Beyond the Walls of the Classroom: Supporting Education in Primary Care
To help support clinicians and staff implementing population health across the network, the Center for Population Health is working with the network to create new ways to provide training and education to clinical and non-clinical members of the care team. This means leveraging novel technologies, creating classes on unique subjects, and offering intensive, short-term courses on-site.
A primary focus of these efforts is addressing behavioral health. The goal is to provide integrated services in primary care so that, for example, a patient with depression or a substance use disorder (SUD) can be appropriately assessed, treated, and triaged right there in the primary care setting. This year, there will be more than 25 educational programs offered that include a behavioral health component. The majority of programs are focused on SUD and range from buprenorphine waiver trainings to mentoring programs and new interactive ways for providers to learn from each other. The strategy includes building capacity in primary care to make sure care teams have the training, tools, and resources they need to provide high quality care, early identification of patients with SUD, and connection to treatment and support.
One approach to building capacity is a new educational program called ECHO (Extension for Community Healthcare Outcomes), which was initially developed by the University of New Mexico for treating hepatitis C. The ECHO model is an educational forum where members of the care team can gather virtually to discuss patient cases and share best practices. This framework was adapted and a teleconferencing platform was identified to support primary care team members in managing their SUD patients, which commonly includes opioid and alcohol misuse.
“We are exploring innovative ways to provide trainings that better meet the needs of providers and their teams,” says Brent Forester, MD, MSc, Medical Director for Behavioral Health for Center for Population Health and Chief of Geriatric Psychiatry at McLean Hospital. “The ECHO model differs from traditional trainings by using virtual technology and a case-based approach, which is a good platform to discuss complex clinical issues amongst interdisciplinary teams.”
Twice per month a group of primary care doctors, nurse practitioners, physician assistants, behavioral health support specialists, social workers, nurses, care managers, addiction specialists, and other interested providers gather together virtually to discuss SUD. These educational discussions, similar to medical grand rounds, are conducted entirely over a web-based video platform. Typical hour-long sessions include an instructional module taught by a substance-use disorder expert on a subject like motivational interviewing, SBIRT training (Screening, Brief Intervention, and Referral to Treatment), or patients with dual diagnosis. But the training portion of the teleconferences is brief; most of the hour is spent reviewing one or two cases presented by attendees. In this way, not only do the presenters get input on possible treatment options from the experts, but the whole group has the opportunity to weigh in.
“It was really helpful to have input from different fields—a pharmacist could pipe up and share his thoughts on a case, and then the therapists would give their input,” says Lilly Stafford, PA, from Newton Wellesley Primary Care, who has presented at the ECHO sessions. “I really felt it was an effective way to form a comprehensive care plan through collaboration. And, I received concrete recommendations I would have never thought to consider as options.”
ECHO is primarily geared for community practices that don’t have access to specialists on site. “Providers and members of the care team relish the idea of having convenient access to a specialty resource like this, because they are often operating with limited resources,” says Dr. Forester. “Integrating behavioral health and general medical care within the system provides an opportunity for knowledge sharing among clinicians and ensures that patients, with chronic conditions like SUD, receive the most comprehensive care.” ECHO is available at Newton Wellesley Hospital and Harbor Medical Associates, and efforts are underway to expand throughout the community practices and the community and island hospitals.
In addition to SUD, there are two other areas of focus for training and education this year that include palliative care and medical assistant (MA) immunization training. To help primary care clinicians feel more skilled and effective with end-of-life conversations, workshops with professional actors who play the role of a patient with a serious illness are being offered. This hands-on experience allows clinicians to practice having these difficult conversations and to establish a greater level of comfort. Hands-on training is also being offered for Medical Assistants (MA) whose job often blurs the line between administrative support and clinical duties. The Center is making plans now to offer immunization refresher courses so medical assistants working in primary care settings can take on this responsibility, under the supervision of a clinician.
These efforts, combined with SUD, provide training, resources, and support to primary care practices across the Partners network and are making a difference in the quality of care delivered to patients. All of these programs are scheduled to continue through next year. “As population health services become more integrated in the primary care setting, the training and education teams are working hard to make sure that we can support our clinicians and non-medical staff to be successful,” says Dan Kobrin, Program Manager, Training and Education, Center for Population Health.