Shannon Lizer

Health Care Provider Education: Older Farmers Shannon Lizer PhD APN-CS Director of Nursing Highland Community College Freeport Illinois; And UIC College of Nursing

Focus of Presentation  The

purpose of this presentation is to review current educational modalities of health care providers for optimal care of older farmers  Short discussion about why this is important  Examples given are not meant to be an exhaustive list

So, why is this important? 

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A partnership exists between a health care provider and patient/family when care is optimal Partnerships are difficult when a knowledge deficit exists The culture of farming & rural is unique Language and concepts are different in farming & rural culture Traditional health care & health promotion take on new meaning

Review of Access to Care Issues  ~30%

of rural residents live in areas with a shortage of health providers & services  Shortage cuts across all disciplines  EMS services in rural and frontier is a critical problem across the country  Lack of health care insurance or high deductibles is also an issue for rural residents

Health Care Professions Education  Emergency

Medical Services  Medicine – predoctoral & residency  Nursing – undergraduate & graduate  Pharmacy  Dental  Allied Health  Public Health  Interdisciplinary programs

Current Educational System Overview  Intentional

Programs  Agricultural Health & Safety Coursework  Rural Location  Community Partnerships  Serendipitous Exposures  Continuing Education Programs

Intentional Programs  Programs

have a rural focus  Programs have some rural content  Programs are located in rural areas  Programs may or may not involve multiple disciplines

Rural Nursing Programs 

Nurse Agricultural Educational Project University of Kentucky –

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farm injuries awareness, agricultural curriculum, injury prevention research, development of instructional materials, and support of research/dissertation work around this topic

Rural Nurse Internship (RNI) –

1 year acute care preceptorship in Oregon, Montana, Washington, & Idaho

More Nursing Programming  Decker

School of Nursing in upstate New York has a rural nursing tract  Frontier Nursing Program in Kentucky  East Tennessee State University  Rural Family Nursing Program at University of Central Missouri

Medical Education  Predoctoral – –

Programs

May be aligned with state scholarships – ex. Rural Health Associations May be tied to commitment to practice in rural areas

 Postdoctoral –

Programs

Most typically tied to a family practice residency program

Predoctoral Medical Rural Programs  Several – – –

examples across US

Texas College of Osteopathic Medicine University of Illinois College of Medicine in Rockford, Illinois Oklahoma State University

 Components – – –

include:

Regular curriculum Rural topics COPC projects

Medical Residency Programs  Formal – – –

Rural Training Track Programs

Richard G. Lugar Center for Rural Health Memorial Family Medicine in South Bend, Indiana Wisconsin Academy for Rural Medicine ”WARM” at the University of Wisconsin

Rockford’s RMED Program  Currently

linked with National Center for Rural Health Professions (NCRHP)  Special admittance process through the University College of Medicine  Some interdisciplinary exposure  Rural curriculum as add-on in M1-M4 years  Rural preceptorship + COPC project in M4 year

No Harm On The Farm Tour  Joint

activity with RMED & UIC CON Occupational Health Nursing Program in Fall 2006  Joint presentation between ag safety & farmers  Toured 2 farms in rural Lee County, Illinois at harvest – –

Beef/grain operation Hog/grain operation

Tenets of Intentional Programs 

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Rural education and exposure are necessary for graduates to understand rural culture Rural people may have credibility Rural people (after education) live in rural areas

Interdisciplinary Programs  East – –

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Tennessee University

Rural Primary Care Tract longitudinal exposure to rural folks Short QI Program - Interdisciplinary teams working together to solve a problem/challenge faced in health care (Burdick funding) Overarching goals are to increase # of health professionals, develop & strengthen links in system, and increase access to services

Rural Mental Health  Rube

Farmer Suicide Prevention, University of Michigan School of Social Work http://www.ssw.umich.edu/simulation/simulati on-rube.html

Gerontology Programs  Many

out there looking at elderly population, some of which are in rural areas  Most of these programs are interdisciplinary by design and mission  All have gerontology content, some have rural content  Case study programs ex. Ithaca College Rural Cases (ithaca.edu)

Agricultural Safety & Health Courses  Individual

courses offered as electives or part of a non-health care program  Ag Safety Centers offer courses  NIOSH ERC health professions offer programs and courses (OHN, Occ. Med)  Texts and supplemental materials are available

Rural Location  Programs

that are housed in universities & colleges located in “rural and frontier” areas  These programs by their location provide a rural experience  There may or may not be curriculum related to agriculture issues or rural life

Community Partnership Models  Tend – –

to be grant supported

Kellogg Robert Woods Johnson

 CCPH –

– Service Learning programs

Structured learning combining community service with objectives & reflection

 Tend

to be interdisciplinary by design

Examples of Community Partnerships  Rural

Health Education Network (RHEN) in rural Nebraska focus on rural folks choosing a healthcare career  Area Health Education Centers (AHEC) – in many states (Florida, Wisconsin, Illinois, Montana, Washington, and others) – –

AHEC supported residency rural tracks Other AHEC programs – ex. SCRIPT

 Quentin

N. Burdick Rural Program for Interdisciplinary Training – multiple programs

More programs…  RMED – – –

Program in Rockford UIC-R

Multiple projects in rural Illinois counties Partnerships between community agencies, leaders, UIC, and M4 students Projects include: exercise programs for older adults, diabetes management in public schools, barriers to diabetes care, screening programs for osteoporosis, and others

Serendipitous Exposures  Students

who without intention are exposed to rural locations  Students who are involved in the care of farmers or farm workers transferred to tertiary centers post injury, post exposure, or as a result of required treatment for chronic diseases

Continuing Education Programs 

Focused programs –

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UW Partners in Agricultural Health 12 contact hours of programming including 10 courses developed by an interdisciplinary group. Participants can enroll for each of the courses or the entire program Agricultural Safety and Health topics NIOSH training topics

Other training (Farmedic, hazmat, etc.)

Current Limitations of Review  The

extent of the agricultural safety and health/injury prevention content remains unclear  Evaluation of agricultural safety and health/injury prevention content is also unclear  The relationship between adequately prepared health care providers and farmer health and safety is also unclear

Barriers to Change  Traditional

silo education  Complex systems  Professional conflict and competition  Resources – – –

Personnel – lack of available faculty Funding Integration of curriculum and interdisciplinary focus is labor & time intensive

Take Home Points 

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There is a need for the development of integrated rural training programs with agricultural safety and health curricula Opportunities exist for further integration of existing programs Interdisciplinary training could be strengthened Program development/modification should be research driven The use of the Internet could be increased

Finally…  Educational

needs are present at ALL health care provider levels  There are common themes in agricultural safety and health with regional differences  Would a common “core curriculum” be of value?  Where do we go from here?