1. 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

2. 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.”

3. 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)

4. 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).

5. Current CME Programs on HIV/AIDS Linear, text-based presentation Live lectures Online offerings - mostly linear, few interactive opportunities

6. 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

7. 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. 1999;282:867-874. -

8. 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

9. 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

10. Utilize Adult Learning Principles Self-directed learning events Use of multiple stimuli Relevant/practical information Problem-based experiences Transference of learning to real life

11. Help Physicians Realize Deficiencies Needs assessment Compare responses to peers (online CME has unique advantage)

12. 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

13. 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

14. Waiting Room

15. 62-year old retired chiropractor Bill Watson complains of fatigue, sleeplessness, weight loss

16. Conference Room

17. 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

18. Library

19. 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

20. Virtual Clinic/map

21. 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

22. More Information HealthCare Education Associates – www.hceassoc.com www.hceassoc.com – RStromb@cs.com RStromb@cs.com

23. Program Available in Fall 2004 The Virtual Lecture Hall www.vlh.com