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

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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
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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.

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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)

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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).

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Current CME Programs on HIV/AIDS

• Linear, text-based presentation
• Live lectures
• Online offerings
• - mostly linear, few interactive
  opportunities

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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

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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.
  1999282867-874.
• -

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Our Challenge

• Address practice problems
• Utilize principles of adult learning when
  designing the program
• Help physicians realize their own deficiencies
• Match the desired learning objective with an
  appropriate education format

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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

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Utilize Adult Learning Principles

• Self-directed learning events
• Use of multiple stimuli
• Relevant/practical information
• Problem-based experiences
• Transference of learning to real life

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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

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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

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Waiting Room
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62-year old retired chiropractor Bill
Watson complains of fatigue,
sleeplessness, weight
loss
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Conference Room
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Conference Room

• SCREENING 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

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Library
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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

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Virtual Clinic/map
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Evaluation

• Immediate Effects
• Comparison to a Traditional CME Group
• Satisfaction
• Long-Term Follow-up (6 months)
• The degree to which information provided in CME
  program is incorporated into practice

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More Information

• HealthCare Education Associates
• www.hceassoc.com
• RStromb_at_cs.com

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Program Available in Fall 2004

• The Virtual Lecture Hall
• www.vlh.com