HIV-AIDS Prevention_ Diagnosis_ and Treatment in Older Patients

HIV%2fAIDS+Prevention%2c+Diagnosis%2c+and+Treatment+in+Older+Patients%0d%0aAn+Interactive+Online+CME+Program+for+Primary+Care+Providers%0d%0aNIA+Grant+%23+R44AG019518%0d%0a%0d%0aRita+Strombeck%2c+Ph.D.%0d%0a%0d%0aHealthCare+Education+Associates%0d%0a%0d%0a%0cStudy+Goals%0d%0a%ef%81%ac%0d%0a%0d%0a%e2%80%9c%e2%80%a6to+develop+a+cost-effective+Internet-based+education+program+that+will+improve+the+performance+of+physicians+and+other+health+professionals+in+preventing%2c+diagnosing%2c+and+managing+HIV%2fAIDS+in+persons+over+age+50.%e2%80%9d%0d%0a%0d%0a%0cStudy+Features%0d%0a%ef%81%ac2%0d%0a%e2%80%93%0d%0a%0d%0a1%2f2+years%0d%0a%0d%0aPhase+1%3a+define+learning+objectives%2c+develop+and+review+curriculum%2c+(6+months)+%e2%80%93+Phase+2%3a+refine+%26+develop+online+program+format%2c+validate+curriculum+in+clinical+setting%2c+compare+online+education+to+traditional+written+format+(2+years)%0d%0a%0d%0a%0cNeed%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aHealth+care+providers+less+likely+to+discuss+HIV%2fAIDS+with+older+patients+(Skiest+%26+Kaiser%2c+1997).+Providers+less+likely+to+recognize+HIVassociated+diagnoses+and+symptoms+in+older+adults+(Alpert+et+al.+1996%3b+Justice+Y+Weissman%2c+1998).+Timely+diagnosis+of+HIV%2fAIDS+in+older+adults+frequently+delayed+(CDC+1996%3b+Vanhems+et+al.+1999).+Treatment+difficulties+in+older+patients+due+to+multiple+comorbidities%2c+potential+drug+interactions%2c+and+altered+pharmacokinetics%0d%0a(Gegeny+2000).%0d%0a%0d%0a%0cCurrent+CME+Programs+on+HIV%2fAIDS%0d%0a%ef%81%ac+Linear%2c%0d%0a%0d%0atext-based+presentation+%ef%81%ac+Live+lectures+%ef%81%ac+Online+offerings+-+mostly+linear%2c+few+interactive+opportunities%0d%0a%0d%0a%0cTransformation+of+CME%0d%0a%ef%81%ac%0d%0a%0d%0aGrowth+of+online+CME+offerings%0d%0a%e2%80%93+%e2%80%93%0d%0a%0d%0a13+sites+in+1997+135+sites+in+2000+204%2c000+physicians+in+2000+363%2c000+physicians+in+2003%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aIncrease+in+number+of+users+of+eCME%0d%0a%e2%80%93+%e2%80%93%0d%0a%0d%0aSource%3a+Manhattan+Research+August%2c+2003%0d%0a%0d%0a%0cWhat+is+Needed%0d%0a%ef%81%ac%0d%0a%0d%0aTo+be+effective%2c+CME+models+need+to+incorporate+interactive+CME+sessions+that+enhance+participant+activity+and+provide+the+opportunity+to+practice+skills+.%0d%0aDavis+DA%2c+Thomson+O'Brien+MA%2c+Freemantle+N%2c+Wolf+FM%2c+Mazmanian+P%2c+Taylor-Vaisey+A.+Do+conferences%2c+workshops%2c+rounds%2c+and+other+traditional+continuing+education+activities+change+physician+behavior+or+health+care+outcomes%3f+JAMA.+1999%3b282%3a867-874.%0d%0a%0d%0a%0cOur+Challenge%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aAddress+practice+problems%0d%0aUtilize+principles+of+adult+learning+when+designing+the+program+Help+physicians+realize+their+own+deficiencies%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aMatch+the+desired+learning+objective+with+an+appropriate+education+format%0d%0a%0d%0a%0cAddress+Practice+Problems%0d%0a%ef%81%ac%0d%0a%0d%0aLink+specific+educational+interventions+to+specific+practice+problems%0d%0a%0d%0aProblem%0d%0a-+%e2%80%9cnot+enough+time+to+screen+all+patients+for+HIV%e2%80%9d%0d%0a%0d%0aPossible+Solutions%0d%0a-+Patient+self-assessment+questionnaire+-+Staff+Training+Guide+-+Train+staff+members+to+conduct+screening+and+counseling%0d%0a%0d%0a%0cUtilize+Adult+Learning+Principles%0d%0aSelf-directed+learning+events+%ef%81%ac+Use+of+multiple+stimuli+%ef%81%ac+Relevant%2fpractical+information+%ef%81%ac+Problem-based+experiences+%ef%81%ac+Transference+of+learning+to+real+life%0d%0a%ef%81%ac%0d%0a%0d%0a%0cHelp+Physicians+Realize+Deficiencies%0d%0aNeeds+assessment+%ef%81%ac+Compare+responses+to+peers+(online+CME+has+unique+advantage)%0d%0a%ef%81%ac%0d%0a%0d%0a%0cMatch+Learning+Objective+to+Appropriate+Educational+Format%0d%0a%ef%81%ac%0d%0a%0d%0aObjectives%3a+To+increase%0d%0a1.+awareness+of+the+epidemiology+of+HIV%2fAIDS+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%2frecognition+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%0d%0a%0d%0a%0cProgram+Overview%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aNeeds+Assessment+Virtual+Patient+Encounters+(8-10)%0d%0ascreening%2fcounseling+(2-4)+testing+(2-4)+pre-+and+post-test+counseling+(2-4)+care+management+(6)%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aConference+Room%0d%0a-+audio%2fvisual+lectures+on+select+topics%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aLibrary%0d%0a-+written+articles+on+various+topics+that+can+be+printed%0d%0a%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0aFile+Cabinet%0d%0a-%0d%0a%0d%0aassessment+tools%2c+patient+handouts%2c+etc.%0d%0a%0d%0aActivities%0d%0a-+Q+%26+A%2c+mini-cases%2c+etc.%0d%0a%0d%0aInternet+Resources%0d%0a%0d%0a%0cWaiting+Room%0d%0a%0d%0a%0c62-year+old+retired+chiropractor+complains+of+fatigue%2c+sleeplessness%2c+weight+loss%0d%0a%0d%0aBill+Watson%0d%0a%0d%0a%0cConference+Room%0d%0a%0d%0a%0cConference+Room%0d%0aSCREENING+FOR+HIV%2fAIDS%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aHOW+TO+CONDUCT+A+ONE-ON-ONE+RISK+ASSESSMENT+SYMPTOMS+OF+HIV%2fAIDS+IN+OLDER+ADULTS+THE+INCIDENCE+OF+HIV%2fAIDS+IN+LATER+LIFE+HIV%2fAIDS+RISK+FACTORS+FOR+OLDER+ADULTS%0d%0a%0d%0aPOST-TEST+COUNSELING%2fEVALUATION%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aPSYCHOSOCIAL+NEEDS+END-OF-LIFE+CONSIDERATIONS+WELLNESS+COUNSELING+HEPATITIS+C%0d%0a%0d%0aMANAGEMENT+OF+HIV%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aTHE+AGING+IMMUNE+SYSTEM+TREATING+OLDER+ADULTS+STRATEGIES+FOR+INCREASING+ADHERENCE+TO+ANTIRETROVIRAL+THERAPY+DEALING+WITH+PSYCHIATRIC+ISSUES%0d%0a%0d%0a%0cLibrary%0d%0a%0d%0a%0cLibrary%2fArticles%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aDIAGNOSTIC+ISSUES+HIV+DISEASE+PROGRESSION+IN+OLDER+ADULTS+%e2%80%93+BEFORE+HAART+HIV+DISEASE+IN+OLDER+ADULTS+%e2%80%93RESPONSE+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%0d%0a%0d%0a%0cVirtual+Clinic%2fmap%0d%0a%0d%0a%0cEvaluation%0d%0aImmediate+Effects+%ef%81%ac+Comparison+to+a+Traditional+CME+Group+%ef%81%ac+Satisfaction+%ef%81%ac+Long-Term+Follow-up+(6+months)%0d%0a%ef%81%ac%0d%0a%e2%80%93%0d%0a%0d%0aThe+degree+to+which+information+provided+in+CME+program+is+incorporated+into+practice%0d%0a%0d%0a%0cMore+Information%0d%0a%ef%81%ac%0d%0a%0d%0aHealthCare+Education+Associates+%e2%80%93+www.hceassoc.com%0d%0a%0d%0a%e2%80%93%0d%0a%0d%0aRStromb%40cs.com%0d%0a%0d%0a%0cProgram+Available+in+Fall+2004%0d%0a%ef%81%ac+The%0d%0a%0d%0aVirtual+Lecture+Hall%0d%0a%0d%0awww.vlh.com%0d%0a%0d%0a%0c