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.
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.
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.
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.
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.
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。
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。
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。
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。
