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Continuing Medical Education
School of Medicine, UAB |
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Online CME Courses
Course Catalog > Online Courses |
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The
Elderly and Comorbid Conditions
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Certified for 1 AMA PRA Category
1 Credit™
Co-Sponsored
by
the
University
of
Alabama
School
of
Medicine
Division of Continuing Medical Education and
The 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, clinicians 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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| SOURCE: |
| FACULTY: |
William
T. O'Byrne, MD
General Internist
Albuquerque, New Mexico |
| DISCLOSURE: |
| Dr.
O'Byrne has no commercial affiliations to disclose. |
| CME
PARTICIPATION: |
| To
participate in this program for CME credit, please review
the objectives before beginning the program. Take the course,
complete the case questions and evaluation before November
2, 2009 to receive CME credit. Your certificate will then
be available online. This process should take approximately
60 minutes. |
| ACCREDITATION: |
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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.
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| DISCLAIMER: |
| Dosages,
indications, and methods of use of any drug referred to in
this online course 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. |
| INTRODUCTION: |
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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: |
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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