ENDO ECHO IMPROVES PRIMARY CARE PROVIDER AND COMMUNITY HEALTH WORKER SELF-EFFICACY IN COMPLEX DIABETES MANAGEMENT IN MEDICALLY UNDERSERVED COMMUNITIES

• Published in: Endocrine practice Vol. 24; no. 1; pp. 40 - 46
• Main Authors: Bouchonville, Matthew F, Hager, Brant W, Kirk, Jessica B, Qualls, Clifford R, Arora, Sanjeev
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.01.2018
• Subjects: Activities of daily living; Behavior; Chronic illnesses; Clinical Competence; Clinical medicine; Community Health Workers - education; Curriculum; Diabetes; Diabetes Mellitus - therapy; Disease Management; Endocrinology - education; Health care access; Health sciences; Hepatitis; Humans; Interdisciplinary Placement; Medical personnel; Medically Underserved Area; Mental depression; Mentoring - methods; New Mexico; Patient Care Team; Patients; Physicians; Physicians, Primary Care - education; Practice Guidelines as Topic; Primary care; Rural areas; Self Efficacy; Systematic review; Videoconferencing; New Mexico; United States > US
• ISSN: 1530-891X; 1934-2403
• DOI: 10.4158/EP-2017-0079

To determine whether participation in a multidisciplinary telementorship model of healthcare delivery improves primary care provider (PCP) and community health worker (CHW) confidence in managing patients with complex diabetes in medically underserved regions. We applied a well-established healthcare delivery model, Project ECHO (Extension for Community Healthcare Outcomes), to the management of complex diabetes (Endo ECHO) in medically underserved communities. A multidisciplinary team at Project ECHO connected with PCPs and CHWs at 10 health centers across New Mexico for weekly videoconferencing virtual clinics. Participating PCPs and CHWs presented de-identified patients and received best practice guidance and mentor-ship from Project ECHO specialists and network peers. A robust curriculum was developed around clinical practice guidelines and presented by weekly didactics over the ECHO network. After 2 years of participation in Endo ECHO, PCPs and CHWs completed self-efficacy surveys comparing confidence in complex diabetes management to baseline. PCPs and CHWs in rural New Mexico reported significant improvement in self-efficacy in all measures of complex diabetes management, including PCP ability to serve as a local resource for other healthcare providers seeking assistance in diabetes care. Overall self-efficacy improved by 130% in CHWs ( P<.0001) and by 60% in PCPs ( P<.0001), with an overall large Cohen's effect size. Among PCPs and CHWS in rural, medically underserved communities, participation in Endo ECHO for 2 years significantly improved confidence in complex diabetes management. Application of the ECHO model to complex diabetes care may be useful in resource-poor communities with limited access to diabetes specialist services. CHW = community health worker; CME = Continuing Medical Education; ECHO = Extension for Community Healthcare Outcomes; FQHC = federally qualified health center; PCP = primary care provider.