BGS Autumn Innovation and emerging practice in Elderly Care Medicine in the Achterberg. Elderly care physician (ECP)

Transcription

1 Elderly care physician (ECP) Innovation and emerging practice in Elderly Care Medicine in the Achterberg Professor of elderly care medicine DEP. OF PRIMARY CARE AND PUBLIC HEALTH LEIDEN UNIVERSITY MEDICAL CENTER

2 Nursing Home Medicine 1989: official recognition as medical specialism, start of first official training program problem-oriented medical care for chronically ill and older people suffering from chronic and intercurrent diseases and physical, cognitive and psychosocial problems who need continuous, often long-term and multidisciplinary care

3 The nursing home physician s field of activity Specialist in long-term care for frail older people* But some young people too Comprehensive proactive integrated multidisciplinary medical care To maintain and improve the quality of life Experts in the field of geriatric rehabilitation, psychogeriatrics, end-of-life care Complex medical care independent of the patients location Inside nursing homes Outside nursing homes Consulting hours in the GP centre, outreach clinic, etc Hospice care, old age psychiatry, etc * Verenso, Elderly care physicians in the Netherlands professional profile and competencies

4 Fields of nursing home medicine Physically disabled patients Psychogeriatrics Rehabilitation Palliative care Special groups (Huntington, Korsakov, )

5 10 largest medical specialists Number of specialists General practice 10,500 Psychiatry 2,600 Occupational medicine 2,100 Internal medicine 1,850 Nursing home medicine 1,500 Anaesthesiology 1,400 Paediatrics 1,300 Surgery 1,150 Obstetrics/Gynaecology 950 Radiology 950 Source: Royal Dutch Medical Association 2010

6 Specialist Training program 3 years training progam Integration Practice and Theory Competency (CANMEDs) and Entrustable Professional Activities based

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8 Structure (theoretical part) 1 day per week at the University Hospital ( days in 3 years) groups with 12 trainees 2 staff members (NHP and Psychologist) start ``experience review round`` two teaching topics each day Regular assessments (formative & summative) Tutor groups: inquiry-based learning

9 Main Teaching Topics 1. Acute care 2. Geriatric giants 3. Rehabilitation 4. Psychogeriatrics 5. Chronic diseases 12. Management 6. Palliative care 7. Methodology of care 8. Communication skills 9. Multidisciplinary collaboration 10. Ethics and legislation 11. Professional attitude 13. Outpatient care 14. Research

10 The trainees Characteristics:* Intrinsic motivation for a career in geriatric medicine Wants to contribute to quality of life of elderly people Empathic Energetic Analytical/ problem solving skills Communicative Initiative Self-conscious Selection: motivation and experience * Vision : elderly care physician training, (opleiden tot Specialist Ouderengeneeskunde Visie en uitgangspunten) 22 mei 2013

11 And how about the rest? - Training program nursing home physicians for consultations at home - Training program for family physicians in Elderly Care (at LUMC: 1,5 years, 6/hours a week) Personal development Medical and scientific skills Communication, consultation and teaching skills Organisations of care

12 All other specialists Comprehensive elderly care in all medical specialism trainings

13 Lower referral rate to hospital Mild to moderate Severe dementia dementia US (n=421) NL (n=223) US (n=280) NL (n=328) Hospital transfer 29 % 1 % 22 % 0.3 % within 30 days after diagnosis Intensive care unit 2 % 0 % 4 % 0 % Antibiotics 84 % 89 % 76 % 67 % Oxygen 10 % 12 % 12 % 15 % Treatment of Nursing Home Residents with Dementia and Lower Respiratory Tract Infection in the United States and the Netherlands: An Ocean Apart J Am Geriatr Soc 52: , 2004

14 Innovation and research are integral part! Based in Academic hospitals Teaching bachelor & master students medicine Teaching nursing home physicians Research programs, PhD trajectories Research together with primary care and hospital specialists, psychologists, physical therapists etc University network of nursing homes Focus Leiden: -Geriatric rehabilitation (7 PhD students) -Quality of life/pain in dementia (6 PhD students)

15 Two problems, one solution: academic nursing homes University has no patients Nursing homes do not have research expertise

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17 Leiden Zoetermeer Rotterdam

18 active cooperation between university and nursing homes, with the aim to: Our mission -Improve the care for the most vulnerable -By stimulating research & knowledge transfer in care homes -And improve research & innovation climate in care homes3

19 Goals 1. Initiate, facilitate and perform relevant research, based on problems & questions that arise from daily practice 2. By working together in research: Improve quality of life of care dependent residents Improve quality of care 3. Transmission of knowledge and expertise within network partners

20 Organisation Local Research comittee Developing and assist in policy nursing home Review of research projects Initiate research Facilitate research

21 Supporting NH researchers -Access to journals/library - Methodological assistance -Assistance in getting results published - Data gathering/management assistance - Courses on research skills - Connect NH-staff that do research - Get best research ideas into practice

22 Theme days, symposia and knowledge cafe s Education

23 BG S Au tu m n Networking & knowledge transfer

24 Other Dutch academic nursing home networks Norwegian nursing home network Cooperation

25 Nordisk tidsskrift for Palliativ Medisin

26 What we can achieve long term care facilities can position themselves stronger research money more easily finds it's way to LTC research becomes more practical research-themes are created 'bottom-up influence funding organisations to make a LTC'-research agenda We can care better, cheaper, with more engagement... And more FUN...!!!!

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28 Contact (secretary)

29 Thank you