Merkel
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Telepsychiatry provides mental healthcare to rural communities through telemedicine. It has been found to be as effective as in-person treatment and patients are generally satisfied, though mental health professionals are less satisfied. The University of Virginia has implemented two models of telepsychiatry - a consultation care model and collaborative care model. The collaborative care model, which incorporates on-site mental health support, has been more successful at increasing follow-up rates and properly diagnosing patients. While telepsychiatry improves access, ongoing investment is still needed to expand services and support collaborative models of care.
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This document summarizes the results of a study examining factors that influence multiple sclerosis (MS) patients' willingness to participate in clinical trials. The study involved questionnaires assessing patients' knowledge of and attitudes towards clinical trials. The results showed that about half of MS patients were willing to consider participating in a trial. The strongest positive predictors of willingness were older age, not having children, progressive MS, and previous trial participation. Risk of side effects was the top negative factor influencing participation. Providing comprehensive information to patients was the most important solution to increase participation. Resident Work Hours To AMSA National 2005
This document discusses the evidence that resident work hours should be reformed to improve resident and patient well-being. It summarizes research showing that sleep deprivation impairs clinical performance and increases medical errors. Studies found residents had high rates of depression, motor vehicle accidents, and obstetric complications due to long work hours and lack of sleep. The document advocates for collaborative efforts between medical schools, hospitals, and unions to implement work hour limits and enforce policies to promote resident and student health and safety.
Rethinking, rebuilding psychosocial care for cancer patients
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Ddsymposiumchapt
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and potential for adverse effects from medications in this population. It reviews factors like legal guardians, family involvement, group home staff, and challenges with diagnostic testing. It provides guidance on antiepileptic drug selection considering efficacy, side effects, and treatment of any co-morbid conditions.
Developmental Disabilities and Community Life
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and limited ability for testing in this population. It reviews factors like legal guardians, family involvement, group home staff, and challenges of medication administration and testing. It provides guidance on antiepileptic drug selection considering efficacy, side effects, and treating co-morbid conditions.
Conferencia de la Dra. Joanne Wolfe sobre Cuidados Paliativos Pediátricos, en...
This document summarizes a presentation on pediatric palliative care given by Dr. Joanne Wolfe. It discusses the scope of pediatric palliative care needs, including common diagnoses, symptoms, and technologies used to treat children with life-threatening illnesses. It also describes the suffering experienced by patients and their families from physical, psychological, social, and existential distress. Additionally, it outlines the Boston Pediatric Palliative Care experience, including the interdisciplinary team approach, strategies used, and outcomes demonstrating improved symptom management, family satisfaction, and reduced healthcare utilization. Finally, it discusses adapting the pediatric palliative care model to low and middle income countries by assessing available resources and integration with local care providers.
Telepsychiatry: The University of Virginia and Clinch River Health Services P...
Telepsychiatry: The University of Virginia and Clinch River Health Services P...Virginia Rural Health Association
This session will discuss the use of telemedicine by the University of Virginia Department of Psychiatry to provide clinical care to primary care agency patients in Southwest Virginia. Consultation and collaborative models of care will be presented, along with a discussion of the strengths and challenges of this technology for treatment of mental health problems. Since 2007, UVA and Clinch River Health Services have contracted to provide psychiatric evaluation and medication management for Dungannon patients. The psychiatric and primary care providers will present a case study illustrating the application of the collaborative model, and discuss the emerging questions related to expansion of this important access to care for rural Virginians.Advanced care planning Hospiscare
Presented by the Exeter Hospiscare Community Palliative Care Team on the 2 March 2011, in Exeter, Devon. More infor at www.hospiscare.co.uk
Developmental disabilities symposium chapter
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and potential for adverse effects from medications. Care is now provided in community settings like group homes rather than institutions. Physicians must work with legal guardians, family members, and caregivers to effectively manage patients' epilepsy and understand historical factors. Choosing antiepileptic drugs requires considering seizure type, psychiatric comorbidities, previous medication responses, and ability to administer medications properly in community settings. Neurodiagnostic testing can be challenging but helps identify seizure type and guide treatment.
ddsymposiumchapt
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes that many principles of antiepileptic drug therapy for non-disabled individuals also apply to those with developmental disabilities, but that treating physicians face additional challenges. These include a higher rate of difficult-to-control seizures, limited ability to do diagnostic testing due to cognitive impairments, and greater risk of adverse drug effects. It also discusses the trend toward deinstitutionalization and relocation of developmentally disabled individuals to community settings, increasing the need for community physicians to treat their medical issues like epilepsy. The role of legal guardians, family members, and group home staff in providing care and information is also covered.
Palliative Care - Dr. Bekanich
The document discusses palliative care and end-of-life care. It notes that patients often suffer from untreated symptoms, and families are unsatisfied with the current healthcare system. Palliative care aims to improve quality of life for patients with life-threatening illnesses through pain management, psychosocial, and spiritual support. The document also discusses the stresses on family caregivers, noting that over 44 million Americans serve as caregivers and it can negatively impact their health. Palliative care focuses on treating the whole patient and coordinating care across settings.
Patient experience: where can we improve?
This document discusses improving the patient experience in primary health care. It outlines issues with the current system such as fragmented care, access problems, and feelings of disempowerment among patients. Data shows many patients experience long wait times, lack of communication between providers, and doctors not spending enough time with them. The document calls for a more coordinated, comprehensive, and consumer-centered primary health care system to address these issues.
Screening for Distress versus Providing Supportive Care: Avoiding a Conflict
How introducing routine screening of cancer patients for distress can have unintended negative consequences.
PCCP Paper.docx
The Psychiatric Care Checklist Project aims to improve transitions of care for psychiatric patients in the emergency department by developing a standardized checklist called SHEDS. A pre-intervention survey found that key aspects of psychiatric care like medication reconciliation and documentation of hold status were completed less than half the time. SHEDS was created to address missed components and implemented through education. Future goals include evaluating its effectiveness through post-intervention surveys in improving completion rates for core psychiatric care elements and reducing preventable adverse events during boarding.
Palliative vs. Hospice Care - READ THIS
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
Palliative vs Hospice Care
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
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This document provides information and instructions for responding to an opioid overdose emergency using naloxone. It begins with an overview of the REVIVE program and training objectives. It then discusses opioid overdoses, how to recognize one, and risk factors. Myths about reversing overdoses are dispelled. The document emphasizes that naloxone is the only effective response and provides step-by-step instructions: check responsiveness and give rescue breaths if needed, call 911, administer naloxone, continue rescue breathing, and give a second dose of naloxone if needed. Proper positioning and calling for emergency help are also described.
Balanced Living with Diabetes
This document provides an overview of the Balanced Living with Diabetes (BLD) program, a community-based lifestyle intervention for improving blood glucose control among people with diabetes. BLD is based on social cognitive theory and community-based participatory research principles. It involves weekly 2-hour classes over 4 weeks that teach diabetes self-management skills like healthy eating, physical activity, and goal setting using interactive lessons and activities. Pilot programs of BLD found improvements in A1c, diet, and physical activity. A large randomized controlled trial of BLD found it effective at lowering A1c levels among African Americans with diabetes in medically underserved areas when delivered in faith-based community settings.
Telehealth: beyond bright shiny objects
This document discusses telehealth, health information technology (HIT), and mobile health (mHealth). It defines these terms and explores their use and potential benefits in rural healthcare settings for improving access to care, care coordination, patient-centered care, and physician mentorship. The document addresses challenges like patient migration, health literacy, and lack of providers in rural areas. It also discusses considerations for vendors and technologies like assessing return on investment and ensuring clinical and financial benefits. The need for pilot testing, feedback loops, and adapting implementation processes is emphasized. In summary, the document provides an overview of digital health innovations and how they can help address rural healthcare challenges if properly planned and evaluated.
Attention-Deficity Hyperactivity Disorder
This document provides an overview of attention deficit hyperactivity disorder (ADHD), including diagnostic criteria, incidence rates, treatment options, and recent Virginia Medicaid data on ADHD diagnoses and medication rates. It begins with the goals of reviewing the ADHD diagnosis, latest treatment algorithms, and Virginia Medicaid data compared to other states and nationally. Diagnostic criteria and symptoms from the DSM-V are outlined. Treatment options discussed include behavioral therapy and FDA-approved medications like stimulants. Virginia Medicaid data on ADHD diagnoses and medication rates among children and adults is presented compared to other state Medicaid plans.
Hazel
The document discusses Virginia's health and human services programs and delivery system. It provides an overview map of the various state agencies and programs involved, including Medicaid, social services, behavioral health, public health, and more. It emphasizes moving from a program-focused model to a more coordinated, customer-centric model to better serve individuals and families. Key challenges discussed include demographic changes, technological shifts, workforce issues, balancing specialization and integration, and coordinating complex federal, state and private systems and requirements.
Veterans Health
This document summarizes a presentation given by Gina Capra, Director of the Office of Rural Health at the Veterans Health Administration. The presentation provided an overview of the VA, including its mission to care for veterans and strategic goals. It also discussed the rural veteran population and challenges they face accessing care. Additionally, it described the VA's efforts to engage community providers through programs like the Community Based Outpatient Clinics and the Veterans Choice Program.
NRHA
This document discusses the challenges facing rural healthcare in the United States. It notes that rural residents generally have worse health outcomes and less access to care compared to urban residents, due to issues like physician and specialist shortages. Many rural hospitals are financially vulnerable and at risk of closure. The document outlines advocacy efforts by the National Rural Health Association to raise awareness of the crisis of rural hospital closures and develop legislative solutions to stabilize rural healthcare.
VHHA
Virginia hospitals face serious financial challenges that threaten their ability to continue serving their communities. Rising costs of caring for an aging population combined with inadequate Medicare and Medicaid reimbursement have led to annual funding shortfalls approaching $1 billion for Virginia hospitals. This has resulted in one-third of Virginia's acute care hospitals operating in the red. If these challenges are not addressed, further hospital closures and service reductions are possible. A public awareness campaign called "Virginia Hospitals: Our Lifeline" aims to educate lawmakers and the public about these issues facing local hospitals.
Guide to Inexpensive Prescription Medications
Melody Counts, M.D., M.H.M. presented information on resources for affordable prescription medications. The presentation identified multiple patient assistance programs (PAPs), 340B programs, private organizations, and pharmacy discount programs that provide low-cost or free prescription drugs. It provided details on eligibility requirements and application processes for several specific programs and resources patients and doctors can access. The goal was to help participants identify affordable prescription medication options to provide to patients and understand why this is an important service.
Getting the Most from Federal & State Loan Repayment Programs
1) The document provides guidance on federal and state loan repayment programs for healthcare practitioners and practice sites.
2) It discusses Health Professional Shortage Areas (HPSAs), their structure and types, and how they are used to determine eligibility for programs like the National Health Service Corps Loan Repayment Program and Virginia State Loan Repayment Program.
3) The National Health Service Corps Loan Repayment Program and Virginia State Loan Repayment Program are described in detail, including eligibility requirements for participants and approved sites, available funding amounts, and application processes.
Telehealth Regulatory Potential Across State Lines
Joshua Kaywood discusses interstate telehealth regulation and licensure issues. He outlines the current status, including common issues around medical board jurisdiction over residents. Landmark decisions established that providers must be licensed in the state where the patient resides. Rules generally require knowing a patient's residency and obtaining licenses in multiple states. Virginia extends reciprocity to bordering states, while others may require full licensing or allow exemptions. The FSMB Compact and PSYPACT aim to enhance license portability across states through compacts, but telehealth regulation remains complex due to varying state laws.
Regional Telehealth Environment
This document provides an overview of telehealth and the Mid-Atlantic Telehealth Resource Center (MATRC). It discusses what telehealth is, including videoconferencing, store-and-forward, remote patient monitoring, and mobile health. Models that effectively use telehealth for rural healthcare are presented, such as telestroke, Parkinson's care, and high-risk obstetrics. The document outlines MATRC's goals of assisting rural sites in developing telehealth programs and describes the technical assistance they provide through their website, social media, in-person meetings, and email support.
Decreasing Cost While Increasing Value
This document discusses challenges facing rural healthcare providers. It notes that 62 million patients rely on rural providers who face unique population, geographic, cultural and healthcare delivery challenges. Rural providers and patients are disproportionately dependent on federal programs like Medicare and Medicaid. Recent federal policies have enacted Medicare cuts that negatively impact rural hospitals. The document examines characteristics of rural hospitals that have closed since 2010 and potential factors contributing to closures. It also reviews characteristics of rural hospitals that have merged with other providers and whether mergers improved financial performance. The document advocates policy solutions to stabilize rural hospitals and ensure their future viability.
Research Data Sources
This document summarizes resources for conducting research on rural populations in Virginia. It identifies several key public data sources for studying chronic disease in central Appalachia, including the Appalachian Regional Commission, Centers for Disease Control and Prevention, and various state-level sources. It also describes a case study using Virginia College of Osteopathic Medicine's study of chronic health conditions in central Appalachia as an example. This involved collecting both primary data through medical record reviews and secondary data from sources like the U.S. Energy Information Administration and Virginia Department of Health. It concludes by discussing future directions for continuing this research.
Triggs-2014
This document outlines a framework for population health management. It discusses fundamentals of population health including individual behavior, community health outcomes, and managing population health. It describes benefits of population health management like prevention and chronic disease management. Critical access hospitals can play a role as conveners by collaborating with local health departments and EMS providers. They can assist with developing population health plans and focus community engagement on key local health issues. The document provides templates for community engagement plans and implementation timelines.
Martinez-2014
This document provides an overview and summary of Virginia's public behavioral health system challenges and opportunities presented by James M. Martinez Jr., Director of the Office of Mental Health Services at DBHDS, to the Virginia Rural Health Association on December 11, 2014. The presentation discusses the current environment of behavioral health reform in Virginia, new laws affecting behavioral healthcare in the state, and DBHDS's vision, mission and transformation process. Key points include the drivers of recent reforms, current demand and utilization of services, new laws on emergency custody, temporary detention facilities, and the psychiatric bed registry.
Morris-2014
This document summarizes differences between rural and urban health care and challenges facing rural areas. Key points include: infrastructure and resources are more limited in rural areas; poverty and health disparities are higher; and the aging population presents issues. Federal programs aim to address rural needs, but top-down solutions have had mixed results. Ensuring a rural voice in policymaking is important. Upcoming opportunities include the 2015 open enrollment period under the Affordable Care Act and workforce development programs.
Shell-2014
The document discusses the evolving rural healthcare environment, including increased affiliations between rural and urban providers, changes to payment models under the Affordable Care Act, and a transition to value-based and managed care. It notes pressures on state budgets, the growth of high-deductible health plans, reduced readmissions, and declining inpatient volumes. The document also summarizes the expansion of Medicaid, Medicare payment reductions, quality reporting programs, accountable care organizations, and the financial challenges rural hospitals may face in this changing environment if they maintain a fee-for-service model.
Wirgau-2014
The document summarizes the New River Valley Livability Initiative, a 3-year regional planning process that developed a vision and strategies for the future of the New River Valley region. It describes the funding and team involved, including working groups on topics like housing, economic development, and health. Public outreach included surveys and meetings. The final report identifies trends in areas like housing, transportation and demographics, and establishes goals and strategies to enhance living and working environments and preserve rural character in the region.
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