Health Care Provider Education: Older

Farmers

Shannon Lizer PhD APN-CS

Director of Nursing
Highland Community College
Freeport 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

 IntentionalPrograms
 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/simulati
on-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

 Individualcourses 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?