Geriatrics in primary care, the Dutch way: eductional programs for (nursing home and family) physicians

Transcription

1 Geriatrics in primary care, the Dutch way: eductional programs for (nursing home and family) Achterberg Elderly care physician (ECP) Professor of elderly care medicine DEP. OF PRIMARY CARE AND PUBLIC HEALTH LEIDEN UNIVERSITY MEDICAL CENTER

2 WE HAVE CHALLENGES! 2

3 Challenges Bron: HED & CBS (Bevolkingsstatistiek & Bevolkingsprognose 2010) 3

4 Dutch demographics and Long term care. 17 million/ 3.08 million (18%) > 65 Majority live at home lin nursing homes/ RCF (4,9%) Nursing home stay paid by long term care Expenses Act (WLZ), and health insurance (geriatric rehabilitation) Nursing staff, mainly Assistent Certified Nurses Nursing Home Physician (1 : 100) PT, OT and speech therapists (1 : 35) Dieticians Psychologists Social and recreational workers 4

5 The challenges of long term care 5

6 EUGMS Nice

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8 We took the challenge! 8

9 Medical care for the elderly Primary care physician (GP/family physician) Clinical geriatrician/int. med elderly Social geriatrician Nursing home physician Old age Psychiatry Elderly care physician 9

10 Elderly care medicine and Training program 10

11 Nursing Home Medicine 1989: official recognition as medical specialism, start of first official training program problem-oriented medical care for chronically ill and elderly people suffering from chronic and intercurrent diseases and physical, cognitive and psychosocial problems who needs continuous, often long-term and multidisciplinary care 11

12 The physician monitors the patient and evaluates treatment in collaboration with a multidisciplinary team that he/she is the coordinator of. [ ] 12

13 Collaborating with innovators implementing innovative care initiatives Evaluating/ Studying (research), are integral to the core business. 13

14 The elderly care physician s field of activity Specialist in long-term care for frail elderly 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 14

15 Fields of nursing home medicine Physically disabled patients Psychogeriatrics Rehabilitation Palliative care Special groups (Huntington, Korsakov, ) 15

16 Specialist Training program 3 years training progam Integration Practice and Theory Competency (CANMEDs) and Entrustable Professional Activities based 16

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18 Structure (theoretical part) 1 day per week at the University Hospital ( days in 3 years) Home study groups with 12 trainees 2 staff members (NHPh and Psychologist) starting with an ``experience review round`` two teaching topics each day Regular assessments Tutor groups: inquiry-based learning 18

19 Main Teaching Topics 1. Acute care 2. Geriatric giants 3. Rehabilitation 4. Psychogeriatrics 5. Chronic diseases 6. Palliative care 7. Methodology of care 8. Communication skills 9. Multidisciplinary collaboration 10. Ethics and legislation 11. Professional attitude 12. Management 13. Outpatient care 14. Research 19

20 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

21 And how about the rest? - Training program elderly care 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 21

22 All other specialists Comprehensive elderly care in all medical specialism trainings 22

23 10 largest medical specialists Fields Number of specialists General practice 10,500 Psychiatry 2,600 Occupational medicine 2,100 Internal medicine 1,850 Elderly care medicine 1,500 Anaesthesiology 1,400 Paediatrics 1,300 Surgery 1,150 Obstetrics/Gynaecology 950 Radiology 950 Source: Royal Dutch Medical Association

24 Lower referral rate to hospital (1) Overall discharge percentage from nursing home into hospital: 3 % (USA / Canada: 110 %), Norway: 58% (16%-149%) 24

25 Lower referral rate to hospital (2) Mild to moderate Severe dementia dementia US NL US NL (n=421) (n=223) (n=280) (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: ,

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28 Thank you 28