116 Chapter 5 training, future EPs in the Netherlands could benefit from this geriatric curriculum. However, current EPs could only benefit from courses, workshops or (local) education programs. The current study evaluates the effects of a local geriatric education program for EPs. Previous studies have addressed the importance of early detection of patients with geriatric syndromes at the ED and the ability of EPs to differentiate these syndromes from other cognitive impairments for the sake of effective and timely care [25]. Our program also had a positive impact on the understanding of elderly care agencies and organization structures in the community. This is an important finding considering that lack of knowledge about post-hospital care has been associated with poorly executed care transitions leading to high-risk events for elders, such as re-hospitalizations [26, 27]. Attitudes towards older adults did not change following the program. This finding corresponds with previous studies illustrating that change of attitudes towards older adults is complex [28], and that the ability of current measures to capture that complexity is questionable [29]. The lack of change in attitudesmay alsobe explainedby the content of theprogram, that is intentionally aimed to improve EPs’ knowledge and skills in geriatric emergency medicine rather than on altering (mis)perceptions of elderly and aging stereotypes. Furthermore, the intensity level and duration of the program may have been insufficient to realize considerable change in attitudes. Our finding that no significant attitudinal changes occurred toward elderly patients is in line with other studies assessing the attitude of EPs post geriatric training [21, 30]. The studied medical charts showed increased attention for the older patient’s socials history and circumstances. This is an important finding, because social circumstances have been identified as a key variable in understanding –and reducing– patient ED revisits [31-34]. Better understanding of the patient’s living situation, presence of informal carers and daily routines helps physicians to identify specific care needs and organize appropriate follow-up care. Although no statistically significant pre-post changes were found in medical decisions by EPs, the interviews provide a more nuanced view as EPs felt more inclined and confident to consult the geriatrician when caring for an older adult with suspected frailty. This is a promising finding knowing that early specialist review or advice by a geriatrician can improve the quality of care at the ED and disposition decisions for older adults [35,36]. Moreover, geriatric consultations also have an educational function by the dissemination of geriatric knowledge and provision of geriatric feedback by geriatricians to EPs [37]. Participant experiences with the program illustrate that web-based learning may be an effective strategy for reaching EPs who often work irregular hours and in separate shifts [38]. However, the interactive case-based sessions were considered most useful by EPs. Unraveling complex cases with fellow colleagues
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