What is professionalism, exactly? Part of a person's character? A set of learned behaviors? In a health care environment that demands increased levels of interprofessional collaboration, how important is it that individual providers understand professionalism across disciplines?
APTA recently hosted a roundtable via Google+ Hangouts event that brought together representatives from physical therapy, nursing, dentistry, pharmacy, and osteopathic medicine to talk about professionalism—what it is, how it's incorporated into education programs, and the importance of understanding how professionalism is manifested in other health care professions. A recording of the session is free to view on the APTA Interprofessional Education and Collaborative Practice Resources webpage.
Be sure to check out the other resources available on the Interprofessional Education and Collaborative Practice Resources webpage to get the latest information on how professions are learning to work together to provide patient- and client-centered care.
The Foundation for Physical Therapy now is accepting applications for the 2014 Florence P. Kendall Doctoral Scholarships and the 2014 Research Grants.
The Kendall Post-Professional Doctoral Scholarships assist physical therapists and physical therapist assistants with outstanding potential within their first year of postprofessional doctoral degree studies. Research grant opportunities are being offered as up to 2 Foundation grants, a Magistro Family Foundation Grant, and a grant for orthopedic research.
The deadline for all applications is Wednesday, August 6, 2014, noon ET—earlier than past years.
Questions? E-mail the Foundation or call 800/875-1378.
Be among the first to receive news about research, funding opportunities, and much more. Sign up today for the F4PT Alert mailing list by contacting Rachael Crockett.
For adults over 70, could the risk of falls due to the effects of antihypertensive medications outweigh the risks of not taking those medications? According to a recent study of nearly 5,000 community-living adults over 70 with hypertension, it's a valid question that should be asked at the individual level.
In an article e-published ahead of print (abstract only available for free) in the February 24 issue of JAMA Internal Medicine, researchers led by Mary Tinetti, MD,concluded that "antihypertensive medications were associated with an increased risk of serious fall injuries," with those taking antihypertensive medications who have already experienced a fall more than twice as likely to experience a subsequent serious fall than those who are not taking the drugs.
"The morbid effects associated with serious fall injuries … which are comparable to those imposed by myocardial infarction and stroke, suggest that treatment decisions should be predicated on maximizing benefit and minimizing harm," the authors wrote.
The study focused on participants in the Medicare Current Beneficiary Survey from 2004 – 2007 who were older than 70, in a community living environment, and were designated as a traditional Medicare beneficiaries (Medicare Advantage beneficiaries were excluded from the research). In all, 4961 participants with a claims-based diagnosis of hypertension were included with a mean age of 80.2 years. Just over 60% were female.
The group was further divided into 3 subgroups, a no-hypertensive medication group (697 participants), a moderate-intensity medication group (2711 participants), and a high-intensity medication group (1553 participants). Researchers then tracked falls incidents for all participants, but limited their review to only serious falls, "which are more clinically equivalent to the cerebrovascular and cardiovascular events that antihypertensive medications are prescribed to prevent."
According to the study, 446 of the 4961 participants experienced a serious fall injury, with 111 of those participants dying during the follow-up period (rates of death were higher for the medication groups, though it was unclear whether death was directly related to the fall). Broken down by subgroup, serious falls were experienced by 52 participants in the no-medication group, 267 in the moderate-intensity group, and 127 in the high-intensity group. When researchers looked further into the histories of the subgroups, they found that for those who had fallen in the year prior, risk of another fall more than doubled for the medication groups. They found no particular class of antihypertensive medication to be more strongly associated with falls risk than another.
"This article highlights some important factors PTs know, but they're ones that bear repeating and should be on our collective radar," says Mindy Renfro, PT, PhD, GCS, research assistant professor at the University of Montana. "Fall risk is multifactorial, and polypharmacy use is high on the list of modifiable risk factors. Cardiovascular medications, including antihypertensive medications, are only surpassed by psychoactive medications in increased risk for falls in all adults—but even more so in older adults. As the profession of choice for falls prevention and management, we need to consider these risk factors."
Authors acknowledged this risk and framed it in light of the relative benefits of antihypertensive medications. "Because most older hypertensive adults have had hypertension and been receiving treatment for many years," they write, "the clinical question is the likely benefit vs harm of continuing medications" at a time when serious falls risk has increased. Researchers wrote that because the morbidity and mortality associated with serious falls-related injuries such as hip fracture and head injury are comparable to morbidity and mortality associated with cardiovascular events, "It is important … to consider the effects of medications not only on the conditions for which the medications are indicated but on coexisting conditions, including fall injury risk."
Renfro pointed out that while health care providers must always be aware of medication effects, particular attention needs to be paid to when a patient begins taking a drug. "PTs and other health professionals should understand that falls due to antihypertensive or psychoactive meds occur most often in the first 2 weeks after a prescription change," she said.
“This research isn’t necessarily news for PTs, but it does point out how important it is for health professionals to recognize the effect that medications can have on a patient’s function, including the very serious risks associated with falls," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "Informing patients of the potential risks of medications and monitoring the effects of the medication on functioning—not just the effect of the medication on the condition being treated—must be considered, particularly in the older adult population."
Authors acknowledged that "although cause and effect cannot be established" through the study, the nationally representative data on older adults suggests an association between the medicines and falls risk strong enough that it should be weighed against the benefits of the drugs on an individual level. "The potential trade-off between serious fall injury and cardiovascular events and mortality suggests that each older adult's prevention priority should drive decision making," they write.
APTA provides continuing education on exercise prescriptions for balance improvement and falls prevention and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, information on evidence-based falls programs, and a clinical summary on falls risk in community-dwelling elderly. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as an online community where members can share information about falls prevention.
Hypertension clinical practice guidelines and their lack of information on physical activity was the subject of a recent PTNow blog post. Check it out—and join the conversation!
Research-related stories featured in News Now are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.
Read APTA's full website disclaimer.
Either you're on The List, or you're not on The List. And you definitely want to be on The List.
And you definitely need to be on The List by April 21.
Time is running out, but your school can still join "The List" of over 70 physical therapist and physical therapist assistant education programs participating in the Foundation for Physical Therapy's popular Miami – Marquette Challenge. The challenge encourages students to be creative in raising funds for physical therapy research, and awards prizes to the top performing schools.
Watch this video to learn more about the Foundation's largest fundraising event. Make your donation to this year's Miami-Marquette Challenge online or mail in the donation form (.pdf) to be sure your school or alma mater is on The List.
Physical therapist (PT) residency and fellowship education programs enrolling their first participants after December 31 will be required to follow new standards for American Board for Physical Therapy Residency and Fellowship Education (ABTRFE) accreditation.
The new procedures include applying for and obtaining recognition as a developing program followed by applying for and obtaining candidate status.
If a residency or fellowship program is currently developing and plans to enroll its first participant on or before December 31, 2014, that program must apply for accreditation using the current procedures by December 31, 2014. Any program that will not enroll its first participant until after December 31, 2014, must follow the new accreditation procedures.
More information, including the ABPTRFE Rules of Practice and Procedure and details on these new procedures, can be found on the ABPTRFE website. For additional questions, please contact APTA staff at email@example.com.
The enforcement delay for the Centers for Medicare and Medicaid Services' (CMS) "2 midnights" rule has apparently left an opening for a legal attack. This week, the American Hospital Association (AHA) announced that it has filed 2 lawsuits against the US Department of Health and Human Services challenging the rule as "wholly arbitrary," according to an AHA press release (.pdf).
Intended to reduce costly admissions in cases better suited to outpatient treatment, the rule stipulates that auditors can presume that an admission is reasonable and necessary if the patient spent at least 2 days as an inpatient, defined as spending 2 midnights in a hospital bed. AHA and some physician organizations view the rule as a usurpation of medical judgment by CMS.
The primary suit (.pdf), filed in the US District Court for the District of Columbia, states that "CMS’s newly-minted 'two-midnights' rule has deprived and will deprive hospitals of Medicare reimbursement for reasonable, medically necessary care they provide to patients. And the rule is arbitrary and capricious: It undoes decades of Medicare policy. It unwisely permits the government to supplant treating physicians’ judgment. And most important, it defies common sense. The word 'inpatient' simply doesn’t mean 'a person who stays in the hospital until Day 3,' and CMS is not at liberty to change the meaning of words to save money."
Although the rule was implemented in October 2013, Medicare Recovery Audit Contractors (RACs) were prohibited from auditing inpatient claims under the 2 midnights rule until September 30, 2014. When Congress passed the sustainable growth rate (SGR) patch legislation in March, the delay on enforcement was extended to March 31, 2015.
CMS still allows Medicare Administrative Contractors (MACs), who process claims for payment, to review and deny payment for short stays if the medical record does not support medical necessity under a “probe and educate” program. This program, which assesses provider understanding and compliance with the 2 midnights rule, will be carried out by the MACs on a prepayment basis through March 31, 2015.
AHA is joined in the lawsuit by several state hospital associations and individual hospitals.
Physical therapists (PTs) have until October 31 to submit abstracts for possible presentations at the 2015 World Confederation for Physical Therapy's (WCPT) Congress in Singapore May 1-4.
WCPT's International Scientific Committee is accepting proposals for platform and poster presentations of research or special interest reports. Platform presentations will be delivered in “classic” format (a session of 8 platform presentations with speakers presenting for 8 minutes) “rapid 5” format (combinations of 10 presentations each delivering key messages using no more than 5 slides in 5 minutes, followed by 15 minutes of discussion of all presentations), or a “state of the art” format (moderator leads a platform presentation session to include sequential high quality abstract presentations of 10 minutes). The "state of the art" format is reserved for presentations "in cutting edge fields likely to influence physical therapy practice," according to WCPT.
Posters will be on display for 1 day during exhibition hours, with presenters assigned a 45-minute period to discuss their poster with delegates.
For more information and instructions, visit the WCPT call for abstracts page, or contact René Malone. The WCPT Congress is held every 4 years, and is the world's largest gathering of physical therapists. APTA is a member organization of WCPT.
Think APTA membership matters? Have we got a week for you.
This week, APTA celebrates the importance of association membership through its "Membership Matters" campaign. It's a time for APTA members to celebrate their connection to the profession's association and to communicate the value of membership to others.
The APTA Membership Matters webpage offers a variety of inspirational resources, including videos and testimonials from physical therapists all over the country sharing why membership is important, and how the association has contributed to their own professional development. There's even a "Promoting Membership" page that offers tips on how to make the case for involvement in APTA.
As helpful as the tips may be, as always, it's the APTA members themselves who make the best case for joining. "I am unable to separate the value of being a physical therapist from the value of APTA," said Leslie Torburn PT, DPT, in her webpage testimonial. "They each exist as they are today because of the other."
With the Centers for Medicare and Medicaid Services' (CMS) release of provider payment data now 3 days old, media attention is turning to discussions of what the data really mean, and the American Medical Association (AMA) is facilitating the discussions by way of media guidelines and a webpage that explains how the data could be easily misinterpreted.
On its "9 ways CMS' claim data could mislead patients, reporters" page, AMA walks readers through issues of accuracy and context that should be considered before drawing conclusions from the massive amounts of data on payments to over 880,000 health care providers. AMA was opposed to the data release.
According to the AMA webpage, the "key takeaway" from the data is to "verify the data before you publish." The physicians' group cites problems from potential errors in actual numbers to the ways in which the data may not accurately represent a physician's entire patient population. Other shortcomings of the data, according to AMA, include its lack of information on patient demographics, the effects of geographic differences in coding and billing, and a lack of specificity around specialty descriptions. "Physicians who appear to have the same specialty could serve very different types of patients and provide a dissimilar mix of services, making some subspecialists appear to be 'outliers,' " the webpage states. APTA has similar concerns about the limits of the data.
APTA staff members are continuing to review the data, which contains information on some 37,000 physical therapists (PTs), and will share findings and updates in News Now and other APTA resources.
President Barack Obama moved quickly today to nominate a replacement for Kathleen Sebelius, who announced her resignation as Secretary of the US Department of Health and Human Services (HHS) on Thursday, by nominating Office of Management and Budget Director Sylvia Mathews Burwell for the post.
The Sebelius announcement came about 6 months after the flawed rollout of HealthCare.gov, the federal insurance marketplace intended to serve uninsured Americans. Although problems were fixed and the program met its goal of getting 7 million signups by March 31, Sebelius weathered harsh criticism for the initial problems.
Burwell has been involved in the federal government since the Clinton administration, having served as chief of staff to former Treasury Secretary Robert Rubin. Before taking the OMB job, she ran the Walmart Foundation and served as president of the Gates Foundation's Global Development Program. She received unanimous consent from the Senate for her appointment to OMB.
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