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Learning Primary Health Care to Serve Adults with Developmental Disabilities

Learning Primary Health Care to Serve Adults with Developmental Disabilities. CPHA 2008 Annual Conference Halifax, N.S. Brian Hennen, MD MA CCFP FCFP FRCGP Professor of Family Medicine, Dalhousie University. Background.

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Learning Primary Health Care to Serve Adults with Developmental Disabilities

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  1. Learning Primary Health Care to Serve Adults with Developmental Disabilities CPHA 2008 Annual Conference Halifax, N.S. Brian Hennen, MD MA CCFP FCFP FRCGP Professor of Family Medicine, Dalhousie University

  2. Background • Ontario committed to closing last three large remaining institutions serving as residences for persons with Developmental Disabilities • Significant advocate support but also pushback from many present residents & their families as well as staff • Ministries of Community and Social Services and Health and Long Term Planning wish to ensure smooth deinstitutionalization process

  3. Background (cont’d) • Concerned practitioners, administrators and academics aware of the need to support primary care providers to whom the residents will be transferred • See opportunity to improve primary care to all persons with Developmental Disabilities • See opportunity to strengthen health professional education programs in Developmental Disabilities

  4. Steering Committee William Sullivan (chair), Elspeth Bradley, Tom Cheetham, Richard Denton, Greg Gillis, Maria Gitta, John Heng, Brian Hennen, Barry Isaacs, Jo-Anne Jackson-Thorne, Marika Korossy, Yona Lunsky, Shirley McMillan, Leeping Tao.

  5. Steps Forward • Acquire financial support for program • Plan Colloquium of Involved Disciplinary Experts to Develop Clinical Practice Guidelines (CPG’s) and Practice Tools (lit searches, position papers, discussion, consensus) • Consult Experts on Guideline Development • Publish CPG’s in Peer-reviewed Journal

  6. Steps Forward (cont’d) • Develop Training Program Proposal • CFPC (Mainpro-C), RCPSC study credits • Fund and implement Training Program • Evaluate Training Program

  7. Goal & Objectives • To teach primary health care providers the Clinical Practice Guidelines: • 1. promote facility in the use of the CPG’s • 2. identify/address barriers to using them • 3. foster inter-professional learning

  8. Learning Objectives • apply new learning in caring for Adults with DD: . general issues in primary care (1-7) . physical health (8-17) .behavioral/mental health (18-24) .specific syndromes .assess family/community resources .institute comprehensive management

  9. Learning Objectives (ii) Enhance skills: • Apply CPG’s and practice tools to individual cases • Communication & rapport • Acquiring informed consent • Assess/monitor challenging behaviours • Screening

  10. Learning Objectives (iii) Assessing attitudes & ethical approach - Self assessment - Societal assessment - Service Systems assessment - Focus on gaps (resources, transitions, silos)

  11. Learning Program & Methods • Reading/discussing CPG’s in workshop in inter-professional small groups (all) • Case presentations (4) staged on website • Regional group, web case discussion (chat rooms) by individuals, home-based input

  12. Learning Methods (cont’d) • Regional teleconference, home-based, facilitated discussion, ending in group-developed management plan for each case • Final workshop (all) comparing/discussing management plans and evaluating program

  13. Four Cases (modules) • 55 yr f with severe DD, cerebral palsy, and no genetic diagnosis • 46 yr m with moderate DD and Down Syndrome • 18 mo f suspected of DD, returns at 19 yrs with mild DD, sleep disturbance & behaviour problem • 18 yr f with mild DD, severe behaviour problems and no genetic diagnosis

  14. Module Participant • “This videoconference is helping me bring things together in my practice. It is helping me to know where to focus my attention. The tools presented have been especially helpful. It has also been able to give me information and knowledge that I was not necessarily aware of.”

  15. Program Evaluation (1-5 rating scale) • Overall: • 29 % above average • 71% excellent Relevance: -- 33% above average -- 67% very relevant

  16. Program Evaluation (cont’d) 1-5 rating scale (Disagree/Strongly Agree) • Objectives clearly stated 4.35 • Adequate time/module 3.74 • Video/conf format enhanced learning 4.34 • Format was interactive 4.48

  17. Program Evaluation (cont’d) • Peer feedback helpful 4.61 • Cases useful in applying CPG’s 4.61 • Available resources useful 4.57 • More confident caring for patients 4.52

  18. Program Evaluation (cont’d) • Would like to have spent MORE time on: • Each module (n=4) • Consent issues (n=3) • Crisis plans, discussion of tools, assessing autism, cerebral palsy mobility, fetal alcohol, advanced directives, medications, genetics, psychological testing, oral care (feeding, swallowing), psychiatric management, role of nursing specific syndrome

  19. Program Evaluation (cont’d) Remaining Problematic Issues: Increasing knowledge, networking with other disciplines, definition discrepancies, access to services (Dual Diagnosis, Psychological Assessment, Genetics), insufficient time and material resources, support for caregivers in crisis situations, legal issues of education/care from adolescence to adulthood

  20. Program Evaluation (cont’d) • Recommendations for Improving Program: • Allow more than 2 wks per module (7) • Send all modules at beginning (2) • Direct guidelines more to OHP’s • Periodic updating of CPG’s • More interactive (I order test & get results) • Raise visibility of program

  21. Program Evaluation (cont’d) • What tools will be most helpful in practice? Comprehensive Health Assessment Program (CHAP) (4) Crisis plan (4) Periodic Health Assessments (3) Checklist for Autism in Toddlers (CHAT) (2) Office Visit Background (2) All (2)

  22. Program Evaluation (cont’d) • Suggested Future topics: Genetic Testing (3) Psychological testing (2) The Aging DD population (2)

  23. Program Evaluation (cont’d) • Other Suggested Topics: • advance directives/consent/SDM’s • current cases/dual diagnosis/special diets • multidisciplinary collaboration/pharmaRx • health assessments/health promotion • highly complex cases/crisis plans • decline in cognitive function • staff training/staff assignments

  24. Program Evaluation (cont’d) • What attracted your participation? To improve my care to persons with DD (6) To increase my knowledge about DD (6) An interest and wish to be supportive (2)

  25. Program Attraction (cont’d) “It was pertinent to my job and brought together the health care needs of people with DD without having to do extensive research on my own”, …….“boss encouraged me”, an opportunity for well-researched clinical approaches and to meet other professionals in the field, increased deinstitutionalization, aging population,

  26. Program Evaluation (cont’d) • 96 % of 22 would be interested in similar courses in the future • 96% of 22 would be interested in participating in a provincial network

  27. Case Development • Real cases, modified • Purposefully selected cases: • Wide range of topics • Mixed age, sex, diagnosis • Overall use of guidelines and tools • Suitable for range of primary care providers

  28. A Case Module Consisted of: • Case description (sequenced sections) • Information re: CPG’s & tools applied • Question sets (5) posted at decision points • Group discussion board (up to 15 pages) • 2-weekly on-line grp discussion (1 hr) • Last group discussion mgt. plan • Final all groups mtg. share/discuss/evaluate mgt plans & course

  29. Module Evaluations (Example Module for case 1) • Content: • Met stated objectives 4.33 • Relevant to my practice 4.42 • Tools were useful 4.50 • Overall 4.55

  30. Module Evaluation (Example Module for Case 1) Process of Discussion • Time adequate 3.82 • Clear presentation, well–timed 3.64 • Discussion Board Interactions helped 4.27 • Moderator kept discussion moving and timed questions well 4.27 • Participants shared in the discussion 4.27 • Overall Discussion rating 4.22

  31. Module Evaluation (Example module for case 1) • Website and Videoconferencing: • Easy to access website 4.08 • Tech instructions/supports helpful 4.36 • Able to access areas of website 4.25 • Able to post comments on website 4.17 • Video/conf mtg helped in mgt plan 4.45 • Overall web/videoconference rating 4.40

  32. Module Evaluation (Example Using module with case 1) • Most important thing learned: • Getting relationship with patient and caregiver • CHAP, periodic health exam, preventive check list, management plan • GERD management • Using the internet for a course • Specific guidelines • I’ll look more closely at the physical aspects • Issues of consent

  33. Module Evaluation (Example of module for case 1) One change in learning process to improve it for you: -more info at beginning re: web medium -more time for 1st case, getting used to web -one question not clear -more interaction on the discussion -need to make the time (spent 20 mins/day) -more on Dual Diagnosis -loosen up timelines

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