Case study - Learning outcomes
Case study - Learning outcomes
Click on the case study title below to view its learning outcomes
- Anticholinergic burden: reducing the impact on older people (For pharmacists and nurses)
- Chronic pain: Supporting patients to taper opioids
- Diagnostic imaging in ankle and knee injuries
- Navigating inhaled medicines management in COPD
- Opioid analgesics: Safe use for acute postoperative pain (For pharmacists and nurses)
- Optimising rheumatoid arthritis treatment
- Otitis media: Clarifying the role of antibiotics
- Practical tools for osteoarthritis management
- Preventing fractures: where to start with osteoporosis
- Safe use of opioid analgesics for acute pain in the Emergency Department (For pharmacists and nurses)
- Tailoring initial treatment in depression: Re-examining the options
- Taking action for acute low back pain
- Urinary tract infections: exploring antibiotic treatment
Anastasia is a new resident at your residential aged care facility. You identify risk factors that make her more susceptible to anticholinergic burden.
How would you help facility staff manage her case?
Learning outcomes
This case study consists of the following activities, which should be completed in this order:
- Pre-module self-assessment questions (optional)
- Interactive learning module (completion required)
- Post-module self-assessment questions (optional)
A 42-year-old woman requests a repeat prescription for opioids at a first consultation with a GP she has not seen before. She has chronic non-cancer pain and has been taking opioids for 4 years. Where do you go from here?
Learning outcomes
On completion of this case study, you should be able to:
- Discuss contributing psychosocial factors with patients with chronic non-cancer pain to develop individualised goals that improve function and quality of life.
- Explain the limited role of opioids in the management of chronic non-cancer pain to better inform patients of their treatment options.
- Review and identify patients who may benefit from tapering opioids to reduce adverse effects of long-term opioid use.
- Implement effective communication when discussing tapering with patients to support lowering or stopping opioids.
- Apply referral criteria to identify patients who may require additional support and access to specialists to improve health outcomes.
This course presents two case histories of injuries (ankle and knee) commonly seen in general practice, with questions designed to lead you through the diagnosis and management of each injury.
Learning outcomes
On completion of this case study, you should be able to:
- Apply Ottawa Knee Rules and Ottawa Ankle Rules to help decide whether an X-ray is required for a probable acute knee/ankle fracture.
- Identify appropriate physical tests based on a targeted history to diagnose acute knee/ankle injury.
- Explain the limited role of MRI in diagnosing acute ACL/meniscal tear.
- Explain the limited role of ultrasound in diagnosing lateral ankle sprain.
- Identify relevant clinical information to include in a detailed imaging referral for acute knee/ankle injury.
How do we navigate the confusing array of inhaled medicines for chronic obstructive pulmonary disease (COPD) to ensure optimal symptom management with minimal side effects?
This case study has content and questions tailored to different health professions.
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Tailor a patient’s medicines to the level and progression of COPD symptoms, using stepwise management based on COPD-X Guidelines.
- Describe the place of inhaled corticosteroids in therapy and outline the risks associated with their use in COPD.
- Review a patient’s medicines list when changing therapy, after an exacerbation or after transitions in care, to avoid harmful duplications.
- Describe key considerations that may influence choice of inhaler.
- Implement a practice-based approach to ensure patients receive training in inhaler technique and both technique and adherence are regularly monitored.
Pharmacists, nurses and other health profesionals
On completion of this case study, you should be able to:
- Outline the stepwise approach to medicines management in COPD, based on COPD-X Guidelines
- Review a patient's medicines list after therapy is changed, exacerbations or transitions in care, to avoid harmful duplications
- Recognise the importance of assessing and demonstrating inhaler technique to help patients use inhalers effectively
- Implement a systematic (or practice-based) approach to ensure patient inhaler technique and adherence are regularly taught and monitored.
Jenny is a 73-year-old woman scheduled for a total knee replacement. She has been taking an oral modified-release opioid analgesic for the last 6 months.
How will you ensure that her pain is effectively and safely managed after her surgery and on transition back into the community?
Learning outcomes
Prescribers, nurses and others
On completion of this activity, for patients with acute pain after surgery, you should be able to:
- Assess both pain intensity and impact of acute postoperative pain on a patient's function to guide appropriate choice of analgesia.
- Apply the biopsychosocial model of pain to develop a tailored pain management plan.
- Select multi-modal management strategies based on individual patient factors, to safely and effectively manage acute postoperative pain and minimise risk of harm from opioid analgesics.
- Identify and manage adverse effects of opioid analgesics to ensure safe use.
- Discuss pain management options and discharge planning with patients and their carers, and provide appropriate information to minimise risks and support recovery.
Pharmacists
On completion of this activity, for patients with acute pain after surgery, you should be able to:
- Describe how to assess both pain intensity and impact of acute postoperative pain on a patient's function to guide appropriate choice of analgesia.
- Describe the biopsychosocial model of pain to develop a tailored pain management plan.
- Select multi-modal management strategies based on individual patient factors, to safely and effectively manage acute postoperative pain and minimise risk of harm from opioid analgesics.
- Identify and manage common adverse effects of opioid analgesics to ensure safe use.
- Discuss pain management options and discharge planning with patients and their carers, and provide appropriate information to minimise risks and support recovery.
How do pharmacists counsel patients taking medicines for rheumatoid arthritis and address barriers to low-dose methotrexate use that their patients may face?
This case study has content and questions tailored to pharmacists.
Learning outcomes
On completion of this case study, you should be able to:
- Identify methotrexate as the recommended first line therapy in rheumatoid arthritis (RA) for most patients.
- Define the role of folic acid in managing adverse effects of methotrexate therapy.
- Recognise potential barriers to patient adherence and help overcome them by counselling patients and dispelling common myths about methotrexate therapy.
- Reinforce the importance of ongoing monitoring in RA to assess disease activity, treatment efficacy and adverse effects.
- Recommend strategies to help patients with RA undertake lifestyle modifications such as stopping smoking and managing their weight.
This activity examines and clarifies the role of antibiotics for acute otitis media, using two different patient presentations.
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Outline recommended pharmacological management of acute otitis media (AOM)
- Assess the need for antibiotic therapy in patients with AOM
- Reassure patients and/or their carers that in most cases, AOM can be adequately managed without antibiotics
- Recognise appropriate prevention strategies for AOM
- Deliver appropriate management of AOM using risk factor assessment and shared decision making with the patient and/or their carer
Pharmacists, nurses and other health profesionals
On completion of this case study, you should be able to:
- Outline recommended pharmacological management of acute otitis media (AOM)
- Reassure patients and/or their carers that in most cases, AOM can be adequately managed without antibiotics
- Identify appropriate prevention strategies for AOM
- Recognise when antibiotic therapy may be needed in patients with AOM
How do healthcare professionals meet the challenges of putting into practice the non-pharmacological treatment options that are the core management for patients with osteoarthritis (OA)
Learning outcomes
On completion of this case study, you should be able to:
- Recognise the central role of non-pharmacological management, including education, self-management, weight management and exercises.
- Explain the appropriateness of OA management strategy based on guidelines, considering patient safety, preferences, motivations, needs and goals.
- Contribute to the development of an individualised OA management plan with a patient.
- Contribute to the implementation of a weight loss program, including adherence.
- Identify different types of exercises and their role in OA management.
During a recent hospital admission, a chest X-ray revealed a vertebral fracture in a 57-year-old man. How would you assess for risk of osteoporotic fracture risk, and what are the management options?
Learning outcomes
On completion of this case study, you should be able to:
- implement a systematic approach to assess, manage and monitor osteoporotic fracture risk
- recognise risk factors for osteoporotic fractures to determine those requiring investigation
- recognise secondary causes of osteoporosis for prevention of osteoporosis or management of osteoporotic fracture risk
- outline management options for those at increased risk of osteoporotic fractures (the role of lifestyle as a complement to pharmacotherapy)
- identify strategies to promote adherence to management in patients being treated for osteoporosis.
Two different patients with depression. How would you progress their initial care?
Learning outcomes
General practitioners
On completion of this activity, you should be able to:
- Develop management plans in collaboration with patients who have depression.
- Suggest non-pharmacological interventions first-line for mild and moderate depression when these can be as or more effective than antidepressant medicines.
- Select and trial a suitable antidepressant considering both medicine and patient characteristics, when starting pharmacological treatment.
- Employ strategies to improve patient adherence to treatment.
- Implement a systematic approach to starting and assessing treatment for depression, in line with current guidelines.
Pharmacists
On completion of this activity you should be able to:
- Discuss management plans with patients who have depression.
- Outline non-pharmacological interventions for mild and moderate depression that are likely to be as or more effective than antidepressant medicines.
- Assess for, and discuss, adverse effects of antidepressants.
- Employ strategies to improve patient adherence to treatment with antidepressant medicines.
Nurses and other health professionals
On completion of this activity you should be able to:
- Develop management plans with patients who have depression.
- Outline non-pharmacological interventions for mild and moderate depression that are likely to be as or more effective than antidepressant medicines.
- Assess for, and discuss, adverse effects of antidepressants.
- Employ strategies to improve patient adherence to treatment with antidepressant medicines.
Brian, a 21-year-old male, presents to the emergency department complaining of severe pain in his chest, due to an injury.
How will you ensure that his pain is effectively and safely managed in the emergency department and on transition back into the community?
Learning outcomes
Prescribers, nurses and others
On completion of this activity you should be able to:
- Assess both pain intensity and impact of acute pain on a patient’s function to guide appropriate choice of analgesia.
- Select multi-modal management strategies based on individual patient factors, to safely and effectively manage acute pain and minimise risk of harm from opioid analgesics.
- Identify and manage adverse effects of opioid analgesics to ensure safe use.
- Discuss pain management options with patients and their carers, and provide appropriate information to minimise risks and support recovery.
Pharmacists
On completion of this activity you should be able to:
- Describe how to assess both pain intensity and impact of acute pain on a patient’s function to guide appropriate choice of analgesia.
- Select multi-modal management strategies based on individual patient factors, to safely and effectively manage acute pain and minimise risk of harm from opioid analgesics.
- Identify and manage common adverse effects of opioid analgesics to ensure safe use.
- Discuss pain management options with patients and their carers, and provide appropriate information to minimise risks and support recovery.
Kyle, a 47-year-old man, presents with a history of low back pain for 8 days. He wants to know if he has damaged his back and is requesting imaging. What now?
Learning outcomes
General practitioners
On completion of this activity, you should be able to:
- Use a targeted history and physical examination to diagnose low back pain.
- Identify the limited role of imaging for low back pain, except when an underlying serious condition is suspected.
- Use a risk stratification approach to identify risk factors for poor prognosis for patients with low back pain at the first or second consultation.
- Outline the benefits of activity and the limited role of medicines in managing low back pain.
Nurses, pharmacists and other health professionals
On completion of this activity you should be able to:
- Explain to a patient that low back pain is diagnosed through a targeted history and physical examination.
- Identify the limited role of imaging for low back pain, except when an underlying serious condition is suspected.
- Use a risk stratification approach to identify risk factors for poor prognosis for patients with low back pain.
- Outline the benefits of activity and the limited role of medicines in managing low back pain.
In this case study you will meet an 82-year-old woman who is a resident in the local residential aged-care facility. Today her carer reports the symptom of urge incontinence and goes to the toilet frequently at night.
Learning outcomes
On completion of this case study, you should be able to:
- classify diagnosis based on presenting symptoms
- define management of a urinary tract infection to reduce antibiotic resistance
- determine prophylactic management options for recurrent urinary tract infections
- implement a systematic approach to review patient’s current medicines and their ongoing use.
