PerspectiveIn the Journals

Telementoring program improves HIV practitioners’ confidence, knowledge

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July 5, 2016

Remote consultation programs connecting HIV specialists using real-time video appeared to improve practitioners’ self-reported confidence and efficacy, and encouraged connection with the wider HIV care community, according to recently published data.

“Clinicians practicing in [rural] communities are often strained by complex caseloads, infrequent access to colleagues for consultation, inadequate availability of specialists, and scarcity of behavioral health treatment services,” Brian R. Wood, MD, assistant professor of medicine in the division of allergy and infectious diseases at the University of Washington School of Medicine, and colleagues wrote. “Novel, technology-based strategies for provider support and education, such as distance telementoring, may reduce these barriers.”

In 2012, the University of Washington and Mountain West AIDS Education and Training Center developed a video-based HIV consultation and mentorship program based on a telehealth model established at the University of New Mexico. Using the system, community practitioners are able to connect with other experts and a multidisciplinary specialist panel in real-time to discuss clinically relevant topics and receive consultation.

Wood and colleagues evaluated the effectiveness of the Extension for Community Healthcare Outcomes (ECHO) program during the first few years of its implementation. From February 2012 to August 2015, they tracked the types of questions community providers most often asked other experts through the system. In addition, they asked participating providers to complete self-assessments of their HIV care at baseline and at regular intervals, and used these data to describe changes in provider knowledge and proficiency.

Twenty-one clinical sites were participating in the program by the end of August 2015, providing data from 172 sessions and 553 case discussions for analysis. Participants came from several specialties, reported a low volume of HIV patients under their care and little experience managing HIV.

Providers most often sought recommendations on changing ART, evaluating acute symptomatology or lab abnormalities, and assessing or treating mental health issues. Among the 45 participants who completed a baseline and at least one follow-up assessment, self-assessed confidence and overall knowledge of HIV care significantly improved during the study period. Providers also said they felt less isolated, more comfortable acting as a resource to peers and better connected to the HIV practice community as a whole.

“A critical component of the United States National HIV/AIDS Strategy is to ‘Take deliberate steps to increase the capacity of systems as well as the number and diversity of available providers of clinical care and related services for people living with HIV,’ ” the researchers wrote. “We believe this analysis validates the ECHO model as a strategy to bolster HIV care capacity, provide continuing HIV education and ensure a high quality of care across a broad geographic region.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.

itj+ Perspective

PERSPECTIVE
Jeremy D. Young

Jeremy D. Young

Telehealth can be used in a multitude of ways to provide expert care to patients and consultation to other health care providers. Given the dearth of subspecialists in many settings, such as the rural communities described in this research study, taking advantage of modern technologies to provide consultation, education and even direct patient care needs to be more widespread.

Using the ECHO model for HIV consultation and mentorship, as Dr. Wood and his colleagues are doing, is an excellent way of improving the clinical care of people living with HIV in communities with previously limited access to HIV expertise.


Jeremy D. Young, MD, MPH
Associate professor of medicine at the University of Illinois at Chicago

Disclosure: Young reports no relevant financial disclosures.