2012 OSU OKGEC Professional Practice Gaps Survey

2012 Professional Practice Gaps: Rural Health Care Providers

Oklahoma State University (OSU) is a consortium partner of the Oklahoma Geriatric Education Center (OKGEC). Today, we are submitting the OSU/OKGEC 2012 Professional Practice Gaps Assessment (PPGA) to gather information needed to develop evidence-based programs related to Gerontology, Aging, and Geriatrics. We need your input to develop educational programs that supports the enhancement of best practices. Only selective OSU staff will see responses. Only summary findings will be reported; names will not be used. Thank you for participating. If you have questions, please contact Dr. Tammy Henderson at tlhokgec@okstate.edu or (405) 744-8350.

For conference information visit www.humansciences.okstate.edu/okgec
To register for the conference: www.surveymonkey.com/s/2012_OSU_OKGEC_Conference_Registration

DIRECTIONS: Please mark the appropriate box or insert your response.
For statistical and annual report purposes, please complete all pages of this form

1. Title (Mr., Mrs., Ms,)

Title (Mr., Mrs., Ms,)

2. Full name (First, MI, Last, Suffix)

Full name (First, MI, Last, Suffix)

3. Credential

Credential

4. Position

Position

5. Organization

Organization

6. Address

Address Home

Work

Please specify

7. City, State, ZIP

City, State, ZIP

8. Daytime phone

Daytime phone

9. Cellular Phone

Cellular Phone

10. Email (Please print clearly)

Email (Please print clearly)

11. Age Group

Age Group Less than 20 years old

40-49 years old

20-29 years old

50-59 years old

30-39 years old

60 or older

12. Gender

Gender Male

Female

13. Ethnicity

Ethnicity American Indian or Alaska Native Asian Black or African American	Native Hawaiian/ Other Pacific Islander White
Other (please specify)

14. Retired

Retired Yes

15. National Health Service Corps Member

National Health Service Corps Member Yes

16. Your most advanced degree

Your most advanced degree Elementary/ secondary school (GED) Associates Degree Diploma (e.g., RN) Bachelor Degree (e.g., BA, BSW)	Masters Degree (e.g., MSW, MS) Doctorate (e.g., PhD, EdD, DNP) MD DO
Other (please specify)

17. Certificate in Geriatrics

Certificate in Geriatrics Yes

18. Please indicate the clinical sites in which you work. (Check all that apply.)

Please indicate the clinical sites in which you work. (Check all that apply.) Check here if you do not have regular therapeutic contact with patients. For each location you check, please indicate the number of patient encounters you have in a average day.

19. For each location you check, please indicate the number of patient encounters you have in a average day.

	# of patients
Ambulatory Care Centers	For each location you check, please indicate the number of patient encounters you have in a average day. Ambulatory Care Centers # of patients
Assisted Living	Assisted Living # of patients
Chronic & Acute Hospitals	Chronic & Acute Hospitals # of patients
Home Care	Home Care # of patients
Hospice	Hospice # of patients
Nursing Homes	Nursing Homes # of patients
Palliative Care	Palliative Care # of patients
Senior Centers	Senior Centers # of patients
Senior Housing	Senior Housing # of patients
Telehealth	Telehealth # of patients

Other (please specify)

20. What is your profession?

What is your profession? Family Medicine Internal Medicine Psychiatry Other MD specialty Chiropractic LPN RN and/ or BSN NP CNS Other nursing specialty Clinical Laboratory Sci. Clinical Psychology/ Counseling	Dentistry Dental (Hygienist, Assist.) Dental Public Health EMT Gerontology Health Administration Health Education Health Information (Admin / Technicians) Home Health Aide/ Medical Assistant Law (Attorney, Paralegal) Law Enforecement/ Security Nursing Home Admin	Nutrition/ Food Services Pastoral Care Pharmacy Physician Associate Podiatry Preventive Medicine Protective Services Public Health Recreational Therapies Rehabilitation (Therapists/ Assistants in OT, PT, Speeach/ Audiology) Social Work Social/Behavioral Sciences
Other nursing specialty and other (please specify)

21. DIRECT CARE PROVIDERS: Do you spend at least 50% of your time in any of the following sites that serve underserved populations? (Check all that apply)

DIRECT CARE PROVIDERS: Do you spend at least 50% of your time in any of the following sites that serve underserved populations? (Check all that apply) Check here if none are applicable Community Health Center Dental Care in HPSA site Federally Qualified Health Center Governor designated area Health Care for Homeless Indian Health Service	Migrant Health Center Primary Care, Health Professional Shortage Area (HSPA) Public Housing Primary Care Rural Health Center State Designated Ambulatory Area Mental Health Center State or local Health Department
Other (please specify)

22. Primary Role: (Check one)

Primary Role: (Check one) Administrator/Manager Clinical Faculty Student, Specify:_________ Resident Fellow Resident	Fellow Academic Faculty In-Service/ Continuing Education Coordinator Health Care Practitioner (anyone in a field related to health care who shares responsibility for delivery of health care or related services)
Other (please specify)

23. 1. What is your preferred delivery format?

	First	Second	Third	Forth	Fifth
Face-to-Face Sessions	*1. What is your preferred delivery format? Face-to-Face Sessions First	Face-to-Face Sessions Second	Face-to-Face Sessions Third	Face-to-Face Sessions Forth	Face-to-Face Sessions Fifth
Live Webinar	Live Webinar First	Live Webinar Second	Live Webinar Third	Live Webinar Forth	Live Webinar Fifth
Online Webinar	Online Webinar First	Online Webinar Second	Online Webinar Third	Online Webinar Forth	Online Webinar Fifth
Conference	Conference First	Conference Second	Conference Third	Conference Forth	Conference Fifth

Other (please specify)

24. How interested would you be to receive an evidence-based presentation to enhance professional practices related to the following acute health conditions of older adults?

	Extremely	Very	Moderate	Mild	None
Arthritis	*How interested would you be to receive an evidence-based presentation to enhance professional practices related to the following acute health conditions of older adults? Arthritis Extremely	Arthritis Very	Arthritis Moderate	Arthritis Mild	Arthritis None
Bladder Control	Bladder Control Extremely	Bladder Control Very	Bladder Control Moderate	Bladder Control Mild	Bladder Control None
Deafness	Deafness Extremely	Deafness Very	Deafness Moderate	Deafness Mild	Deafness None
Falls, Preventing	Falls, Preventing Extremely	Falls, Preventing Very	Falls, Preventing Moderate	Falls, Preventing Mild	Falls, Preventing None
Hearing Aids	Hearing Aids Extremely	Hearing Aids Very	Hearing Aids Moderate	Hearing Aids Mild	Hearing Aids None
Hip Fracture	Hip Fracture Extremely	Hip Fracture Very	Hip Fracture Moderate	Hip Fracture Mild	Hip Fracture None
Hip Replacement	Hip Replacement Extremely	Hip Replacement Very	Hip Replacement Moderate	Hip Replacement Mild	Hip Replacement None
Knee Replacement	Knee Replacement Extremely	Knee Replacement Very	Knee Replacement Moderate	Knee Replacement Mild	Knee Replacement None
Sleep problems	Sleep problems Extremely	Sleep problems Very	Sleep problems Moderate	Sleep problems Mild	Sleep problems None
Human Sexuality	Human Sexuality Extremely	Human Sexuality Very	Human Sexuality Moderate	Human Sexuality Mild	Human Sexuality None
Cancer	Cancer Extremely	Cancer Very	Cancer Moderate	Cancer Mild	Cancer None
Cardiovascular Disease	Cardiovascular Disease Extremely	Cardiovascular Disease Very	Cardiovascular Disease Moderate	Cardiovascular Disease Mild	Cardiovascular Disease None
Chronic Respiratory Diseases	Chronic Respiratory Diseases Extremely	Chronic Respiratory Diseases Very	Chronic Respiratory Diseases Moderate	Chronic Respiratory Diseases Mild	Chronic Respiratory Diseases None
Diabetes	Diabetes Extremely	Diabetes Very	Diabetes Moderate	Diabetes Mild	Diabetes None
Cataract	Cataract Extremely	Cataract Very	Cataract Moderate	Cataract Mild	Cataract None
Glaucoma	Glaucoma Extremely	Glaucoma Very	Glaucoma Moderate	Glaucoma Mild	Glaucoma None
Dental Care	Dental Care Extremely	Dental Care Very	Dental Care Moderate	Dental Care Mild	Dental Care None
Dental Health and Cognitive Status	Dental Health and Cognitive Status Extremely	Dental Health and Cognitive Status Very	Dental Health and Cognitive Status Moderate	Dental Health and Cognitive Status Mild	Dental Health and Cognitive Status None
Dentures	Dentures Extremely	Dentures Very	Dentures Moderate	Dentures Mild	Dentures None
Mixing Medications with Dental Care	Mixing Medications with Dental Care Extremely	Mixing Medications with Dental Care Very	Mixing Medications with Dental Care Moderate	Mixing Medications with Dental Care Mild	Mixing Medications with Dental Care None
Oral Cancer	Oral Cancer Extremely	Oral Cancer Very	Oral Cancer Moderate	Oral Cancer Mild	Oral Cancer None
Nutrition and Oral Health	Nutrition and Oral Health Extremely	Nutrition and Oral Health Very	Nutrition and Oral Health Moderate	Nutrition and Oral Health Mild	Nutrition and Oral Health None
Personal Traits and Bruxism*	Personal Traits and Bruxism* Extremely	Personal Traits and Bruxism* Very	Personal Traits and Bruxism* Moderate	Personal Traits and Bruxism* Mild	Personal Traits and Bruxism* None
Tooth Loss	Tooth Loss Extremely	Tooth Loss Very	Tooth Loss Moderate	Tooth Loss Mild	Tooth Loss None
Aging Workplace	Aging Workplace Extremely	Aging Workplace Very	Aging Workplace Moderate	Aging Workplace Mild	Aging Workplace None
Working Retirement Part-Time	Working Retirement Part-Time Extremely	Working Retirement Part-Time Very	Working Retirement Part-Time Moderate	Working Retirement Part-Time Mild	Working Retirement Part-Time None
Financial & Retirement Planning	Financial & Retirement Planning Extremely	Financial & Retirement Planning Very	Financial & Retirement Planning Moderate	Financial & Retirement Planning Mild	Financial & Retirement Planning None
Transmission of Family Values	Transmission of Family Values Extremely	Transmission of Family Values Very	Transmission of Family Values Moderate	Transmission of Family Values Mild	Transmission of Family Values None
Transmission of Culture	Transmission of Culture Extremely	Transmission of Culture Very	Transmission of Culture Moderate	Transmission of Culture Mild	Transmission of Culture None

*NOTE: Bruxism refers to the clenching or grinding of teeth, especially at night.

25. How interested would you be to receive an evidence-based presentation to enhance professional practices related to the following issues of economics of aging?

	Extremely	Very	Moderate	Mild	None
Medicare	*How interested would you be to receive an evidence-based presentation to enhance professional practices related to the following issues of economics of aging? Medicare Extremely	Medicare Very	Medicare Moderate	Medicare Mild	Medicare None
Medicaid	Medicaid Extremely	Medicaid Very	Medicaid Moderate	Medicaid Mild	Medicaid None
Reverse Mortgage	Reverse Mortgage Extremely	Reverse Mortgage Very	Reverse Mortgage Moderate	Reverse Mortgage Mild	Reverse Mortgage None
Pre-Retirement	Pre-Retirement Extremely	Pre-Retirement Very	Pre-Retirement Moderate	Pre-Retirement Mild	Pre-Retirement None
Working Retirement Full-Time	Working Retirement Full-Time Extremely	Working Retirement Full-Time Very	Working Retirement Full-Time Moderate	Working Retirement Full-Time Mild	Working Retirement Full-Time None
Phased Retirement	Phased Retirement Extremely	Phased Retirement Very	Phased Retirement Moderate	Phased Retirement Mild	Phased Retirement None
Aging In Place	Aging In Place Extremely	Aging In Place Very	Aging In Place Moderate	Aging In Place Mild	Aging In Place None
Nursing Homes	Nursing Homes Extremely	Nursing Homes Very	Nursing Homes Moderate	Nursing Homes Mild	Nursing Homes None
Assistant Living	Assistant Living Extremely	Assistant Living Very	Assistant Living Moderate	Assistant Living Mild	Assistant Living None
Retirement Communities	Retirement Communities Extremely	Retirement Communities Very	Retirement Communities Moderate	Retirement Communities Mild	Retirement Communities None
Relocation	Relocation Extremely	Relocation Very	Relocation Moderate	Relocation Mild	Relocation None
Neighborhoods	Neighborhoods Extremely	Neighborhoods Very	Neighborhoods Moderate	Neighborhoods Mild	Neighborhoods None
Friendships	Friendships Extremely	Friendships Very	Friendships Moderate	Friendships Mild	Friendships None
Spiritual Activities	Spiritual Activities Extremely	Spiritual Activities Very	Spiritual Activities Moderate	Spiritual Activities Mild	Spiritual Activities None
Church Activities	Church Activities Extremely	Church Activities Very	Church Activities Moderate	Church Activities Mild	Church Activities None
Senior Day Services	Senior Day Services Extremely	Senior Day Services Very	Senior Day Services Moderate	Senior Day Services Mild	Senior Day Services None
Aging Workforce	Aging Workforce Extremely	Aging Workforce Very	Aging Workforce Moderate	Aging Workforce Mild	Aging Workforce None
Cultural Competence	Cultural Competence Extremely	Cultural Competence Very	Cultural Competence Moderate	Cultural Competence Mild	Cultural Competence None
Transmission of Cultural	Transmission of Cultural Extremely	Transmission of Cultural Very	Transmission of Cultural Moderate	Transmission of Cultural Mild	Transmission of Cultural None

26. Please give additional presentation topics and other suggestions that would support your promotion of the health and well-being of older adults in Oklahoma:

Please give additional presentation topics and other suggestions that would support your promotion of the health and well-being of older adults in Oklahoma:

Hit the submit button in this survey or Send comments to:
Dr. Tammy L. Henderson
Oklahoma State University
233 Human Sciences, Stillwater, OK 74078-6122.
OFFICE PHONE: 405-744-8350
EMAIL: tlhokgec@okstate.edu

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