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The
Elderly and Comorbid Conditions
|
Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by
the
University
of
Alabama
School
of
Medicine
Division of Continuing Medical Education and
Alabama Quality Assurance Foundation
| Release
Date: November 2, 2006 |
Expiration
Date: November 2, 2009
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| TARGET
AUDIENCE: |
| Primary
care physicians |
| OBJECTIVES: |
| Upon
completion of this CME activity, physicians and other
healthcare professionals should be able to: |
- Recognize
the implications of pay-for-performance and its
limitations in treating chronically ill older persons.
- Recognize
potential conflicts when treating elderly patients
with multiple co-morbid illnesses according to
clinical practice guidelines.
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| Top of Page |
| SOURCE: |
| FACULTY: |
|
William
T. O'Byrne, MD
General Internist
Albuquerque, New Mexico
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| Top of Page |
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| DISCLOSURE: |
The
faculty has no commercial affiliations to disclose.
Because of the nature of preliminary studies, some products
mentioned are unlabeled and investigational. Dosages,
indications, and methods of use of drugs mentioned in
this publication may reflect the experience of the authors,
clinical literature, or other resources. Therefore, please
see the full prescribing information before using any
licensed product mentioned. |
| CME
PARTICIPATION: |
| To participate
in this online course for CME credit, please review
the objectives before beginning the program. Complete
the course and the self-assessment test before November
2, 2009 to receive CME credit. Your certificate will
then be available online. This process should take
approximately 1 hour. |
| ACCREDITATION: |
|
The University of Alabama
School of Medicine is accredited by the Accreditation
Council for Continuing Medical Education to provide
continuing medical education for physicians.
The University of Alabama
School of Medicine designates this educational activity
for a maximum of 1 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate
with the extent of their participation in the activity.
The boards of nursing
in many states, including Alabama, recognize Category
1 continuing medical education courses as acceptable
activities for the renewal of license to practice
nursing.
|
| DISCLAIMER: |
| Dosages,
indications, and methods of use of any drug referred
to in this publication may reflect the clinical experience
of the authors, clinical literature, or other clinical
resources. Therefore, please see the full prescribing
information before using any product mentioned. UAB
is an equal opportunity/affirmative action institution. |
| INTRODUCTION: |
|
In
this era of evidence-based medicine, physicians and
other providers have been turning to clinical practice
guidelines (CPG’s), treatment position statements,
and other peer-produced/reviewed materials in order
to improve the quality of care their patients receive,
as well as to standardize and streamline patient
care as much as possible. More recently, the term
pay-for-performance has entered the clinician’s
lexicon. Pay-for-performance, as it was originally
conceived, involves rewarding physicians who provided
evidenced-informed, data driven, guideline-centered
care; the ultimate goal is improved patient outcomes.[1] Many
health plans currently employ pay incentives for
physicians who provide such care, though the question
remains as to whether such system will improve outcomes
in the long term.[2] The
Centers for Medicare and Medicaid Services (CMS)
has been advised to link pay-for-performance to physician
and hospital reimbursement.[3]
By
design, clinical practice guidelines focus on a single
disease entity, such as chronic obstructive pulmonary
disease or diabetes mellitus. On the contrary, a
significant proportion of Medicare beneficiaries
have multiple chronic illnesses, and consequently,
following the exact dictates of CPG’s may lead
to inappropriate care.[4] Thus,
in a pay-for-performance system, physicians may be
discouraged from caring for sicker older individuals.[2] One
recent study using CPG’s to treat a hypothetical
79-year-old with 5 common chronic illnesses, discovered
that doing so resulted in potential medication and
treatment interactions, increased monthly medication
costs, and increased risk of non-adherence to treatments.[5]
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| Case
1: |
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Mrs.
J. is an 81-year-old female with mild to moderate
hypertension, which has been treated for the past
3 years with hydrochlorothiazide and lisinopril.
She is also prescribed calcium carbonate for osteoporosis.
The patient presents today for follow-up fasting
laboratory results, which show a glucose value of
164 mg/dL. A review of previous glucose data for
this patient reveals persistent elevations above
180 mg/dL for the past 6 months. The remainder of
her lab studies is within
normal limits. You consider oral antiglycemic therapy.
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