Health Care Provider Education: Older Farmers

1. Health Care Provider Education: Older Farmers Shannon Lizer PhD APN-CS Director of Nursing Highland Community College Freeport Illinois; And UIC College of Nursing

2. Focus of Presentation • The purpose of this presentation is to review current educational modalities of health care providers for optimal care of older farmers • Short discussion about why this is important • Examples given are not meant to be an exhaustive list

3. So, why is this important? • A partnership exists between a health care provider and patient/family when care is optimal • Partnerships are difficult when a knowledge deficit exists • The culture of farming & rural is unique • Language and concepts are different in farming & rural culture • Traditional health care & health promotion take on new meaning

4. Review of Access to Care Issues • ~30% of rural residents live in areas with a shortage of health providers & services • Shortage cuts across all disciplines • EMS services in rural and frontier is a critical problem across the country • Lack of health care insurance or high deductibles is also an issue for rural residents

5. Health Care Professions Education • Emergency Medical Services • Medicine – predoctoral & residency • Nursing – undergraduate & graduate • Pharmacy • Dental • Allied Health • Public Health • Interdisciplinary programs

6. Current Educational System Overview • Intentional Programs • Agricultural Health & Safety Coursework • Rural Location • Community Partnerships • Serendipitous Exposures • Continuing Education Programs

7. Intentional Programs • Programs have a rural focus • Programs have some rural content • Programs are located in rural areas • Programs may or may not involve multiple disciplines

8. Rural Nursing Programs • Nurse Agricultural Educational Project University of Kentucky • farm injuries awareness, agricultural curriculum, injury prevention research, development of instructional materials, and support of research/dissertation work around this topic • Rural Nurse Internship (RNI) • 1 year acute care preceptorship in Oregon, Montana, Washington, & Idaho

9. More Nursing Programming • Decker School of Nursing in upstate New York has a rural nursing tract • Frontier Nursing Program in Kentucky • East Tennessee State University • Rural Family Nursing Program at University of Central Missouri

10. Medical Education • Predoctoral Programs • May be aligned with state scholarships – ex. Rural Health Associations • May be tied to commitment to practice in rural areas • Postdoctoral Programs • Most typically tied to a family practice residency program

11. Predoctoral Medical Rural Programs • Several examples across US • Texas College of Osteopathic Medicine • University of Illinois College of Medicine in Rockford, Illinois • Oklahoma State University • Components include: • Regular curriculum • Rural topics • COPC projects

12. Medical Residency Programs • Formal Rural Training Track Programs • Richard G. Lugar Center for Rural Health • Memorial Family Medicine in South Bend, Indiana • Wisconsin Academy for Rural Medicine ”WARM” at the University of Wisconsin

13. Rockford’s RMED Program • Currently linked with National Center for Rural Health Professions (NCRHP) • Special admittance process through the University College of Medicine • Some interdisciplinary exposure • Rural curriculum as add-on in M1-M4 years • Rural preceptorship + COPC project in M4 year

14. No Harm On The Farm Tour • Joint activity with RMED & UIC CON Occupational Health Nursing Program in Fall 2006 • Joint presentation between ag safety & farmers • Toured 2 farms in rural Lee County, Illinois at harvest • Beef/grain operation • Hog/grain operation

15. Tenets of Intentional Programs • Rural education and exposure are necessary for graduates to understand rural culture • Rural people may have credibility • Rural people (after education) live in rural areas

16. Interdisciplinary Programs • East Tennessee University • Rural Primary Care Tract longitudinal exposure to rural folks • Short QI Program - Interdisciplinary teams working together to solve a problem/challenge faced in health care (Burdick funding) • Overarching goals are to increase # of health professionals, develop & strengthen links in system, and increase access to services

17. Rural Mental Health • Rube Farmer Suicide Prevention, University of Michigan School of Social Work http://www.ssw.umich.edu/simulation/simulation-rube.html

18. Gerontology Programs • Many out there looking at elderly population, some of which are in rural areas • Most of these programs are interdisciplinary by design and mission • All have gerontology content, some have rural content • Case study programs ex. Ithaca College Rural Cases (ithaca.edu)

19. Agricultural Safety & Health Courses • Individual courses offered as electives or part of a non-health care program • Ag Safety Centers offer courses • NIOSH ERC health professions offer programs and courses (OHN, Occ. Med) • Texts and supplemental materials are available

20. Rural Location • Programs that are housed in universities & colleges located in “rural and frontier” areas • These programs by their location provide a rural experience • There may or may not be curriculum related to agriculture issues or rural life

21. Community Partnership Models • Tend to be grant supported • Kellogg • Robert Woods Johnson • CCPH – Service Learning programs • Structured learning combining community service with objectives & reflection • Tend to be interdisciplinary by design

22. Examples of Community Partnerships • Rural Health Education Network (RHEN) in rural Nebraska focus on rural folks choosing a healthcare career • Area Health Education Centers (AHEC) – in many states (Florida, Wisconsin, Illinois, Montana, Washington, and others) • AHEC supported residency rural tracks • Other AHEC programs – ex. SCRIPT • Quentin N. Burdick Rural Program for Interdisciplinary Training – multiple programs

23. More programs… • RMED Program in Rockford UIC-R • Multiple projects in rural Illinois counties • Partnerships between community agencies, leaders, UIC, and M4 students • Projects include: exercise programs for older adults, diabetes management in public schools, barriers to diabetes care, screening programs for osteoporosis, and others

24. Serendipitous Exposures • Students who without intention are exposed to rural locations • Students who are involved in the care of farmers or farm workers transferred to tertiary centers post injury, post exposure, or as a result of required treatment for chronic diseases

25. Continuing Education Programs • Focused programs • UW Partners in Agricultural Health 12 contact hours of programming including 10 courses developed by an interdisciplinary group. Participants can enroll for each of the courses or the entire program • Agricultural Safety and Health topics • NIOSH training topics • Other training (Farmedic, hazmat, etc.)

26. Current Limitations of Review • The extent of the agricultural safety and health/injury prevention content remains unclear • Evaluation of agricultural safety and health/injury prevention content is also unclear • The relationship between adequately prepared health care providers and farmer health and safety is also unclear

27. Barriers to Change • Traditional silo education • Complex systems • Professional conflict and competition • Resources • Personnel – lack of available faculty • Funding • Integration of curriculum and interdisciplinary focus is labor & time intensive

28. Take Home Points • There is a need for the development of integrated rural training programs with agricultural safety and health curricula • Opportunities exist for further integration of existing programs • Interdisciplinary training could be strengthened • Program development/modification should be research driven • The use of the Internet could be increased

29. Finally… • Educational needs are present at ALL health care provider levels • There are common themes in agricultural safety and health with regional differences • Would a common “core curriculum” be of value? • Where do we go from here?