Rhoads Kristoffer, Isenberg Nancy, Schrier Allyson
University of Washington, Seattle, WA, USA.
Swedish Neuroscience Institute, Edmonds, WA, USA.
Alzheimers Dement. 2021 Dec;17 Suppl 8:e051217. doi: 10.1002/alz.051217.
Primary care providers are on the front lines of dementia care and frequently the first point of contact for individuals and families concerned about changes in memory and thinking. In addition to the challenges of managing complex medical comorbidities, primary care providers in rural or lower-resource settings often lack access to specialists, interdisciplinary teams or other programs and services to aid in diagnosis and care of individuals with mild cognitive impairment and dementia. The current project extends an existing technology-based hub and spoke model virtual clinic, Project ECHO (Extension for Community Healthcare Outcomes, University of New Mexico), to improve diagnosis and care of dementia in primary care.
The current project is an extension of work related to the Washington State Plan for Alzheimer's Disease and Other Dementias with implementation supported by legislative funding. The program includes an interdisciplinary expert panel ("hub") meeting with participants ("spokes") including primary and allied health care providers from healthcare systems, group practices, and solo practitioners. The twice-monthly virtual clinic sessions include a brief didactic followed by case-based learning in an "all-teach, all-learn" format emphasizing expertise and experience of spoke sites as well as the hub. Participants are provided with resources discussed during the clinic session, ongoing opportunities for consultation, and free continuing education credits.
Launching amid the COVID-19 pandemic, the program has provided over 250 hours of education to more than 50 providers across 20 unique sites. Post session surveys indicate that the program is well-received with 2 in 3 providers indicating that they will change their practice based on learning. Surveys also demonstrate significant increases in both knowledge and confidence in dementia-specific diagnosis and care.
The success of the current project demonstrates both the feasibility and benefit of leveraging technology to deliver dementia-related education to primary care providers in rural and under-resourced settings. While initially hampered by disruptions in care due to the COVID-19 pandemic, increased technological proficiency on the provider and systems level has appeared to be a benefit in terms of resources and comfort participating in a virtual education program to scale Dementia Capable Care in Primary Care.
初级保健提供者处于痴呆症护理的前沿，通常是关注记忆和思维变化的个人及家庭的首个接触点。除了应对复杂的医疗合并症带来的挑战外，农村或资源匮乏地区的初级保健提供者往往难以获得专家、跨学科团队或其他项目及服务，以协助诊断和护理轻度认知障碍及痴呆症患者。当前项目扩展了现有的基于技术的中心辐射型虚拟诊所——新墨西哥大学的社区医疗成果推广项目（Project ECHO），以改善初级保健中痴呆症的诊断和护理。
当前项目是与华盛顿州阿尔茨海默病及其他痴呆症计划相关工作的扩展，由立法资金支持实施。该项目包括一个跨学科专家小组（“中心”）与参与者（“辐射点”）会面，参与者包括来自医疗系统、团体诊所和个体从业者的初级及相关医疗保健提供者。每月两次的虚拟诊所课程包括简短的教学内容，随后是以“人人教学，人人学习”形式的基于案例的学习，强调辐射点及中心的专业知识和经验。会为参与者提供诊所课程中讨论的资源、持续的咨询机会以及免费的继续教育学分。
该项目在新冠疫情期间启动，已为20个不同地点的50多名提供者提供了超过250小时的教育。课后调查表明该项目受到广泛好评，三分之二的提供者表示他们将根据所学改变其诊疗方式。调查还显示，在痴呆症特定诊断和护理方面的知识和信心都有显著提高。
当前项目的成功证明了利用技术为农村和资源匮乏地区的初级保健提供者提供痴呆症相关教育的可行性和益处。虽然最初因新冠疫情导致护理中断而受阻，但提供者和系统层面技术熟练程度的提高，在资源和参与虚拟教育项目以扩大初级保健中痴呆症适宜护理规模的舒适度方面似乎是一项优势。
