Empowering General Practitioners to manage children with ADHD using the ECHO? model

摘要

Introduction : ADHD is very common and becoming an increasing burden for public outpatient departments. Ongoing management of children with ADHD is usually provided by paediatricians, however many of these children are medically stable and could be safely managed by their GP. A GP-led model would facilitate holistic family care and release capacity for specialists to see more complex children. Whilst GPs believe they have a role managing children with stable ADHD, they have not historically done so due to lack of training. Children’s Health Queensland (CHQ) will address this gap in training by using the ECHO model (Extension for Community Healthcare Outcomes). Change implemented : ECHO is a collaborative model of tele-mentoring and case-based learning, which empowers providers to work at the top of their scope of practice. It is a hub and spoke model, in which an expert multidisciplinary hub team mentors clinicians at community spoke sites. GPs master complexity through case-based learning, and become part of an online community of practice. ECHO exponentially increases access to specialty-level care in underserved areas by providing GPs with knowledge and support required to manage complex patients. By moving knowledge, rather than moving patients, a GP-led model of care is delivered, and patients receive the right care, at the right place and right time. ECHO originated in New Mexico, and has been used to train providers in over 20 countries, for more than 50 conditions. This is the first paediatric application of the ECHO model in Australasia. Target population and stakeholders : Stakeholders include patients, families, paediatricians, hospital executives and GPs. Children being served are those with diagnosed ADHD, aged 6-18, medically stable and with no significant comorbidities. Timeline : Each GP participates in a weekly videoconference-based ‘teleECHO clinic’, lasting 90 mins, for 10 weeks. They may return to teleECHO clinics at any time in the future to seek advice on challenging patients with ADHD. Over 18 months, CHQ aims to train 60 GPs. Highlights : First paediatric ECHO implementation in Australasia. Participation of GPs from throughout Queensland. Evaluation shows ECHO training increases GP self-efficacy in managing children with ADHD Sustainability and transferability : An initial grant enabled the project team to undergo training in New Mexico, set up infrastructure, and employ expert panelists and support staff for 18 months. Following this initial investment, ongoing costs are dramatically reduced. ECHO-trained GPs become local ‘experts’ within their practices and go on to mentor colleagues and registrars. Cost-effectiveness will be evaluated in 2018, but early results indicate future low ongoing costs can be offset by savings. The ECHO model can be replicated for other common, complex conditions. Conclusions : CHQ has successfully launched Project ECHO to train GPs to manage children with ADHD. Participating GPs have enjoyed being part of an online community of practice and have demonstrated increased self-efficacy at the completion of training.