CHRONIC DISEASE MANAGEMENT

Transcription

1 CHRONIC DISEASE MANAGEMENT VIA TELEMEDICINE TELEHEALTH VISION Telehealth / Telemedicine uses audiovisual technologies to link healthcare providers, patients, educators, consumers and their families to a comprehensive continuum of care and education, reducin the isolation of living and working in rural communities. NORTH COUNTRY HEALTHCARE SERVICE AREA 1

2 NORTH COUNTRY SERVICES Clinical Primary Care FM, IM, OB/GYN, Pediatrics Dental Behavioral Health Prenatal Care Breast & Cervical Cancer Screening Diabetes Management Program Integrative Medicine Pharmacy HIV/AIDS HCV (Hepatitis C) Community Health Well Woman Program Health Coach Program Fit At Fifty Health Check Programs Prenatal & Well Child Programs Diabetes Management RESEP HIV/AIDS Program NACASA Hermosa Vida Educational / Administrative Human Resources CME Community Health Education Research HEPATITIS C CARE AT NORTH COUNTRY In 2011: 950+ patients with a Hepatitis C diagnosis Today (2016): 2500 patients with diagnosis EXTREMELY-LIMITED ACCESS TO CARE Virtually none of these patients were receiving Hep C care Rurality of location No Hep C providers in their communities of residence. To receive treatment patients drove to Phoenix, or to Flagstaff Flagstaff had a one-day-per-month Hep C treatment program A 6 month-long waiting list to receive treatment 2

3 SERVING THE NEED Due to this need, NCH determined to implement a Hep C program providing care to patients via telemedicine. NCH - HEP C PROGRAM HISTORY The NCH Hep C program started 2011 Richard Manch, MD and Ann Moore, FNP. Were then employed by Banner Health Care Would Manch/Moore be willing to provide Hep C care to pts at remote NCH satellite clinics, via telemedicine? More than 100 direct patients consults occurred in the ensuing year. IN-PERSON CARE V. TELEMEDICINE In late 2012, Banner changed the focus of their liver program. Manch/Moore then moved to St Joseph Hospital/Dignity Health. NCH Hep C program was closed in the interim, for a number of months. 3

4 IMPLEMENTING THE PROJECT ECHO MODEL When restarted, the NCH Hep C program was modeled on the University of New Mexico s Project ECHO program New Mexico, a largely rural state like Arizona, had a real scarcity of providers capable of providing Hep C care to patients Rural patients had previously traveled to Albuquerque for treatment, which was a hardship for many. PROJECT ECHO MODEL - HISTORY In year 2003, Sanjeev Arora MD, at the University of New Mexico created Project ECHO ECHO = Extensions for Community Healthcare Outcomes Project ECHO joined UNM specialists with primary care providers through a series of weekly care conferences where they comanaged Hepatitis C patients PROJECT ECHO MODEL - HISTORY A collaborative model of medical education and care management that empowers clinicians everywhere to provide better care to more people, right, where they live. -- Sanjeev Arora, MD 4

5 PROJECT ECHO - CLINICS Bone Health Chronic Pain and Headache Management Complex Care Dementia Care Endocrinology Epilepsy Across the Lifespan Hepatitis C Community HIV/AIDS Integrated Addictions and Psychiatry NMDOH TO TeleECHO Clinic Primary Care TeleECHO Clinic Palliative Care Rheumatology Clinc Women s Health and Genomics Clinic NCH IMPLEMENTATION OF ECHO MODEL At North Country, Manch and Moore no longer see Hep C patients directly, instead, they videoconference each Wednesday morning with most of North Country satellite clinics The video conference runs 8-9am, North Country encourages providers to participate, allowing them to block their schedules during that time CME credit is earned for each session attended WEEKLY CARE CONFERENCE - FORMAT Patient presentations Initial presentation Follows a standard Hep C protocol- once reviewed treatment plan is decided Follow up presentation Includes patient updates during or post treatment All patients identified by ECHO ID number Didactic sessions follow (when/if time) 5

6 DIDACTIC SESSION TOPICS Cirrhosis Fatty Liver Non-alcoholic liver disease Drug Interactions HCV Complications HCV Case Studies and many more NCH PARTICIPATING CLINICS NCH clinics participating Ash Fork/Seligman / Bullhead City / Flagstaff / Holbrook / Kingman / Round Valley / Show Low / St Johns / Winslow GOAL: All NCH clinics participating by end of 2017 CLINICAL AND TECHNICAL SUPPORT Colleen Hopkins, NCH Telehealth Coordinator, moderates the videoconference NCH-IT maintains availability to address technical problems in real-time Call is bridged by The Arizona Telemedicine Program ATP also available in real time, if needed throughpete Yonsetto, Sr Engineer 6

7 NCH/PROJECT ECHO PROVIDER EXPERIENCE Richard Manch, MD Ann Moore, FNP See Video Clip NCH HEP C PROGRAM - STATISTICS Weekly Videoconference Initiated: Dec. 05, 2011 Total weekly Hep C Clinics: 260 Total attendee Hours: 2860 Total patient presentations: 1049 HEP C PROGRAM - STATISTICS Patients currently in treatment: 29 Patients with Sustained Viral Responses: 102 Cures! Awarded 2013 Arizona Association of Community Health Centers Health CareC Innovation Award 7

8 NCH HEP C PROGRAM - STATISTICS Average Weekly Provider/Staff Attendance: 25 Physician (MD, DO): 5 Clinical Pharmacist (PharmD): 2 Physician Assistant (PA): 4 Advanced Practice Nurse (NP, CRNA, CNM, CNS): 5 Registered Nurse: 1 Medical Assistant: 6 Other: 7 NCH/PROJECT ECHO PROVIDER EXPERIENCE Elaine Accomando, PA-C See Video Clip HEP C - IN CONCLUSION There truly is no way for NCH to be able to treat these patients, other than via telemedicine! 8

9 NCH/PROJECT ECHO PAIN CLINIC Statement of Need Pain management is a touchy subject in primary care. It s a little bit taboo, because there s so many ramifications about how to manage it Prior to Project ECHO, many NCH providers were somewhat reticent to identify patients as pain management patients, or to manage them in any way in the primary care setting NCH/PROJECT ECHO PAIN CLINIC Collaboration started in 2014 Current participants include Pharmacy Director Clinical Pharmacists DO s from NCH satellite clinics Pharmacy residents Pharmacy students NCH/PROJECT ECHO PAIN CLINIC Result of Participation NCH has completely reviewed and revised all of its pain management protocols, patient agreements, both in English and in Spanish. Have started to develop a broader scope of controlledsubstance policies for providers and patients. Providers are now more comfortable providing care, and feel more confidence, in ability to prescribe controlled substances, when needed. 9

10 NCH/PROJECT ECHO PAIN CLINIC Benefit of Participation ECHO provides the opportunity to present individual patient cases, with privacy protected The opportunity to tap in to expert resources, that would not otherwise have access to in NCH rural communities. Have been able to develop collaborations with other providers: Physical therapy, chiropractic, behavioral health, surgeons and specialists in different fields. Has brought a robust amount of care to NCH patients, that would have otherwise not been available. NCH/PROJECT ECHO PAIN CLINIC Result of Participation Program allowed provider to understand the full-range of NCH services available to the patient, which extends beyond medications to provide the opportunity to participate in their care Various modalities including Behavioral health Physical Therapy Mindfulness-Based Stress Reduction Yoga ECHO participation has given providers a clear picture of when it s appropriate to treat chronic pain patients in a primary care setting, and when it may not be. NCH/PROJECT ECHO SUCCESS STORY Kim Christoff, NCH Pharmacy Director See Video Clip 10

11 HIV/AIDS TREATMENT VIA TELEMEDICINE Steve McCrosky, FNP, AAHIVS, Nurse Practitioner, HIV Specialty Care Current: Consultant and Trainer / HIV Specialist, North Country HealthCare, Flagstaff, AZ Consultant and Trainer, Yohana Wavenza Heatlh Institute, Mbozi, Tanzania Medical Director / HIV Specialist, Northland Cares, Prescott, AZ NCH/HIV AIDS WORLD AIDS DAY Steve McCrosky, FNP See Video Clip HIV/AIDS Provides care and disease management for over 300 people living with HIV. Expanded access to rural HIV services by 30% through consultation and collaboration with telemedicine program. 11

12 HIV/AIDS Developed HIV telemedicine program, expanding access to HIV specialty care in a rural area covering 60,000 miles 2 (155,000 kilometers 2 ). Championed the use of the telemedicine network, increasing number of HIV specialty care visits by 30%. Provided ongoing consultation with telemedicine program. HIV Appointments in Mohave County by Location BHC LHC KING Total HIV Appointments in Mohave County Using Face-to-face and Telemedicine 100 Total TM 80 Total F2F

13 TELEHEALTH VISION The telehealth/telemedicine uses audiovisual technologies to link healthcare providers, patients, educators, consumers and their families to a comprehensive continuum of care and education, in order to reduce the isolation of living and working in rural communities. CONTACTS Greg Hales, Director of Telemedicine Tuba City Regional Healthcare Corporation Direct: gregory.hales@tchealth.org Colleen Hopkins, Telehealth Coordinator North Country HealthCare Direct: chopkins@nchcaz.org 13