Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
University of Cincinnati, Cincinnati, OH, USA.
Acad Psychiatry. 2023 Aug;47(4):360-367. doi: 10.1007/s40596-023-01800-x. Epub 2023 Jun 6.
The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach.
Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy. Secondary measures included self-reported practice change and emergency department (ED) mental health referrals 12 months pre- and post-course completion.
Sixteen out of 18 participants in cohort 1 and 21 out of 23 participants in cohort 2 completed the pre- and post-assessments. Clinical knowledge and self-efficacy showed statistically significant improvement pre- and post-course completion. ED mental health referrals from participant PCPs decreased by 34% (cohort 1) and 17% (cohort 2) after course completion.
These findings indicate that utilizing the Project ECHO format to provide subspecialist support and education on the treatment of depression can improve pediatric PCPs' clinical knowledge and confidence in their ability to independently treat depression. Secondary measures suggest that this can translate into practice change and improved treatment access with decreased ED referrals for mental health assessments by participant PCPs. Future directions include more robust outcomes measurement and developing more courses with an in-depth approach to a single or similar cluster of mental health diagnoses such as anxiety disorders.
通过采用综合、特定于疾病的方法，将社区医疗保健结果扩展模型（ECHO 项目）用于将专科支持扩展到青少年抑郁症的儿科医疗之家，以治疗青少年抑郁症。
儿童和青少年精神科医生构建了一门课程，培训社区儿科初级保健提供者（PCP）对抑郁症患者进行筛查、启动基于证据的干预措施，并提供持续管理。参与者的临床知识和自我效能感评估发生了变化。次要措施包括自我报告的实践变化和 12 个月课程完成前后的急诊部（ED）心理健康转诊。
队列 1 的 18 名参与者中的 16 名和队列 2 的 23 名参与者中的 21 名完成了预评估和后评估。临床知识和自我效能感在课程完成前后均显示出统计学上的显著改善。完成课程后，参与者 PCP 的 ED 心理健康转诊减少了 34%（队列 1）和 17%（队列 2）。
这些发现表明，利用 ECHO 项目格式提供治疗抑郁症的专科支持和教育可以提高儿科 PCP 的临床知识和对独立治疗抑郁症的能力的信心。次要措施表明，这可以转化为实践的改变，并改善治疗的机会，减少 ED 对参与者 PCP 进行心理健康评估的转诊。未来的方向包括更强大的结果测量和开发更多课程，采用深入的方法针对单一或类似的精神健康诊断集群，如焦虑障碍。
