Emerging Challenges in Primary Care: 2015

Transcription

1 Emerging Challenges In Primary Care: Activity Summary CME Activity: Saturday, October 24, Loews Vanderbilt Hotel Nashville Nashville, TN Course Director: Gregg Sherman, MD Date of Summary: December 16, 300 NW 70th Avenue Plantation, Florida (954) Phone (954) Fax

2 In October, the National Association for Continuing Education (NACE) sponsored a CME program,, in Nashville, TN. 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 Stroke Prevention, Congestive Heart Failure, Hypercholesterolemia, Nonalcoholic Steatohepatitis, Hepatitis C, 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 sixty five healthcare practitioners registered to attend Emerging Challenges in Primary Care: in Nashville, TN. One hundred forty six 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 thirty four completed forms were received. The data collected is displayed in this report. CME ACCREDITATION The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The National Association for Continuing Education designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number This program has been approved for 7.0 contact hours of continuing education (which includes 1.75 pharmacology hours). 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 educational 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. 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 1.25 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: 2.25 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: Stroke: Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Prostate: Frequency Percent Mean: 2.51 Frequency Percent Mean: 2.63 None None > > 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: HCL: Frequency Percent Mean: 2.99 Frequency Percent Mean: 4.01 None None > > No No

4 Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: NASH: Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: HEP C: Frequency Percent Mean: 2.28 Frequency Percent Mean: 2.27 None None > > No No Upon completion of this activity, I can now: Recognize the risk of cardioembolic stroke in patients with atrial fibrillation (AF) and the importance of prophylaxis; discuss current recommendations for cardioembolic stroke risk reduction in individual patients; recognize the need for good clinician-patient communication about the benefits and risks of antithrombotic therapy for stroke risk reduction, and the importance of persistence with therapy; and describe the management of bleeding in AF patients on oral anticoagulant therapy for stroke risk reduction. 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; and understand the process of shared decision making in prostate evaluations. Frequency Percent Mean: 1.06 Frequency Percent Mean: 1.03 Yes Yes Somewhat Somewhat Not at all Not at all No No Upon completion of this activity, I can now: Discuss the epidemiology of heart failure (HF); describe pathophysiologic factors contributing to increased risk of HF; utilize the most recent clinical evidence to inform their decisions for the management of HF; and identify approaches to facilitate early recognition and optimization of HF management. Upon completion of this activity, I can now: Discuss the benefits of LDL-C lowering with pharmacologic therapies that improve cardiovascular outcomes; recognize and understand the role of alternative or additional therapies in conjunction with statins; recognize the strengths and limitations of the 2013 ACC/AHA cholesterol guidelines and how to optimally implement the recommendations; recognize the potential role of emerging pharmacologic therapies to further lower LDL-C in those at high risk for cardiovascular disease; recognize and develop appropriate treatment strategies for special populations (women, elderly, ethnic minorities) that would benefit from lipid lowering therapy. Frequency Percent Mean: 1.12 Frequency Percent Mean: 1.09 Yes Yes Somewhat Somewhat Not at all Not at all No No

5 Upon completion of this activity, I can now: Identify patients at high risk for nonalcoholic fatty liver disease (NAFLD); distinguish non-alcoholic fatty liver (NAFL) from nonalcoholic steatohepatitis (NASH) and understand how to stage the disease; implement ongoing evidence based general management of patients with NASH; and describe the available and emerging treatment options for patients with NASH. 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: 1.13 Frequency Percent Mean: 1.12 Yes Yes Somewhat Somewhat Not at all Not at all No No Overall, this was an excellent CME activity: Overall, this activity was effective in improving my knowledge in the content areas presented: Frequency Percent Mean: 1.19 Frequency Percent Mean: 1.22 Strongly Agree Strongly Agree Agree Agree Neutral Neutral Disagree Disagree Strongly Disagree Strongly Disagree 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: 1.24 Frequency Percent Mean: 1.35 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: Check Herrbitis status, us for fibrosis, etc. New HTN guidelines. Atherosclerosis risk score Identification of patient for statin use. Escalation of statins New anti-coag therapies, Ease in identifying Hep C pt and treatments. How to stage NASH Consider agents other than Warfarin/ PSA in high risk group. Patient learned deurium. Use of ISO. Hydralyzine. Rx Lipid by ASCV calculator New screening guidelines. Risk calculators. Considering new medications Hydralyzine and Isosorbide dinitrate Monitor kidney function more reg with DM Spend more time explaining what PSA testing is indicated. Calculating Atherosleratic heart disease Interpretation on CHA2 DS2 VASC and treatment strategies with DOACS vs Coumadin. Screening steps to diagnosis Prostate cancer; Biomarkers for screening Prostate cancer. Heart failure treatment

6 As a result of this activity, I have learned new strategies for patient care. List these strategies: 4K screening for aggressive prostate cancer Good info on apps, new medications and guidelines Differences in the DOACs was very useful and will change my practice. Assess ASCUD risk using app Applying knowledge to patient care. Discussing slides with colleagues/ patients Add HASBLED score in my pt population Using the CHA2 DS2- VASc score. Using bio markers in Prostate screening. Obesity is an important risk factor for NASH and Vitamin E can be used in treatment Approach to elevated LDL and CHF Lipid lowering and bridging anticoagulants. Using DOACs safely. When to screen PSA. Treating AA patients with HF. Drink more coffee Use of the new Pabigatran Reversal agent. Heart Failure approach. Change PSA strategy. Change Lipid Rx Strategies Biomarkers with Prostate cancer. PCSK-9 inhibitors. Fixed dose ISBN and HyD with HF Monitoring ASCVD risk. NASH monitoring. CHADS score. I strongly feel these review courses will help to pass my Adult- Gero NP boards Statins Chemoprotective for HCC. Monitor hispanics closer for NASH. New reversal drug for Prodaxa. Drink more coffee. Do not routinely obtain PSA without discussing with patient Quick reference tables. Case studies I will now consider a DOAC (rather than Warfarin) for my insured AF patients. Have convo with patients re: PSA increased. I will add an aldosterone antag, as well as FDC/ IH for symp pts. Will consider adding ezetimibe or PCSK-9. Rec. liver bx for NAFLD. Check HCV RNA in all Hep C + pts. Refer for treatment Trasitioning from Warfarin to DOAC and use vesh. Done doing in renal function. Logical approach to surely prostate ca using Biomarkers for surely aggressive cancer Learned about prostate Biomarkers- will make screening for prostate cancer and management easier Noninvasive fibrosis testing. New reversal agent(s) for DOACs. AUA Prostate guidelines When to bridge for procedures and Afib. Better idea of when to do PSA screening. Use Bidil in African Americans with CHF. LDL >190 consider familial hypocholesterolemia. Use more Zetia Checking Biomarkers to further evaluate the significance of the PSA levels. Using CHA2 DS2 VASc more in screening pts Evaluating anticoagulation therapies for patients with atrial fibrillation. Screening for Prostate disease Using Biomarkers R/t monitoring for prostate CA. tx of FH R/t EB medicine. Using CHADS/VASC score R/t implementing anticoagulation. Tx differences b/t reduced EF and preserved EF HF. Monitoring liver fxn R/t NAFLD and NASH and Hep C and Cirrhosis and Liver CA Use of DOAC. Will use BSH Biomarker. Greater use of BiDil. Will monitor changes in Lipid therapy. Would use Vit E for NASH. Will be more proactive in referral for Hep C patients Ways to treat AF and fatty liver Treatment strategy for NASH and other Liver D2 Learned a stepwise approach to using new medication when an alternative treatment or combination treatment may need to be used I will screen prostate CA starting 4540 and use biomarkers PSA screening/ using Biomarkers, Treatment of AF with DOACs N/A Incorporate HASBLED. PSA biomarkers Assure community outreach for Men in getting their prostate exams and PSA's completed (I am currently seeing extremely high levels of stage 3-4 cancers in men Initiation of statin in appropriate groups. Discuss nlks/ renegets with male pt re: prostate CA. More confident in txing pts with HF Improve treatment of stroke patients. Understand the process of shared Prostate decision making. Treatment of Hepatitis C in primary care setting New apps to review to eval

7 As a result of this activity, I have learned new strategies for patient care. List these strategies: Use CHA2DS2- VASC score for AF patients. Utilize tromalors for patients with increased PSA at risk for CA Will implement testing strategies and F/U medications Heart failure- Isosorbide clinitrate/ hydralyzine Axel combo and colanor. 4K to determine aggressive prostate CA. PSK9 use in cholesterol Better screening, Better monitoring I am not in active practice at the moment New cardiac rise scoring. Prostate screening education. Better mgt of NASH FAC I/H for CHF. Statin/ Zetia for FH. Biomarkers for prostate CA. One time Hep C test (adults born ) Will use in direct pt care and pt education with my FNP students' patients and in lecture development and clinical case presentations. I teach in a college of nursing I will definitely be more involved in evaluating, educating and treating NASH/ NAFLD patients Start recommendation Change frequency of PSA tests Better info/ decision making strategies with pts in regard to PSA screening. Info to better manage CHF pts Treatment for/ management hyperlipidemia Prostate screening guidelines. Screening for risk of CVR Management of patient with HF. Recommendation of therapy to pt with medical history of Hyperlipidemia More accurate Bio marker tools and appropriate referral/ and or treatment Better statin therapy for prevention of lipids causing CVD I will work up my increased PSA differently- PHI/ PCA 3/ 4K score. I will screen pts born for Hepatitis C Prostate screening guidelines. Implement stroke prevention with new drop Bio markers use in determining prostate cancer risk. Utilizing CHADSVAS score New diagnostic tests. New pharmacologic agents Will do better on Prostate testing and education and consider 4K Bio marker. Plan to add ezemib for increased LDL Bio markers for Prostate Cancer. CHF use Bidil. HCV screening adv to born Engage patient in discussion. Order diagnostic tests earlier Stratify response of elevated PSA (follow-up) Improvement in screening, diagnostic and treatment options Anticoagulant therapy Practical guidelines for PSA screening. Tools for HTN/ Lipid management Avoid unnecessary biopsy. Manage ACT with DOAC Biomarkers for prostate CA. Fun facts about NASH Use of screening tool Identify patient's at risk. Use communication when discussing testing protocols- LDL criteria- when to implement therapy. Identify Better screening for prostate CA. Will use more Zetia. May start using newer meds in Afib I will consider new treatment options or at least reconsider ongoing recommendations New medications, testing Add ezetimibe to treat patient with hyperlipidemia for which statin therapy is not enough. Differentiation between NASH vs NAFLD treatment approach Looking at PSA level 1.5 (above or below). How to decrease oxidative stress with NASH Management of DOAC. Patient education and CHA2 DS2 VASC use. Prostate Cancer screening treatment of HFrEF/ HFpEF Slides available in all presentation to print and use in pt evaluation and education. Algorithms applicable to practice and tx. Taking a different approach to Prostate PSH results and direction in further evaluation for increased numbers Risk stratification for lipid mgt. Prostate cancer screening

8 As a result of this activity, I have learned new strategies for patient care. List these strategies: More use of CHADS VASC score. Higher vigilance looking for Hepatitis C (and HIV). More aggressive lipid treatment CHADS- VASC Test pt's born between birth for HCV. Start Vitamin K on NASH pts. Lipid lowering meds update Use algorithm to screen for Prostate CA as provided by Dr. Rosenberg. Using CHADS VASC score to assess for stroke risk Better knowledge of PSA- discussion, tx 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: Elizabeth A. Jackson, MD - Stroke: Frequency Percent Mean: 1.46 Frequency Percent Mean: 4.73 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: Matt T. Rosenberg, MD Prostate: In terms of delivery of the presentation, please rate the effectiveness of the speaker: Icilma Fergus, MD Heart Failure: Frequency Percent Mean: 4.88 Frequency Percent Mean: 4.62 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: Icilma Fergus, MD HCL: In terms of delivery of the presentation, please rate the effectiveness of the speaker: Kalyan R. Bhamidimarri, MD NASH: Frequency Percent Mean: 4.63 Frequency Percent Mean: 4.73 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No

9 In terms of delivery of the presentation, please rate the effectiveness of the speaker: Kalyan R. Bhamidimarri, MD HEP C: To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Elizabeth A. Jackson, MD - Stroke: Frequency Percent Mean: 4.72 Frequency Percent Mean: 4.92 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? Matt T. Rosenberg, MD Prostate: To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Icilma Fergus, MD Heart Failure: Frequency Percent Mean: 4.91 Frequency Percent Mean: 4.84 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? Icilma Fergus, MD HCL: To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Kalyan R. Bhamidimarri, MD NASH: Frequency Percent Mean: 4.84 Frequency Percent Mean: 4.87 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? Kalyan R. Bhamidimarri, MD HEP C: Which statement(s) best reflects your reasons for participating in this activity: Frequency Percent Mean: 4.88 Frequency Percent Mean: - Excellent Topics covered Very Good Location/ease of access Good Faculty Fair Earn CME credits Unsatisfactory No No

10 Future CME activities concerning this subject matter are necessary: Frequency Percent Strongly agree Agree Neutral Disagree Strongly Disagree No Mean: 1.60 What topics would you like to see offered as CME activities in the future? Diabetes, Lab tests and interpretations Tx of common dz., HTN, peripheral neuropathy Muskuloskeletal system DO Dementia with behavior problem, Anemia M/S new guidelines, abx, Determining illicit drug use and what to do in clinical setting Gyn, Rheum Interpreting results of Echocardiogram, Stress testing, Recommendations for primary care treatment and eval of LUTS, thyroid disease, depression, ADHD Anemia work ups- hematology, HIV, COPD updates Review EKG course Primary care updates for non-primary care Treatments and therapy for mixed incontinence for females More Diabetes topics Celiac Disease Hypertension, Diabetes HIV treatment update Opiod addiction, Health disparities, Preventative medicine, Violence epidemic, Prison health, Homeless, Obesity (Make a change in World) STDs, Menopause More cardiology, endocrinology Depression, handling polypharmacy in patients, Dermatology issues Women's health, Adolescent Health topics, Mental health topics, Preventative medicine Diabetes Dermatology, Ortho, Hematology, Women's health (PCOS, Menopause, breast disease) Diabetes, CAD, Arthritis, Lupus, RA, Dermatology conditions, etc Pain management, Narcotic overdose management in primary care Continue to cover CV topics such as A.Fib HF and HLD COPD Kidney Failure/ Insufficiency Management DM, ESRD Substance abuse, Orthopedic emergencies/ referral guidelines, patient compliance improvements Asthma/ COPD, Postmenopausal/ HRT, Dermatological problems (common ones) Dre of hormones in men and women, Hypo active sexual desire Pain mgmt, Women's health, Orthopedics Schedule II Drugs Rules and Regulations

11 What topics would you like to see offered as CME activities in the future? New recommendations for PAP smears Anemia in elderly, Pain management in primary care, esp in Geriatric, Dementia EKG interpretation, Laboratory Interpretation Thyroid Disorders and other Endocrine problems, Hyperparathyroid, Increased prolactemia COPD, Depression, Anxiety Overweight- Obese management, Dermatological skin disorders, ENT conditions presenting in Primary care Asthma, COPD, HTN New treatment of Type II DM, HSV diagnosis and tz plans Pain, Geriatric care, Muscle weakness, Rehab Occupational illnesses and injuries and work related illnesses, cejing and exposures- prevention and care Pulmonary, Heart, Renal Palliative/ EOL care conversations Urgent care, Emergent Nursing Diabetes management, COPD management NAFLD/ NASH Women's Health, Diabetes Osteoporosis, Diabetes Diabetes, Dementia/ Alzheimers, Obesity, Thyroid Disease Pediatric topics e.g. DM II, Alzheimers and other dementias Treatment of Depression, Anxiety, ADHD, Testosterone low T Tx Pain management HIV, Infectious Disease topics, Insulin initiation, medical persons in adolescent medicine, Hep B, Pregnancy, Primary care for psychiatric patient HepB, HIV, Breast Cancer Osteoporosis tx Wound care, Patient centered medical surgery, Update on Diabetes Chronic renal suthcery, Dermatology (Acne Vulgar) in premenopausal women (post adolescent) Dermatological diseases Hyperband medicine and Wound care Treating addiction disorders, Dermatology treatments CHF, Depression/ Mental Health, Heart Murmurs, Hep B COPD, Urinary incontinence PCOS, Raynards Stroke, Memory in pannins ADHD, COPD, Hep C Thyroiditis, RA and OA mgmt Pain management, How to manage non-compliance patient with psych problem or geriatric patients Weight loss, Antibiotic stewardship HTN, DM Health care policy Pain management, Management of COPD, Microbiology DM- insulin management Use of narcotics, opiod analgesics Topics on management of Thyroid Disorders- Nodules, evaluation of Thyroid Treating ED

12 What topics would you like to see offered as CME activities in the future? Managing elevated B12 levels of not on any B12 administration IM, P.O., S.L. Is this a marker for cancer? Discuss large increase in low vit D levels and approach Diet/ Lifestyle changes/ exercise, Diabetes Integrative medicine Drug Addiction Pain management, Allergic Rhinitis, Upper Respiratory infection, Asthma Diabetes Mx, HIV, Immunization schedule Dermatology in Primary Care, Diabetes, Wt loss, ADD/ ADHD in children and adults Derm issues, OBGYN Guidelines and need for breast CA screening Additional comments: Topics are very interesting Great job Great course, appreciate it Well organized Audio-visual and setting Great conference! Thank you Are any coming to Atlanta or Augusta, GA? Dr. Rosenberg was great! I work in orthopedics but certify in family practice so questions about change in practice not really applicable NA Great as always Do not put a monotone speaker before and after lunch (same person before and after) Loved, loved, loved the Prostate cancer presentation Very informative speakers/ wonderful sessions I would like to see more CE towards obtaining NP degree as the speakers put info into plain English and don't talk above the level of education. The NASH and NAFLD presentations were a little difficult to follow The women's bathrooms were HORRIBLE- I told the desk we were out of soap, paper towels and some stalls were out of TP. The rest of the conference we had TP and paper towels and only one soap dispenser (all others remained empty!). They should anticipate lots of bathroom use during a conference and have staff to check/ stock. I can only imagine what you had to pay for such a wonderful conference to not have soap for medically inclined people to wash hands More Heart failure tx trends, this presentation I was more confused This was a great conference! Thank you Well done with speakers. Great credentials More animated speakers for late discussions ex: Dr. Rosenberg. Helps hold attention longer I am not working right now, I am maintaining my license and CME requirements. I had to leave early but I will look at the Hep C program on the NACE website. (I was doing Homehealth (mostly elderly) for the last 1 1/2 years- Family Practice before that) NA Good CME- less biased than previous years Very well organized and professional presentation Should have more speakers for short periods of time instead of a few speakers speak for a long time. After about 20 min or so, you start to lose your audience Thank you for this opportunity Would like to be able to download slides on ipad

13 Additional comments: Thank you very much! Good conference Thank you Great overall Love the slides availability for download Thanks for making the conference affordable Thank you for a great CME event Good conference I am retired and not seeing patients at this time but am maintaining my medical license Dr. Fergus, although knowledgeable, over played the focus of A.A. group in her slides. Hep C lecture was presented well just a little over my head for F.P. Great venue and good presenters. Very relevant info. Female sexual health Love Dr. Rosenberg! And Dr. Bhamidimarri Dr. Fergus should also mention significantly lower life expectancy of AA (unless I missed seeing that on a slide). Is onset of CVD and HCO at a younger age? Great lectures Great conference Great conference with applicable topics Conference room was too cold None This is very informative Excellent topics, speakers and location. Thank you Thank you Excellent conference Data from 2003 cited in HCL presentation- isn't there more recent data than this? Excellent presentation as always Very good presentation Very good quality conference This was great! Thank you Really enjoyed Dr. Bhamidimarri Great conference. I liked the interactive format. Food was good! Please bring back the blueberries None Would have been nice to have a copy of slides provided Very informative!! Correlates with my studies for the ABIM The Hep C lecture was probably more geared to hepatology subspecialists rather than targeted to primary care Presides have slide of "Apps" that they mention for use by PCP. Thanks None None