Parsons Elizabeth C, Mattox Elizabeth A, Beste Lauren A, Au David H, Young Bessie A, Chang Michael F, Palen Brian N
1 Pulmonary and Critical Care Section, and.
2 Division of Pulmonary and Critical Care.
Ann Am Thorac Soc. 2017 Feb;14(2):267-274. doi: 10.1513/AnnalsATS.201605-361BC.
Primary care providers (PCPs) frequently encounter sleep complaints, especially in regions with limited specialty care access.
The U.S. Department of Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program (based on Project ECHO) has successfully provided rural PCP education in subspecialty areas, including hepatitis C. We describe the feasibility of an ECHO program for sleep medicine.
ECHO creates a virtual learning community through video-teleconferencing, combining didactics with individualized clinical case review. We invited multidisciplinary providers to attend up to 10 stand-alone, 1-hour sessions. Invitees completed a needs assessment, which guided curriculum development. After program completion, we examined participant characteristics and self-reported changes in practice and comfort with managing sleep complaints. We surveyed participation barriers among invitees with low/no attendance.
Of the 39 program participants, 38% worked in rural healthcare. Participants included nurse practitioners (26%), registered nurses (21%), and physicians (15%). Seventeen (44%) completed the summative program evaluation. Respondents anticipated practice change from the program, especially in patient education about sleep disorders (93% of respondents). Respondents reported improved comfort managing sleep complaints, especially sleep-disordered breathing, insomnia, and sleep in post-traumatic stress disorder (80% of respondents each). A follow-up survey of program invitees who attended zero to two sessions reported scheduling conflicts (62%) and lack of protected time (52%) as major participation barriers.
Participants in a pilot sleep medicine VA-ECHO program report practice change and increased comfort managing common sleep complaints. Future work is needed to identify objective measures of return on investment and address participation barriers.
初级保健提供者（PCP）经常遇到睡眠相关的投诉，尤其是在专科护理服务有限的地区。
美国退伍军人事务部社区医疗成果扩展项目（VA - ECHO，基于ECHO项目）已成功在包括丙型肝炎在内的亚专科领域为农村初级保健提供者提供教育。我们描述了一个睡眠医学ECHO项目的可行性。
ECHO通过视频电话会议创建一个虚拟学习社区，将教学与个性化临床病例审查相结合。我们邀请多学科提供者参加多达10次独立的1小时课程。受邀者完成了一项需求评估，该评估指导了课程开发。课程结束后，我们检查了参与者的特征以及他们在处理睡眠投诉方面自我报告的实践变化和舒适度。我们调查了低出席率/未出席的受邀者参与的障碍。
在39名项目参与者中，38%在农村医疗保健机构工作。参与者包括执业护士（26%）、注册护士（21%）和医生（15%）。17人（44%）完成了总结性项目评估。受访者预计该项目会改变他们的实践，尤其是在对患者进行睡眠障碍教育方面（93%的受访者）。受访者报告称，在处理睡眠投诉方面，尤其是睡眠呼吸障碍、失眠和创伤后应激障碍中的睡眠问题时，舒适度有所提高（每项均为80%的受访者）。对参加零至两次课程的项目受邀者的后续调查显示，日程安排冲突（62%）和缺乏受保护时间（52%）是主要的参与障碍。
一个试点性的退伍军人事务部睡眠医学ECHO项目的参与者报告了实践变化以及在处理常见睡眠投诉方面舒适度的提高。未来需要开展工作来确定投资回报率的客观衡量标准并解决参与障碍。
