Sockalingam Sanjeev, Arena Amanda, Serhal Eva, Mohri Linda, Alloo Javed, Crawford Allison
University of Toronto, Toronto, Ontario, Canada.
University Health Network, Toronto, Ontario, Canada.
Acad Psychiatry. 2018 Aug;42(4):451-457. doi: 10.1007/s40596-017-0735-z. Epub 2017 Jun 7.
OBJECTIVE: Project Extension for Community Healthcare Outcomes (Project ECHO©) addresses urban-rural disparities in access to specialist care by building primary care provider (PCP) capacity through tele-education. Evidence supporting the use of this model for mental health care is limited. Therefore, this study evaluated a mental health and addictions-focused ECHO program. Primary outcome measures were PCP knowledge and perceived self-efficacy. Secondary objectives included: satisfaction, engagement, and sense of professional isolation. PCP knowledge and self-efficacy were hypothesized to improve with participation. METHODS: Using Moore's evaluation framework, we evaluated the ECHO program on participant engagement, satisfaction, learning, and competence. A pre-post design and weekly questionnaires measured primary and secondary outcomes, respectively. RESULTS: Knowledge test performance and self-efficacy ratings improved post-ECHO (knowledge change was significant, p < 0.001, d = 1.13; self-efficacy approached significance; p = 0.056, d = 0.57). Attrition rate was low (7.7%) and satisfaction ratings were high across all domains, with spokes reporting reduced feelings of isolation. DISCUSSION: This is the first study to report objective mental health outcomes related to Project ECHO. The results indicate high-participant retention is achievable, and provide preliminary evidence for increased knowledge and self-efficacy. These findings suggest this intervention may improve mental health management in primary care.
目的:社区医疗成果项目拓展(Project ECHO©)通过远程教育培训提升初级保健提供者(PCP)的能力,以解决城乡在获得专科护理方面的差距。支持将该模式用于精神卫生保健的证据有限。因此,本研究评估了一个以精神健康和成瘾问题为重点的ECHO项目。主要结局指标是初级保健提供者的知识水平和自我效能感。次要目标包括:满意度、参与度和职业孤立感。假设初级保健提供者的知识水平和自我效能感会随着参与而提高。 方法:我们使用摩尔的评估框架,对ECHO项目的参与者参与度、满意度、学习情况和能力进行评估。采用前后设计,分别通过每周问卷调查来测量主要和次要结局。 结果:ECHO项目结束后,知识测试成绩和自我效能感评分有所提高(知识变化显著,p < 0.001,d = 1.13;自我效能感接近显著水平;p = 0.056,d = 0.57)。流失率较低(7.7%),所有领域的满意度评分都很高,参与讨论者表示孤立感有所减轻。 讨论:这是第一项报告与Project ECHO相关的客观精神卫生结局的研究。结果表明可以实现高参与者留存率,并为知识水平和自我效能感的提高提供了初步证据。这些发现表明,这种干预措施可能改善初级保健中的精神卫生管理。
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