Module LMS ID No Title and Direct Link Geriatrics VA 8896 Advance Care Planning A Collaborative Interdisciplinary Process ID: 699424
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Slide1
Primary Care Rural Health Education Series
Primary Care Program Office, PCSMay 2011Slide2
PC Rural Health SeriesSlide3
PC Rural Health Series in LMSSlide4
Module
LMS ID No.
Title and Direct Link
Geriatrics
VA 8896
Advance Care Planning: A Collaborative Interdisciplinary Process
Geriatrics
VA 8897
Co morbidity and Frailty: Two Important Concepts in Geriatric Care
GeriatricsVA 8900Evaluation and Management of Dementia: Key Concepts for Primary CareGeriatricsVA 8910Screening for Common Geriatric Conditions among Older Adults in Primary CareGeriatricsVA 8911Sex and Driving: Two Tough Conversations We Need to Have with our Older PatientsMental HealthVA 8899Evaluation and Management of Alcohol Misuse in Primary CareMental HealthVA 8901Evaluation of Anxiety, Depression, and Suicidality in Primary CareMental HealthVA 8909Screening and Evaluation of PTSD in Primary CareMental HealthVA 8914Treatment of Anxiety and Depression in Primary CarePain ManagementVA 8898Collaborative Care Model of Complex Chronic PainPain ManagementVA 8905Practical Suggestions for Helping Veterans with Complex Chronic PainPain ManagementVA 8913Stepped Integrated Pain Care in the VHA, Part 1Pain ManagementVA 8912Stepped Integrated Pain Care in the VHA, Part 2Post Combat CareVA 8886Environmental Agent Exposures in Veterans and Risk Communication for Frontline ProvidersPost Combat CareVA 8888Post Deployment Care for Frontline ProvidersPost Combat CareVA 8890The Compensation and Pension Exam Process and VA BenefitsPost Combat CareVA 8891Why Military Culture Matters: The Military Member's Experience
Direct Link to Courses
Tip: LMS Search Slide5
PC Rural Health National Call Series
Questions regarding the Primary Care Rural Health Education Initiative may be directed to Miyako Wilson at 202-461-7180 or Gordon Schectman at 414-384-2000 ext.42684.Slide6
Heather Whitson, MD
Durham Geriatric Research, Education, and Clinical Center (GRECC)
Duke University School of MedicineB. Josea Kramer, PhDGreater Los Angeles GRECC
UCLA David M. Geffen School of Medicine
Geriatrics in
Rural VHA Primary CareSlide7
Geriatrics Challenges in
VHA Rural Primary Care
>50% of Veterans seen in VHA Primary Care are age 65 and above>30% are age 75 and above
Rural counties have higher proportions of elderly residents than urban and suburban ones; trend is even greater for Veterans
Elderly rural Veterans are challenged by travel, communications, non-institutional resources, community support systems
…the resources described in this hour are offered
to help support and enhance your Primary Care PACT’s abilities and confidence to do as much as you can
for the older Veterans in your panels!Slide8
Support for Rural VHA Primary Care
from Geriatrics & Extended Care (GEC)
New non-institutional programs supported by the Office of Rural Health (ORH)
New and modified Home-Based Primary Care programs
VHA/Indian Health Service collaborations
Non-institutional extended care pilots
Dementia care “circuit riders”
Mobile vans
A variety of GRECC* educational materials and opportunities
Pocket cards of GEC services; Differential Diagnoses; Geriatric Assessment; Falls assessmentCBOC educational outreach/QI training (VISNs 11, 19)Monthly Geriatrics Audioconferences (national) 4th Thursday, 3 pm eastern, 1-800-767-1750; x89095#Audio and visual content archived at http://www.greccaudio.geriu.org/ “Geri-Scholars”--an intensive specifically for rural primary care cliniciansPrimary Care Rural Health Education Series*http://www.va.gov/GRECC/GRECC_Demographics_and_Profiles.aspSlide9
The VA Geriatric Scholars Program
A collaboration of
VA Office of Geriatrics and Extended Careand
Geriatric Research Education & Clinical Centers (GRECC)
B. Josea Kramer, PhD
Director, VA Geriatric Scholars Program
Associate Director for Ed/Eval, GRECC
VA Greater Los Angeles Healthcare System GRECC
A program made possible by funding from the VA Office of Rural Health Slide10
Geriatric Scholars Program
VISN
# CBOC
# Scholars
VISN
# CBOC
# Scholars
1
9
12122325615673
3
3
16
8
8
4
3
3
17
3
5
5
2
4
18
8
9
6
3
6
19
4
674520348782110109710220010811238121158
Geriatric Scholars Program: 2008-2010
140 VA Scholars
40 States, 2 US Territories
110 # Rural ClinicSlide11
Who are the Scholars?
Primary Care Providers
Support Team MembersSlide12
Geriatric Scholars ProgramSlide13Slide14Slide15
Goals:
To provide professional development to the health provider participating in the Geriatric Scholars program
Objectives:
Webinar Part 1 –
To improve their communication skills in knowledge transfer with their peers who work in Community Based Outpatient Clinics (CBOCS)
Webinar Part 2 –
To define the basic theories of adult learning to better understand what motivates and engages adults to incorporate new information into their health behaviors
Webinar Part 3 –
To identify literacy barriers that affect learning in older patients.
“SLIDES WILL BE ARCHIVED”For Further Assistance Contact:Lauren Ila Jones, Ph.D.Program Manager, Geriatric Scholars ProgramGRECC/VA GLAHS-Sepulveda Campus16111 Plummer St. (11E)Ph (818) 891-7711 x9156; lauren.jones@va.govSlide16
Learning Community
Geriatric Scholars Program informationState-of-the-Art Geriatrics
Toolkits, Clinical Guidelines, ResourcesCPRS TemplatesEducation calendarDiscussion Boards
http://vaww.portal.gla.med.va.gov/sites/GRECCNew/scholars/default.aspx
Slide17
Quality Improvement Projects
in collaboration with national Quality Scholars Program
Evaluation: Application of knowledgeParticipation in annual Geriatrics & Extended Care Leads conferenceProjects on display in facilities and VISN offices
Other benefits:
Meets recertification requirement:
Self evaluation of practice performance
Project approval through Quality Management Slide18Slide19Slide20
The Scholars’ Own Words
About the Geriatric Scholar Program
“This program has helped me with my day to day practices. I feel more comfortable in my role. I can communicate better with my team and patients...”
“Please send my thanks to the people in charge--you really motivated me to decide to go back and do my doctorate.”
“Very fortunate to have the opportunity to be a part of the program.”
“It's been great - great to learn something new on a regular basis.”Slide21
Who is Eligible and How to Apply
New class enrollment will be announced by DUSHOM to the Networks
VISNs nominate Scholars to attendEligibility: Rural VA CBOCs, VA employee DisciplineCommitment to complete course
New Class Enrollment
Starting Soon!Slide22
The Geriatric Scholars Collaboration
Josea Kramer, PhD
Kenneth Shay, DDSJudy Howe, PhDRonni Chernoff, PhDSteven Barczi, MDKathy Horvath, PhD
Terri Huh, PhD
Nina Tumosa, PhD
Michele Saunders, DMD
Robert Dittus, MD & Jacob Hathaway, MD
Greater Los Angeles GRECC
VA Office of GEC
Bronx GRECCLittle Rock GRECCMadison GRECCNew England GRECCPalo Alto GRECCSaint Louis GRECCSan Antonio GRECCTennessee Valley GRECC & Nat’l VA Quality ScholarsSlide23
Primary Care Rural Health Education Series
in Geriatrics
Main goal: To increase providers’
comfort and knowledge
about
important and common
geriatric
conditions and issuesSlide24
Almost all providers in the VA have experience and skill in caring for older adults
We all have a lot to learn
AssumptionsSlide25
Assessment
and referral of geriatric conditions
Frailty Dementia and other cognitive changes
Palliative care
Falls and
locomotor
problems
Pharmacology in older adults
Genitourinary issues in older adults
Long-term careCaregiver and home assessment Musculoskeletal diseases in older adultsInfections in older adults Circulatory diseases in older adultsEndocrinopathies in older adults Original Topic ListSlide26
Advance Care Planning: A Collaborative Interdisciplinary Process
Comorbidity
and Frailty: Two Important Concepts in Geriatric Care
Evaluation and Management of Dementia: Key Concepts for Primary Care
Screening for Common Geriatric Conditions among Older Adults in Primary Care
Sex and Driving: Two Tough Conversations We Need to Have with our Older Patients
Current LecturesSlide27
Highlight:
Advance Care Planning
Next of Kin Hierarchy in VA
A relative 18 years of age or older, in the following order of priority:
Spouse
Child
Parent
Sibling
Grandparent
GrandchildClose friendSlide28
Highlight:
Frailty and
Comorbidity
Pearls for Management
Less May Be More
Avoid
polypharmacy
.
Can the problem be addressed without a prescription pad?
More permissive approach chronic disease managementCease preventive screening if life expectancy is < 5 years U.S. Air Force Photo by Airman 1st Class Adam Grant/ReleasedSlide29
Highlight:
Dementia
Current
Year
Peak
Year
After
Peak
Veterans
563,7582012571,614DeclineThru 2022Enrollees317,9432015339,248Slight DeclineThru 2022Patients192,7242017218,017Very Slight DeclineThru 2022Dementia in the VAUrban rural split: 38% of Veterans live in rural areas and 75% of rural Veterans are over the age of 65.Slide30
Screening
for
Urinary Incontinence
Single item screener (with follow-up items for positive response)
“During the past 3 months, have you leaked urine (even a small amount)?”
If yes, then ask:
“During the past 3 months, did you leak urine most often”:
“When you were coughing, laughing, sneezing, lifting or exercise?” (suggests stress incontinence)“When you had the urge to urinate, but you couldn’t get to the toilet fast enough?” (suggests urge incontinence)Neither or bothHighlight: ScreeningSlide31
Highlight:
Sex and Driving
Older adults are sexually active
Population survey (n=3005, age range 57 – 85)
Sexual activity is associated with quality of life
Predictors of reduced sexual activity:
Advanced age, lack of partner, female sex, poor health of person or partner
Lindau ST,
et al.
NEJM, 2007Age% sexually active57 – 647365 – 745375 – 8526Slide32
Questions?