RESUMEN
BACKGROUND: Project ECHO (Extension for Community Healthcare Outcomes) trains and mentors primary care providers (PCPs) in the care of patients with complex conditions. ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic based at the University of New Mexico Health Sciences Center that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. METHODS: Since 2005, specialists in treatment of SUDs and behavioral health disorders at Project ECHO have offered a weekly 2-hour Integrated Addictions and Psychiatry (IAP) TeleECHO Clinic focused on supporting PCP evaluation and treatment of SUDs and behavioral health disorders. We tabulate the number of teleECHO clinic sessions, participants, and CME/CEU (continuing medical education/continuing education unit) credits provided annually. This teleECHO clinic has also been used to recruit physicians to participate in DATA-2000 buprenorphine waiver trainings. Using a database of the practice location of physicians who received the buprenorphine waiver since 2002, the number of waivered physicians per capita in US states was calculated. The increase in waivered physicians practicing in underserved areas in New Mexico was evaluated and compared with the rest of the United States. RESULTS: Since 2008, approximately 950 patient cases have been presented during the teleECHO clinic, and more than 9000 hours of CME/CEU have been awarded. Opioids are the substances discussed most commonly (31%), followed by alcohol (21%) and cannabis (12%). New Mexico is near the top among US states in DATA-2000 buprenorphine-waivered physicians per capita, and it has had much more rapid growth in waivered physicians practicing in traditionally underserved areas compared with the rest of the United States since the initiation of the teleECHO clinic focused on SUDs in 2005. CONCLUSION: The ECHO model provides an opportunity to promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas.
Asunto(s)
Buprenorfina/uso terapéutico , Servicios de Salud Comunitaria/métodos , Educación Médica Continua/estadística & datos numéricos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Atención Primaria de Salud/métodos , Curriculum , Humanos , Telecomunicaciones/estadística & datos numéricosRESUMEN
Postpartum depression is a clinical depressive episode that occurs in 13% to 20% of women after birth or miscarriage. This illness has potentially devastating consequences for both mother and infant, and is thought to be highly underreported and under-diagnosed. Our study examined the use of the Postpartum Depression Screening Scale (PDSS) in a high-volume collaborative obstetric and midwifery practice. The prevalence of women with a positive screen for major postpartum depression in our study was 16%, which is consistent with other studies. An additional 20% of the participants had symptoms that indicated a potential postpartum depression. Obstetric clinicians were willing to use the PDSS, and 15 of 20 clinicians actively participated in the study. Women who had a positive screen at 6 weeks after birth were more likely to have not completed a high school education, be unpartnered, be exclusively bottle feeding, and have a history of depression. Two variables were statistically significant predictors of screening positively with the PDSS following logistic regression: history of depression (risk ratio, 4.8; 95% confidence interval, 4.4-5.2) and exclusive bottle feeding (risk ratio, 2.0; 95% confidence interval, 1.6-2.4).