Health Care Health Care to to Serve Adults with Serve Adults with Developmental Developmental Disabilities Disabilities CPHA 2008 Annual Conference CPHA 2008 Annual Conference Halifax, N.S. Halifax, N.S. Brian Hennen, MD MA CCFP FCFP FRCGP Brian Hennen, MD MA CCFP FCFP FRCGP Professor of Family Medicine, Dalhousie Professor of Family Medicine, Dalhousie University University
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Learning Primary Health Care to Serve Adults with Developmental Disabilities Learning Primary Health Care to Serve Adults with Developmental Disabilities.
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Learning Primary Health Learning Primary Health Care Care to Serve Adults to Serve Adults with with Developmental Developmental DisabilitiesDisabilities
Brian Hennen, MD MA CCFP FCFP FRCGPBrian Hennen, MD MA CCFP FCFP FRCGP
Professor of Family Medicine, Dalhousie University Professor of Family Medicine, Dalhousie University
BackgroundBackground
• Ontario committed to closing last three large Ontario committed to closing last three large remaining institutions serving as residences remaining institutions serving as residences for persons with Developmental Disabilitiesfor persons with Developmental Disabilities
• Significant advocate support but also Significant advocate support but also pushback from many present residents & pushback from many present residents & their families as well as stafftheir families as well as staff
• Ministries of Community and Social Services Ministries of Community and Social Services and Health and Long Term Planning wish to and Health and Long Term Planning wish to ensure smooth deinstitutionalization processensure smooth deinstitutionalization process
Background (cont’d)Background (cont’d)
• Concerned practitioners, administrators Concerned practitioners, administrators and academics aware of the need to and academics aware of the need to support primary care providers to whom support primary care providers to whom the residents will be transferredthe residents will be transferred
• See opportunity to improve primary care See opportunity to improve primary care to all persons with Developmental to all persons with Developmental DisabilitiesDisabilities
• See opportunity to strengthen health See opportunity to strengthen health professional education programs in professional education programs in Developmental DisabilitiesDevelopmental Disabilities
Steering CommitteeSteering Committee
William Sullivan (chair), Elspeth William Sullivan (chair), Elspeth Bradley, Tom Cheetham, Richard Bradley, Tom Cheetham, Richard Denton, Greg Gillis, Maria Gitta, John Denton, Greg Gillis, Maria Gitta, John Heng, Brian Hennen, Barry Isaacs, Jo-Heng, Brian Hennen, Barry Isaacs, Jo-Anne Jackson-Thorne, Marika Anne Jackson-Thorne, Marika Korossy, Yona Lunsky, Shirley Korossy, Yona Lunsky, Shirley McMillan, Leeping Tao.McMillan, Leeping Tao.
Steps ForwardSteps Forward
• Acquire financial support for programAcquire financial support for program
• Plan Colloquium of Involved Disciplinary Plan Colloquium of Involved Disciplinary Experts to Develop Clinical Practice Guidelines Experts to Develop Clinical Practice Guidelines (CPG’s) and Practice Tools (lit searches, (CPG’s) and Practice Tools (lit searches, position papers, discussion, consensus)position papers, discussion, consensus)
• Consult Experts on Guideline DevelopmentConsult Experts on Guideline Development
• Publish CPG’s in Peer-reviewed JournalPublish CPG’s in Peer-reviewed Journal
Steps Forward (cont’d)Steps Forward (cont’d)
• Develop Training Program ProposalDevelop Training Program Proposal
• CFPC (Mainpro-C), RCPSC study creditsCFPC (Mainpro-C), RCPSC study credits
• Fund and implement Training ProgramFund and implement Training Program
• Evaluate Training ProgramEvaluate Training Program
Goal & ObjectivesGoal & Objectives
• To teach primary health care providers To teach primary health care providers the Clinical Practice Guidelines:the Clinical Practice Guidelines:
– 1. promote facility in the use of the CPG’s1. promote facility in the use of the CPG’s
– 2. identify/address barriers to using them2. identify/address barriers to using them
(i)(i) apply new learning in caring for Adults apply new learning in caring for Adults with DD:with DD:
. general issues in primary care (1-7). general issues in primary care (1-7) . physical health (8-17). physical health (8-17) .behavioral/mental health (18-24).behavioral/mental health (18-24)
- Service Systems assessment- Service Systems assessment
- Focus on gaps (resources, transitions, - Focus on gaps (resources, transitions, silos)silos)
Learning Program & Learning Program & MethodsMethods• Reading/discussing CPG’s in workshop in Reading/discussing CPG’s in workshop in
inter-professional small groups (all)inter-professional small groups (all)
• Case presentations (4) staged on websiteCase presentations (4) staged on website
• Regional group, web case discussion (chat Regional group, web case discussion (chat rooms) by individuals, home-based inputrooms) by individuals, home-based input
• Regional teleconference, home-Regional teleconference, home-based, facilitated discussion, ending based, facilitated discussion, ending in group-developed management in group-developed management plan for each caseplan for each case
• Final workshop (all) Final workshop (all) comparing/discussing management comparing/discussing management plans and evaluating programplans and evaluating program
Four Cases (modules)Four Cases (modules)
• 55 yr f with severe DD, cerebral palsy, and no 55 yr f with severe DD, cerebral palsy, and no genetic diagnosisgenetic diagnosis
• 46 yr m with moderate DD and Down Syndrome46 yr m with moderate DD and Down Syndrome
• 18 mo f suspected of DD, returns at 19 yrs with 18 mo f suspected of DD, returns at 19 yrs with mild DD, sleep disturbance & behaviour problemmild DD, sleep disturbance & behaviour problem
• 18 yr f with mild DD, severe behaviour problems 18 yr f with mild DD, severe behaviour problems and no genetic diagnosisand no genetic diagnosis
Module ParticipantModule Participant
• ““This videoconference is helping me This videoconference is helping me bring things together in my practice. bring things together in my practice. It is helping me to know where to It is helping me to know where to focus my attention. The tools focus my attention. The tools presented have been especially presented have been especially helpful. It has also been able to give helpful. It has also been able to give me information and knowledge that I me information and knowledge that I was not necessarily aware of.” was not necessarily aware of.”
Increasing knowledge, networking with Increasing knowledge, networking with other disciplines, definition discrepancies, other disciplines, definition discrepancies, access to services (Dual Diagnosis, access to services (Dual Diagnosis, Psychological Assessment, Genetics), Psychological Assessment, Genetics), insufficient time and material resources, insufficient time and material resources, support for caregivers in crisis situations, support for caregivers in crisis situations, legal issues of education/care from legal issues of education/care from adolescence to adulthoodadolescence to adulthood
Program Evaluation (cont’d)Program Evaluation (cont’d)
• Recommendations for Improving Recommendations for Improving Program:Program:
– Allow more than 2 wks per module (7)Allow more than 2 wks per module (7)– Send all modules at beginning (2)Send all modules at beginning (2)– Direct guidelines more to OHP’sDirect guidelines more to OHP’s– Periodic updating of CPG’sPeriodic updating of CPG’s– More interactive (I order test & get results)More interactive (I order test & get results)– Raise visibility of programRaise visibility of program
Program Evaluation (cont’d)Program Evaluation (cont’d)
• What tools will be most helpful in practice?What tools will be most helpful in practice?
Comprehensive Health Assessment Program Comprehensive Health Assessment Program (CHAP) (4)(CHAP) (4)
Crisis plan (4)Crisis plan (4)
Periodic Health Assessments (3)Periodic Health Assessments (3)
Checklist for Autism in Toddlers (CHAT) (2)Checklist for Autism in Toddlers (CHAT) (2)
Program Evaluation (cont’d)Program Evaluation (cont’d)
• What attracted your participation?What attracted your participation?
To improve my care to persons with DD To improve my care to persons with DD (6)(6)
To increase my knowledge about DD (6)To increase my knowledge about DD (6)
An interest and wish to be supportive (2)An interest and wish to be supportive (2)
Program Attraction (cont’d)Program Attraction (cont’d)
“ “It was pertinent to my job and brought together the It was pertinent to my job and brought together the health care needs of people with DD without health care needs of people with DD without having to do extensive research on my own”, having to do extensive research on my own”, …….“boss encouraged me”, …….“boss encouraged me”,
an opportunity for well-researched clinical an opportunity for well-researched clinical approaches andapproaches and to meet other professionals in the to meet other professionals in the field,field,
Program Evaluation (cont’d)Program Evaluation (cont’d)
• 96 % of 22 would be interested in 96 % of 22 would be interested in similar courses in the futuresimilar courses in the future
• 96% of 22 would be interested in 96% of 22 would be interested in participating in a provincial network participating in a provincial network
Case DevelopmentCase Development
• Real cases, modifiedReal cases, modified
• Purposefully selected cases:Purposefully selected cases:– Wide range of topicsWide range of topics– Mixed age, sex, diagnosisMixed age, sex, diagnosis– Overall use of guidelines and toolsOverall use of guidelines and tools
• Suitable for range of primary care Suitable for range of primary care providersproviders
A Case Module Consisted of:A Case Module Consisted of:
• Case description (sequenced sections)Case description (sequenced sections)
• Last group discussion mgt. planLast group discussion mgt. plan
• Final all groups mtg. Final all groups mtg. share/discuss/evaluate mgt plans & course share/discuss/evaluate mgt plans & course
Module Evaluations (Example Module Evaluations (Example Module for case 1)Module for case 1)
• Content:Content:– Met stated objectives 4.33Met stated objectives 4.33– Relevant to my practice 4.42Relevant to my practice 4.42– Tools were useful 4.50Tools were useful 4.50
– Overall 4.55Overall 4.55
Module Evaluation (Example Module Evaluation (Example Module for Case 1)Module for Case 1)
Process of DiscussionProcess of Discussion– Time adequate Time adequate 3.82 3.82– Clear presentation, well–timed 3.64Clear presentation, well–timed 3.64– Discussion Board Interactions helped 4.27Discussion Board Interactions helped 4.27– Moderator kept discussion moving andModerator kept discussion moving and timed questions well 4.27timed questions well 4.27– Participants shared in the discussion 4.27Participants shared in the discussion 4.27
Module Evaluation (Example Module Evaluation (Example module for case 1)module for case 1)
• Website and Videoconferencing:Website and Videoconferencing:– Easy to access website 4.08Easy to access website 4.08– Tech instructions/supports helpful 4.36Tech instructions/supports helpful 4.36– Able to access areas of website 4.25Able to access areas of website 4.25– Able to post comments on website 4.17Able to post comments on website 4.17– Video/conf mtg helped in mgt plan 4.45Video/conf mtg helped in mgt plan 4.45
Module Evaluation (Example Module Evaluation (Example Using module with case 1)Using module with case 1)
• Most important thing learned:Most important thing learned:– Getting relationship with patient and caregiverGetting relationship with patient and caregiver– CHAP, periodic health exam, preventive check CHAP, periodic health exam, preventive check
list, management planlist, management plan– GERD managementGERD management– Using the internet for a courseUsing the internet for a course– Specific guidelinesSpecific guidelines– I’ll look more closely at the physical aspectsI’ll look more closely at the physical aspects– Issues of consent Issues of consent
Module Evaluation (Example of Module Evaluation (Example of module for case 1)module for case 1)
One change in learning process to improve it for One change in learning process to improve it for you:you:
-more info at beginning re: web medium-more info at beginning re: web medium
-more time for 1-more time for 1stst case, getting used to web case, getting used to web
-one question not clear -one question not clear
-more interaction on the discussion -more interaction on the discussion
-need to make the time (spent 20 mins/day) -need to make the time (spent 20 mins/day)