Professional Education/CME

Web CME Course - Early Recognition and Treatment of Dementing Disorders
Release date: January, 2007. End date: January, 2009.
Overview and registration information.

Web CME series - Diagnosis and Management of Dementing Disorders
Webconference held on February 20, 2007, March 20, 2007, April 17, 2007 and May 15, 2007.
Archives of the 4 sessions are available: Details

Family Practice Residency Training
Goal: To introduce family practice residents to a cognitive screening and diagnostic process that will promote early recognition, treatment and support of persons with dementia and their families.

Objectives: Upon completion of this unit, family practice residents will be able to:
• Screen for dementia.
• Diagnose and treat persons with Alzheimer’s disease.
• Refer to community resources that support patients and families living with Alzheimer’s disease.
• Discuss current Alzheimer’s disease research.
• Implement a screening program in a primary care practice that will identify person’s with early stage Alzheimer’s disease.

Target Audience: Family Practice residents and faculty.

Curriculum Content: Diagnosis, treatment, current research on Alzheimer’s disease prevention and how this model of disease diagnosis and management works in a family practice setting.

Diagnosis
• Importance of diagnosis
• Who diagnoses Alzheimer’s disease?
• Why it has not been a priority in the primary care setting?
• Screening (guidelines, suggested tools, interpreting scores)
• Diagnostic protocol/guidelines (medical history, medical examination, lab and imaging, family history, functional assessment, psychological assessment, cognitive assessment)
• Telling the patient and the family the diagnosis is Alzheimer’s disease

Treatment
• Managing the disease based on current research (cholinesterase inhibitors and other)
• Pharmacological interventions for challenging behavior
• Non-pharmacological interventions for challenging behavior
• Community resources to support the physician in managing the illness and to support the patient and the family
• Driving issues

Current research on Alzheimer’s disease prevention

How does this model of disease diagnosis and management work in a family practice setting?
• Time
• Cost
• Staff
• Referral

Faculty: Mark Sager, MD, Asenath LaRue, PhD, Wisconsin Alzheimer’s Institute and Bruce Hermann, PhD, Dept. of Neurology, UW School of Medicine and Public Health; Staff from the County Aging and Disability Resource Center; and staff from the Alzheimer’s Association.

Teaching methods: Needs assessment,lecture, discussion, demonstration, supervised practice, case study, handouts, bibliography, Internet resources and/or follow-up case review.

Suggested time line: Approximately 4 hours of content depending on time spent in discussion. The agenda would be developed based on needs assessment and time available. Content could be presented in one, two or 4 hour increments. Follow-up case review would occur after an interval of time agreed upon by faculty and resident participants.

Cost: No cost to the residency program.

For more information, contact Barbara Lawrence BSN, MS, Senior Outreach Specialist at 608-829-3302 or blawrence@wisc.edu.

Needs Assessment
In 2003, the Office of Continuing Medical Education (CME) and the Wisconsin Alzheimer’s Institute at the University of Wisconsin School of Medicine and Public Health completed a statewide needs assessment. The goal of the needs assessment was to:

1. Identify the critical gaps facing health professionals in translating science and evidence into best care practices for patients with Alzheimer’s disease.
2. Identify the learning and practice needs of primary care physicians, specialists and allied health professionals in this therapeutic area.

This research was designed to identify current practice in the care of persons with dementia and then to determine best practices throughout the State. There were multiple methods of data collection including surveys, telephone interviews with opinion leaders and focus group meetings occurring in 4 sites throughout Wisconsin. The results of the statewide needs assessment were as follows:

Knowledge Deficiencies: The participants in the needs assessment identified very specific gaps in current knowledge that served as barriers to the diagnosis and treatment of dementia. These included:
• Inability to identify persons needing evaluation (the absence of routine screening).
• Absence of readily available and easily interpretable diagnostic tools.
• Inability to monitor the effectiveness of current therapies.
• Lack of information about the benefits of current treatments.
• Lack of knowledge about available resources for patients and families.

Practice Obstacles: Barriers to diagnosis and treatment of persons with dementia were accentuated by obstacles identified in medical practice. Practice obstacles included:
• 15-minute appointments.
• Inadequate reimbursement for the time required to make a diagnosis.
• Reliance on families to bring symptoms of cognitive impairment to the attention of the physician (the absence of screening and diagnostic tools).
• Administrative pressure to "produce".
• Absence of a social worker and/or supportive staff to assist families and patients with dementia.

The knowledge and practice obstacles identified by the focus groups led to uncertainties about the clinician’s ability to diagnose dementing disorders, manage complications of dementia and deal with the multiple needs of patients and families. One important comment was that making the diagnosis of dementia was like opening “a can of worms,” creating an added burden on an already busy primary care physician. As a result, “dementia is not a priority.”

Translation of Knowledge into Practice
Based on the outcomes of the needs assessment described above, physician education is included in the Memory Screening Initiative. These initiatives have been designed to break down the barriers that physicians encounter with the lack of screening tools for identifying early memory loss symptoms, the time to perform the screen, the lack of knowledge about the treatment of dementing disorders and the lack of knowledge about community services that can support patients and families.

The memory screening initiative is targeted in Wisconsin counties that participate in the Family Care Program and those that have been funded by the Administration on Aging Alzheimer’s Disease Demonstration Grant. These counties include Richland Center, La Crosse, Milwaukee, Jefferson, Rock, Barron, Eau Claire, Chippewa, Dunn, Kewaunee and Door.

For more information, contact Barbara Lawrence BSN, MS, Senior Outreach Specialist at 608-829-3302 or blawrence@wisc.edu.