Emerging Challenges in Primary Care: 2015

Transcription

1 Emerging Challenges In Primary Care: Activity Summary CME Activity: Saturday, May 2, Hilton Miami Airport Miami, FL Course Director: Gregg Sherman, MD Date of Summary: August 4, 300 NW 70th Avenue Plantation, Florida (954) Phone (954) Fax

2 In May, the National Association for Continuing Education (NACE) sponsored a CME program,, in Miami, FL. This educational activity was designed to provide primary care physicians, nurse practitioners, physician assistants and other primary care providers the opportunity to learn about varied conditions such as Heart Failure, Hypercholesterolemia, Hepatitis C and B, and Prostate Cancer. In planning this CME activity, the NACE performed a needs assessment. A literature search was conducted, national guidelines were reviewed, survey data was analyzed, and experts in each therapeutic area were consulted to determine gaps in practitioner knowledge, competence or performance. Two hundred forty seven healthcare practitioners registered to attend Emerging Challenges in Primary Care: in Miami, FL. One hundred forty eight healthcare practitioners actually attended this conference. Each attendee was asked to complete and return an activity evaluation form prior to the end of the conference. One hundred forty five completed forms were received. The data collected is displayed in this report. CME ACCREDITATION The University of Miami Leonard M. Miller School of Medicine is accredited by the Accreditation Council (ACCME) for Continuing Medical Education to provide continuing medical education for physicians. The University of Miami Leonard M. Miller School of Medicine designates this live activity for a maximum of 4.75 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The Association of Black Cardiologists, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Association of Black Cardiologists, Inc. designates this live activity for a maximum of 2.25 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

3 What is your professional degree? Integrated Item Analysis Report What is your specialty? Frequency Percent Mean: - Frequency Percent Mean: 2.29 MD Primary Care DO Endocrinology NP Rheumatology PA Pulmonology RN Cardiology Other Gastroenterolog y Other No No Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Heart Failure: Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Hypercholesterolemia: Frequency Percent Mean: 2.71 Frequency Percent Mean: 4.62 None None > > No No Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Chronic Hepatitis C: Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Chronic Hepatitis B: Frequency Percent Mean: 2.07 Frequency Percent Mean: 1.92 None None > > No No

4 Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Prostate Cancer: Upon completion of this activity, I can now: Discuss the epidemiology of heart failure; describe pathophysiologic factors contributing to increased risk of heart failure; utilize the most recent clinical evidence to inform their decisions for the management of heart failure; and identify approaches to facilitate early recognition and optimization of heart failure management. Frequency Percent Mean: 2.25 Frequency Percent Mean: 1.08 None Yes Somewhat Not at all > No No Upon completion of this activity, I can now: Identify concepts of residual cardiovascular risk despite statin therapy; review the role of genetics in statin efficacy; understand identification of minority populations that would benefit from lipid lowering therapy; and discuss the role of novel therapies to lower LDL and treat other lipid disorders. Upon completion of this activity, I can now: Identify patients at risk for hepatitis C and explain the approach to screening and confirmation of the diagnosis in these patients; discuss guidelines for the overall medical management of patients with hepatitis C; discuss patient and viral factors that determine the appropriate drug treatment for patients with chronic HC infection; and distinguish patients who may be treated in the primary care setting from those who require specialty referral. Frequency Percent Mean: 1.06 Frequency Percent Mean: 1.07 Yes Yes Somewhat Somewhat Not at all Not at all No No Upon completion of this activity, I can now: Identify patients who should be screened for chronic hepatitis B and discuss appropriate testing for those patients; apply evidence-based strategies for the overall medical management of patients with chronic hepatitis B; determine which patients require medication for chronic hepatitis B and which should be monitored clinically; and discuss the medications available for treating chronic hepatitis B and associated resistance issues. Upon completion of this activity, I can now: Recognize the prevalence, risk factors and impact of prostate cancer; compare the USPSTF and American Urological Association (AUA) guidelines for prostate cancer screening; understand the process of shared decision making in prostate evaluations; and define the role of the primary care provider in treating prostate cancer patients with localized disease and metastatic disease. Frequency Percent Mean: 1.06 Frequency Percent Mean: 1.09 Yes Yes Somewhat Somewhat Not at all Not at all No No

5 Overall, this was an excellent CME activity: Overall, this activity was effective in improving my knowledge in the content areas presented: Frequency Percent Mean: 1.11 Frequency Percent Mean: 1.17 Strongly Agree Strongly Agree Agree Agree Neutral Neutral Disagree Disagree Strongly Strongly Disagree Disagree No No As a result of this activity, I have learned new and useful strategies for patient care: How likely are you to implement these new strategies in your practice? Frequency Percent Mean: 1.22 Frequency Percent Mean: 1.30 Strongly Agree Very likely Agree Somewhat likely Neutral Unlikely Disagree Not applicable Strongly Disagree No No As a result of this activity, I have learned new strategies for patient care. List these strategies: How to treat increased LPL effectively. When to and who to screen for HBV/HCV Options for reaching goals of cholesterol to decrease CHD Re-challenge statin-intolerant patients. Use HVD and ISON in AA patients with HFvEF. Testing for HCV adults born between Better management of cholesterol. Treatment of chronic Hep B. New treatments for Hep C. Management of Prostate Cancer Implement comprehensive treatment regimen for patients with heart failure. Screen, identify, and treat high risk patients who present drem/statin therapy. Screen more patients for Hep C and B Integrate nitrates/hydralazene in care of African American patients with NHHA 3-4 CHF initiate routine HCV testing in appropriate birth cohorts Better optimization of Ikal failure medications. Appropriate utilization of antinyzilinitonic medications. Better screening and treatment of Hep B. Better management of Hep C. Better consideration in PSA screening on my patients. Better understanding prostate cancer treatment Treat Hf by ABCD classifications. Screen for HepC patients born between Implement followup testing for men with PSA >1.5 Better screening for HepC and B. Statin therapy in patients at risk To improve the knowledge in my practice Combination therapist and who benefits most. New meds coming out. Education on lifestyle modification needs to be stressed on each visit Use of Mydralarine and Idonobide. Diagnosis and management of Hep B and C Better understanding of CHF and treatment. New concept of Dyslipidemia, concep and treatment. Mono use antibody. New medications for treatment of Hep B and C I will treat more cases prior to referring to a specialist More accurate testing (lab) Approaches to treatment of HFrEF and HFpEF. New meds for statin-resistant increase LDL-C. No need for liver bx in many HBV cases. Treat all HCV per Dr. Schiff. Some clarity on all or none in PSA testing

6 As a result of this activity, I have learned new strategies for patient care. List these strategies: Increase use of ISAN/Hydremia in CHF. How to treat statin resistant patients. Incorporate AUA guidelines for prostate cancer screening Identify potential patients. Early prevention and diagnosis. Correct diagnosis and management Better options and comprehension for treatment plans. Evidence based practice information for more effective therapy. Options of new available meds can start to use in my practice HTN management in CHF. Screening on Hepatitis B and C. Share decision process - more info to patient Use of new information for heart failure. Optimal medication regimen for heart failure. Screen for Hep B and C Use the 10 year calculator risk. Reevaluate treatment of CHF in my AA patients who are going to start chemotherapy. Screen for Hep B. Follow up with use of antibiotics - possible Hep B patients Diagnostics tests. Treatments Learned how to treat patients with heart failure. Learned how to screen patients for chronic Hepatitis and Prostate Cancer. Learned new treatments available for HF, Hep B, C Diagnostic approaches for Hepatitis screening and heart failure Use combination of HYD and ISDN more frequently in CHF in African American patients. of IVABRADing for SHF in the future. I will be more aggressive in treatment of Hypercholesterolemia - no under PSA as routine only patient with sistain of prostatism Improve knowledge about treating HepB. Best strategies for treating HC Early diagnosis. Early treatment. Motivation of medical personnel. Education of the patient More proactive in screening patients with HepB/C. Consider other meds for HF Better management of HF in African Americans. Better management of Hypercholesterolemia, High LDL-C. Better management of HF I reviewed the different stages of HF and what treatment to use depending on the type and obese of HF. Who to screen, when and how per Hep B and C Identify disorder. Implement Rx. Monitor response Care of Hepatitis C by genotype I would consider the use of new drugs on patients with high LDL resistant to status, especially in lipid/cardiovascular disease Better screening of patients for Hepatitis - especially immigrants. More aggressive treatment of dyslipidemia Better treatment of CHF. Testing pre-chemo for HepB. Options for patients with prostate cancer Control HBP (first concern). Addition of beta blockers to classic treatment Treatment refinement. Monitoring changes Updates in prostate cancer. New drugs in treatment of high cholesterol. Hep B, C updates and HF treatment Screening for HCV and meds for treatment. LDL role in cholesterol treatment. PSA and role in screening No strategies, just more knowledge Utilize the most recent clinical evidence for management of heart failure. Review genetics in statin efficacy to lower LDL. Current treatment guidelines. Determine which patient may be treated in primary care or referral specialty Screening tools Hep changes. Screening patient CAF stage A-B Treatment options for Hep B and Hep C More aggressive with treatment of stage A and B HFrEA. More aggressive with use of med-high potency statins. More aggressive with screening in Hep C. Make better decisions for follow up of high PSA Modalities of treatment. Different or better approvals to disease treatment. Better understanding of treating my patient Manage patients better New ways for DA and therapy Do more PSAs New treatment plans for patients with CHF, new treatment (meds) in patients with persistent high LDL levels due to familial hypercholesterolemia. Screening for prostate cancer, how to properly diagnose Hepatitis B and C Recognize patient that should be screened for Hep B and C. Who should be treated and who not. Reduction CV risk, looking at LDL-C level

7 As a result of this activity, I have learned new strategies for patient care. List these strategies: Get family history with HB patients. Check PA PCSK9 mutation New and upcoming therapy, screening guidelines ADT new medications, side effects and treatment. Not all HBV should be treated. No limit to decrease the LDL cholesterol. Lower it is better Recognizing patients with risk factors. Patients that should be tested Consider the use of PSK9 drugs when applicable. Educate patients about the possibility of new drugs to eradicate HB infection Guidelines to begin different therapies. Alternative treatments discussed Shared decision making to order a P/A. New strategies to treat Hep C. Prostate cancer decision making and screening and treatment Treatment for Hep B and C will increase. Better screening, particularly those born Most of my patients with Hepatitis I refer, but I will begin to start treatment myself Combination of meds LFTG are not needed for follow up (only baseline) unless patient is symptomatic for statin therapy. In patients with HepB you do not have to do new biopsy unless there is comorbidity (ie NASH, etc.) Add AAB/ADLES to CHF management receiving especially in AA patients Management and treatment Understanding drugs used in HepC Test patients born between for HCV Better treatment options to help my patients. New drugs learned to help reduce mortality in HF. Now have the tools to diagnose and treat Hep B and C. When to refer out patient with PSA levels above 1.5 New approach to management Use of combination Isosorbide Dinit and Hydralazine in patient with HFvEF. Vaccinate against HepB newborn from Endemic (immigrant) counting mother. To consider a person is intolerant to statins. We need to try at least 2 statins at once Increase testing/screening for HBV more aggressively. Will discuss PSA screening in more detail with patients Appropriate screening HepB/C. Early recognition of medreal conditions, CHF, CAD, leads to optimization, control, management Required screening. Treatment algorithms HF classification based treatment. Hyperlipidemia treatment. HBV-HCV diagnosis and treatment/moment to refer New rules in the treatment of Hypercholesterolemia. Recognize how to treat Hepatitis B and C New approaches to CHF. New drugs available. Updates in all these topics Confident to make decisions about treatment. Evidence-based approach/diagnosis Treatment of HTN with high cholesterol Better approach to diagnosing, treating, and follow up Use isosorbide hydralazine for HFREF patients. No longer any numbers for LDL treatment, treat with statin for CVD, stroke, TIA, DM years old with Hepatitis B or C evaluate for cirrhosis with Fibroscan. Most common Hep C genotype is 1 and that is treated with Harbona New drugs therapies Will change the way I treat patients with CHF and Hyperlipidemia. Which population to screen for Hepatitis B and C. Also will improve my screening strategies and treatment of prostate cancer Drugs in heart failure. Very useful Hepatitis drugs and tab test very interesting In order to diagnose and treat each disorder. Improve the quality of life of patients Better understanding and management of CHF (especially black patients). Lipids, Hep B and C, Prostate Cancer

8 When do you intend to implement these new strategies into your practice? In terms of delivery of the presentation, please rate the effectiveness of the speaker: Jan Basile, MD - Heart Failure: Frequency Percent Mean: 1.48 Frequency Percent Mean: 4.92 Within 1 month Excellent months Very Good months Good Not applicable Fair Unsatisfactory No No In terms of delivery of the presentation, please rate the effectiveness of the speaker: Jan Basile, MD - Hypercholesterolemia: In terms of delivery of the presentation, please rate the effectiveness of the speaker: Eugene R. Schiff, MD - HCV: Frequency Percent Mean: 4.94 Frequency Percent Mean: 4.89 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No In terms of delivery of the presentation, please rate the effectiveness of the speaker: Eugene R. Schiff, MD - HBV: In terms of delivery of the presentation, please rate the effectiveness of the speaker: M. Rosenberg, MD - Prostate Cancer: Frequency Percent Mean: 4.90 Frequency Percent Mean: 4.90 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No In terms of delivery of the presentation, please rate the effectiveness of the speaker: E. David Crawford - Prostate Cancer: To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Jan Basile, MD - Heart Failure: Frequency Percent Mean: 4.86 Frequency Percent Mean: 4.94 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No

9 To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Jan Basile, MD - Hypercholesterolemia: To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Eugene R. Schiff, MD - HCV: Frequency Percent Mean: 4.94 Frequency Percent Mean: 4.90 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Eugene R. Schiff, MD - HBV: To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? M. Rosenberg, MD - Prostate Cancer: Frequency Percent Mean: 4.91 Frequency Percent Mean: 4.91 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? E. David Crawford, MD - Prostate Cancer: Which statement(s) best reflects your reasons for participating in this activity: Frequency Percent Mean: 4.89 Frequency Percent Mean: - Excellent Topics covered Very Good Location/ease of access Good Faculty Fair Earn CME credits Unsatisfactory No No Future CME activities concerning this subject matter are necessary: Frequency Percent Strongly agree Agree Neutral Disagree Strongly Disagree No Mean: 1.48 What topics would you like to see offered as CME activities in the future? Uncontrolled DM. NASH management. Correct to start Hep B Rx in pregnancy at third trimester on WK28, not WK32 CKD. DM. Genetically modified organisms and health Diabetes Mellitus insulin management. Antibiotics in Palliative Care. Dermatologic diseases in PC

10 What topics would you like to see offered as CME activities in the future? Management of diabetes Myelodys plastic diseases, CKD Anything related to Primary Care Diabetes, Hypertension, movement disorder, cancer screening Diabetes, HTN, Hypogonadism The new anticoagulants/new retint in Hyperkalemia treatment Preventative medicine STD and GI Diabetes therapies. Insulin therapy and insulin pump. Gyn topics, especially post menopausal. Obesity and nutrition. GMO/organics/non-GMO Nephrotic syndrome. Breast cancer. Memory disease. Depression All issues in Primary Care Diabetes Mellitus 2 management. Alzheimer's Disease management. PVD. Insomnia. MDD geriatric patients. COPD management Diagnostic codes, diagnoses and treatment of ADHD and Autism. Advances of vaccines, orthopedic problems New therapies on same diseases. Molecular med. Antibody Rx for cancer General discussion on screening in practice (preventative) COPD. DM Diabetes management/endocrine disorders. Asthma/COPD management. HIV DM. Asthma Diabetes MGUS CAD Autoimmune diseases DM treatment Radiation/Oncology - IMRT, chemotherapy, sleep medicine, Rheumatology, liver transplant Updates in NACE guidelines Breast cancer - lung cancer - gray cancer HIV/STD Any in medicine Asthma/Anaphylaxis/vasculating obesity/metabothesynd Renal failure. Hyponatremia. Diabetes Obesity, HTN, anxiety disorder Pain management. Updates in Psychiatry. Updates in Neurology Genetic testing in Primary Care Acute stroke Hypercoagulopathy state. Anti-coagulation guidelines Dermatology. IBS Diabetes. Immune Dx. Blood disorders New updates in treatment of DM, Derm Sleep apnea All vaccination current guidelines Common skin rash Psoriasis. Managing overweight Today - genetics studies - preventive medicine, BRCA, BACA2, etc. Diabetes, stroke, genetic

11 What topics would you like to see offered as CME activities in the future? HIV management. COPD/Asthma management Same topics as well as diabetes type 2 Medical (new) diagnostic procedures and tests advancements Type II DM, GERD, autoimmune disorders, osteoporosis Gyn topics Diabetes. Stroke. A Fib Atrial fibrillation. Testosterone therapy. CVA COPD/Hep C/atypical tbc Pacemaker and ICDO follow up Breast cancer. HTN management. P MI management Psychopharmacology HIV today. Ebola. US Dopper Interpretations Pulmonary Tuberculosis More CME in Geriatrics in general with emphasis on topics more commonly seen in patients 65 and up. Depression. Diabetes (MI DDM to IPDM required). Lifestyle (exercise). D.A. and safety. End of life issues - hospice/advanced directives. Dealing with family members Neurology for Primary Care. Arthritis Update in gastrointestinal stromal tumors. Prostate cancer review, again Menopause in women Atrial fibrillation. Malignant hypertension Diabetes Mellitus. Psychiatric disorders HIV/AIDS current guidelines. HTN new drugs to start treatment. Hepatitis C new treatment Harvone. Follow up recurrent high HCV Chronic renal failure management. Malignant HTN Continuing updates on treatments for Hepatitis B and C Lungs disease and gastrointestinal Respiratory diseases Depression, anxiety disorders, diabetes Obesity management Advances in HIV Pediatrics Idiopathic Pulmonary Fibrosis. Brain tumors Diabetes management/metabolic syndrome management in primary care. Atrial Fibrillation in Primary Care/preoperative risk Diabetes management and treatment. Strategies on how to deal with demanding 'customers' (patients) Chronic pain evaluation/management. Diabetes management updates Diagnosis and management of ADHD. Anemia discussion. Management/DDx increased liver function testing. Management of Nephrolithiasis Alzheimers Disease, Parkinson Disease, Epilepsy Thyroid diseases. Arthritis, Rheumatoid. GERD Cardiology (hypertension)/pulmonary, Diabetes, HIV Interventional cardiology, Rheumatology, end-stage heart disease, chronic pain management Dermatology, hypo/hypertension Obesity, DM Neurology, dermatology, office orthopedics, ENT Rheumatologic topics. Hematologic topics

12 What topics would you like to see offered as CME activities in the future? COPD Colon cancer. Hypertension. Myocardol infarct Additional comments: Great topics, overall great meeting Excellent information This is my first time with NACE and it was great! Amazing quality of the presentations and then CME activity overall. Very convenient location. Will come again Great program! Thank you for the invitation! Dr. Basile's slides were excellent Great conference Superb presentations Excellent event Great activity Please mail me the certificate. Thank you Excellent presentation Overall good Lectures were very informative Excellent venue Excellent conference Excellent activity Great presentation. Well informative This is just what I wanted. Thank you Day well spent N/A N/A This CME was extremely helpful and well organized. I really had an amazing experience. Thanks Thank you Pretty good, I am happy Excellent conference for Primary Care Future of Primary Care Thanks for inviting. Good CME for free. Thanks again Well done Excellent activity Excellent CMEs OK Thank you for offering this program (and lunch too) Excellent program Very good It was nice to have everything free Excellent course in all areas. Need bibliography of all speakers Great networking. I have 52 years of caring. I graduated in 1963 June Connecticut. I love my profession since day 1. I love to go to work Tropical diseases should be covered Thank you

13 Additional comments: Excellent conference. Organized. Thank you Dr. Sherevant and staff; Mane Excellent topics. Excellent speakers Thanks for sharing this important information Very well developed topics. Very informative Excellent discussion. Presenters very knowledgeable in their respective topics. I will definitely attend future presentations and internet courses. Begin to lower PSA levels to 1.5 instead of the usual 4.0 Thank you for this CME program - I appreciate the breakfast/coffee, food, and boxed lunches and free parking Great lectures Great program Great format for learning. Excellent selection of speakers and topics CME was great Excellent program Thank you all for this great opportunity to improve our knowledge Excellent faculty Excellent program. Thank you Great free lunch and conference Keep doing these activities in Miami (Dade County) Great speakers OK Good presentations Dr. Rosenberg was excellent Thank you