Welcome to SCAN Health Plan Continuing Medical Education Program

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Its prevalence is estimated to at least double in the next 50 years as the population ages. AF confers a 5-fold risk of stroke, and one in five of all strokes is attributed to this arrhythmia. Ischemic strokes in association with AF are often fatal, and those patients who survive are left more disabled by their stroke and more likely to suffer a recurrence than patients with other causes of stroke. In consequence, the risk of death from AF-related stroke is doubled and the cost of care is increased 1.5-fold. Appropriate management of the AF patient has been shown to reduce the related morbidity and mortality.

Heart failure is increasing in both incidence and prevalence with roughly 5 million people in the United States having this disorder. This is partially a result of decreased mortality from myocardial infarction as a result of improved treatment, as well as improved treatment of the heart failure itself leading to prolonged survival. Heart failure is a major cause of sudden cardiac death with more than half of the deaths due to heart failure are from sudden cardiac death. The second leading cause of death in heart failur patients is due to progressive heart failure. The most important preexisting condition and the best predictor of sudden death is left ventricular dysfunction, the underlying cause of heart failure.Congestive heart failure is one of the top conditions leading to hospitalization among the elderly. It is important that physicians recognize and treat heart failure with knowledge of therapies that minimize mortality and morbidity.

Chronic Obstructive Pulmonary Disease (COPD) is a frequently encountered problem among primary care physicians managing older adults and geriatric patients. The prevalence of COPD has been increasing and although it can be treated, it cannot be cured, which results in it having a significant impact on healthcare.

Chronic Obstructive Pulmonary Disease (COPD) is a frequently encountered problem among primary care physicians managing older adults and geriatric patients. The prevalence of COPD has been increasing and although it can be treated, it cannot be cured, which results in it having a significant impact on healthcare.

As one ages the possibility of injuring oneself due to falling become an increasing concern to both patients and family members. Health care providers also need to be aware of this not uncommon occurrence since the overall population is aging and will result in an increased incidence of falling.

Hip fracture is often an inflection point in the quality of life for an older person. The relationship between falls and fractures is bidirectional with falls resulting in fractures as well as fractures resulting in falls. The potential for falls can be evaluated in the office setting and actions taken to minimize the risk. This is an important enough issue that CMS has included a falls measure in the CMS Star Quality Ratings, described in the introduction that follows.

Components of comprehensive geriatric assessment include medical, cognitive, affective, functional, social support, economic, environmental, advance directives, prevention, prognosis and patients' goals and preferences. This approach provides and organized methodology for performing geriatric assessment in a timely manner; and provides the basis for care plan for multiple chronic conditions. This approach is more efficient than the customary piecemeal evaluation that takes place in primary care today, as it engages the patients and/or his caregiver, and utilizes expertise from physicians, nurses and social workers, thereby avoiding duplication and misuse of healthcare professionals' time.

Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.

Public health experts have recognized that bone health and osteoporosis can have a significant impact on the overall health and wellbeing of Americans. Prevention and early recognition of the condition can lead to treatment of osteoporosis and related bone diseases which in turn will minimize the negative impact of osteoporosis on the elderly in particular.

Management of pain is often challenging in Long Term Care settings, particularly because many residents have some type of cognitive impairment that keeps them from readily self-reporting pain. In addition, myths such as the belief that pain should be expected in older adults and fears about potential addiction prevents many older adults and their family members from asking for pain medication. Similar concerns and beliefs by nurses and physicians may also contribute to poor pain management and resident suffering.

Long Term Care settings need to establish a comprehensive program that creates a systematic approach to pain management. A good pain management program needs to be resident focused and include pain assessment, interventions/treatments, monitoring, quality improvement and education for patients, families and staff. By establishing a systematic and comprehensive program, Long Term Care settings can ensure that residents have their pain goals met and do not suffer needlessly.

Establishing patient-centered goals of care and treatment limitations is an important component of care in patients facing advanced illness. At the same time, communication during serious illness can be difficult for patients as well as providers. Research has demonstrated that the ethical ideal for decision making, involving shared decision making between an informed patient and a physician knowledgeable in both the patient's values and achievable treatment outcomes, is far from the norm in clinical practice.

Improving communication about goals of care and treatment limitations requires that providers and patients (or their surrogates) develop a shared understanding of desired and achievable outcomes, which can be accomplished by incorporating key principles and a step-wise approach to the goals of care discussion. This approach leads to high levels of patient satisfaction as well as treatment decisions that truly reflect the patient's goals.

Urinary incontinence (UI) is a common and treatable problem, especially in women and the elderly. The prevalence of UI increases with age, but it is not a part of normal aging. In women over age 60 years the prevalence of UI ranges from 15% to 43%. In contrast, the prevalence of UI in men at all ages, ranges from 1.6% to 24%. Despite this, UI remains under diagnosed and underreported with only 32% of primary care physicians routinely asking all of their patients about UI, and 50%-75% of incontinent community-dwelling patients never describing their symptoms to physicians.