scholarly journals Distance learning: the “Extension for Community Healthcare Outcomes: ECHO” project: a case study

2021 ◽  
Vol 9 (40) ◽  
pp. 60-64
Author(s):  
Jularat Panyayen ◽  
Teerapat Nantsupawat ◽  
Wittawat Tangwijitsakul ◽  
Nopakoon Nantsupawat
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Critical Care Patient ◽  
Care Patient ◽  
Case Conference ◽  
Healthcare Outcomes ◽  
Community Healthcare ◽  
Primary Care Teams ◽  
Key Words Telemedicine

This article reports a case conference that was part of the Extension for Community Healthcare Outcomes (ECHO®) project, which is a model of monthly telemedicine conferences on chronic disease and behavioral health, important topics for primary care teams in rural areas and for university-based specialists. The ECHO® project has proved to be a successful learning model in health care. The main goal of the project is moving knowledge not the patients, so this tele-mentoring builds capacity and creates access to high-quality specialty care serving local communities. A secondary goal is shared learning between community providers and specialists about best practices that are practical, achievable, and sustainable for the community. We present the case of a critical care patient who was brought to the emergency department with left-side weakness and dysarthria. Computed tomography of the head and electrocardiograms established the diagnosis during the admission. Discussion points from a multidisciplinary team and specialty consultants via telemedicine are listed in this article. Key words: telemedicine, teleconsulting, primary care, developing countries, rural area

scholarly journals The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5656
Author(s):  
Krzysztof Studziński ◽  
Tomasz Tomasik ◽  
Adam Windak ◽  
Maciej Banach ◽  
Ewa Wójtowicz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Primary Care Patient ◽  
Care Patient ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Rural Primary Care

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (p = 43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.

scholarly journals New teams in general practice

2018 ◽  
Vol 11 (9) ◽  
pp. 506-512 ◽  
Author(s):  
Kamila Hawthorne ◽  
Ben Jackson ◽  
Danielle Fisher
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Continuity Of Care ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Healthcare Outcomes ◽  
Complex Patients ◽  
Primary Care Teams ◽  
A Priority ◽  
Parallel Stream

The NHS is seriously under-doctored, with general practice being one of the worst-affected specialties. GPs are a highly trusted and valued profession by patients. In addition, the ‘gatekeeping’ function and continuity of care they provide is critical to the efficiency of the services as a whole, keeps hospital admissions down, and produces better healthcare outcomes for communities and populations. Major efforts are being made to recruit new GPs and retain existing GPs, but there are serious implications for the future of primary care, and general practice in particular, as GPs struggle to cope with increased workloads. Increasing the number of GPs in the workforce is critical, and this work continues as a priority. However, a parallel stream of work has developed to consider ways in which tasks ‘traditionally’ undertaken by a GP might be diverted to new healthcare professionals within primary care teams, freeing up GPs to concentrate on the care and management of their more complex patients.

scholarly journals A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial (Preprint)

2017 ◽  
Author(s):  
Graciela Rojas ◽  
Viviana Guajardo ◽  
Pablo Martínez ◽  
Ariel Castro ◽  
Rosemarie Fritsch ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Rural Areas ◽  
Care Program ◽  
Open Label ◽  
Rural Primary Care ◽  
Primary Care Teams ◽  
Clinical Records

BACKGROUND In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. OBJECTIVE The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. METHODS In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. RESULTS Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). CONCLUSIONS Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. CLINICALTRIAL Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ)

scholarly journals Impact of Sleep Telementorship in Primary Care: Sleep VA-ECHO (Veterans Affairs-Extension for Community Healthcare Outcomes)

2021 ◽  
Vol 18 (18) ◽  
pp. 9914
Author(s):  
Brian N. Palen ◽  
Elizabeth A. Mattox ◽  
Ken He ◽  
Lauren A. Beste ◽  
Joleen Borgerding ◽  
...  
Keyword(s):  
Primary Care ◽  
Sleep Disorders ◽  
Nurse Practitioners ◽  
Veterans Affairs ◽  
Program Participation ◽  
Healthcare Outcomes ◽  
Community Healthcare ◽  
Team Members ◽  
Pharmacologic Management

Sleep VA-ECHO (Veterans Affairs–Extension for Community Healthcare Outcomes) is a national telementorship program intended to improve knowledge about sleep disorders among non-specialty providers. The project goal was to describe the characteristics of Sleep VA-ECHO participants from primary care and their use of program-obtained knowledge in practice. Sleep VA-ECHO consisted of 10 voluntary, 75-min teleconference sessions combining didactics and case discussion. Out of 86 participants, 21 self-identified as primary care team members and completed a program evaluation. Participants self-reported their application of knowledge gained, including changes to practice as a result of program participation. These 21 participants represented 18 sites in 11 states and attended a median of 5.0 sessions. They included physicians (29%), nurse practitioners (24%), and registered nurses (24%). Nearly all participants (95%) reported using acquired knowledge to care for their own patients at least once a month; 67% shared knowledge with colleagues at least once a month. Eighty-five percent reported improved quality of sleep care for their patients, and 76% reported an expanded clinical skillset. The greatest self-reported change in practice occurred in patient education about sleep disorders (95%) and non-pharmacologic management of insomnia (81%).

scholarly journals Counterintuitive results from observational data: a case study and discussion

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026447 ◽  
Author(s):  
Erik Doty ◽  
David J Stone ◽  
Ned McCague ◽  
Leo Anthony Celi
Keyword(s):  
Intensive Care ◽  
Medical Information ◽  
Current Knowledge ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Critical Care Patient ◽  
Care Patient ◽  
Hospital Length ◽  
Hospital Length Of Stay

ObjectiveTo explore the issue of counterintuitive data via analysis of a representative case in which the data obtained was unexpected and inconsistent with current knowledge. We then discuss the issue of counterintuitive data while developing a framework for approaching such findings.DesignThe case study is a retrospective analysis of a cohort of coronary artery bypass graft (CABG) patients. Regression was used to examine the association between perceived pain in the intensive care unit (ICU) and selected outcomes.SettingMedical Information Mart for Intensive Care-III, a publicly available, de-identified critical care patient database.Participants844 adult patients from the database who underwent CABG surgery and were extubated within 24 hours after ICU admission.Outcomes30 day mortality, 1 year mortality and hospital length of stay (LOS).ResultsIncreased pain levels were found to be significantly associated with reduced mortality at 30 days and 1 year, and shorter hospital LOS. A one-point increase in mean pain level was found to be associated with a reduction in the odds of 30 day and 1 year mortality by a factor of 0.457 (95% CI 0.304 to 0.687, p<0.01) and 0.710 (95% CI 0.571 to 0.881, p<0.01) respectively, and a 0.916 (95% CI −1.159 to –0.673, p<0.01) day decrease in hospital LOS.ConclusionThe finding of an association between increased pain and improved outcomes was unexpected and clinically counterintuitive. In an increasingly digitised age of medical big data, such results are likely to become more common. The reliability of such counterintuitive results must be carefully examined. We suggest several issues to consider in this analytic process. If the data is determined to be valid, consideration must then be made towards alternative explanations for the counterintuitive results observed. Such results may in fact indicate that current clinical knowledge is incomplete or not have been firmly based on empirical evidence and function to inspire further research into the factors involved.

Dermatology ECHO: A case presentation demonstrating benefits of specialty telementoring in primary care

2018 ◽  
Vol 25 (8) ◽  
pp. 506-509 ◽  
Author(s):  
Ryan Ladd ◽  
Mirna Becevic ◽  
Hope Misterovich ◽  
Karen Edison
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Healthcare Outcomes ◽  
Care Providers ◽  
Community Healthcare ◽  
Rural Primary Care ◽  
Timely Access ◽  
New Treatment ◽  
Allergic Contact ◽  
Improve Patient

Allergic contact dermatitis (ACD) is a common dermatologic disorder that is estimated to affect 15–20% of the general population. Because of its prevalence, it may be expected that ACD should be easily recognized. However, it can present with many clinical variations that may complicate diagnosis. Although ACD is a treatable condition, patients from rural and underserved areas suffer if timely access to specialty care is limited. Dermatology Extension for Community Healthcare Outcomes (Dermatology ECHO) telemedicine sessions were created to mentor rural primary care providers (PCPs). To illustrate their benefit, we present the case of a 19-year-old female patient who suffered from worsening undiagnosed ACD for over nine months following a laparoscopic appendectomy. During that time, the surgeon and multiple PCPs treated her with antibiotics, antivirals, and Scabicide without improvement in her condition. The de-identified patient case was presented by her PCP during the Dermatology ECHO session. The Dermatology ECHO specialty team mentored and educated the PCP in the diagnosis and treatment of ACD. After making the diagnosis, the patient received new treatment and her condition improved significantly. Dermatology ECHO provides a knowledge-sharing network for participating PCPs that may improve patient outcomes and reduce patient suffering.

scholarly journals Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

2021 ◽  
Vol 9 (1) ◽  
pp. e002262
Author(s):  
Ashby F Walker ◽  
Nicolas Cuttriss ◽  
Michael J Haller ◽  
Korey K Hood ◽  
Matthew J Gurka ◽  
...  
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Diabetes Care ◽  
Primary Care Providers ◽  
Health Centers ◽  
Medical Decision ◽  
Diabetes Knowledge ◽  
Healthcare Outcomes ◽  
Community Healthcare

IntroductionProject ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs’ abilities to manage patients with T1D.Research design and methodsHealth centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences.ResultsIn Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01).ConclusionsThe ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.

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