Health Care Provider Education: Older Farmers

Shannon Lizer PhD APN-CSDirector of NursingHighland Community CollegeFreeport 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?

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

– 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

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 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/simulation-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– 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

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?