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New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
New Mexico Telehealth Commission and ENVISION Presentation
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New Mexico Telehealth Commission and ENVISION Presentation

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  • 1. <ul><li>Envision New Mexico </li></ul><ul><li>Telehealth Clinic </li></ul><ul><li>Proposal </li></ul>Jane McGrath, MD, Director of Envision New Mexico Jane Epstein, CNP, Telehealth Program Manager, Envision NM Envision NM Telehealth receives support from Project ECHO UNM Dept of Pediatrics, and NM Human Services Department.
  • 2. GOAL 1 <ul><li>New Mexican children and youth who are overweight or at risk of overweight will receive </li></ul><ul><ul><ul><li>Accessible, timely and high level care </li></ul></ul></ul><ul><ul><ul><li>In their home community </li></ul></ul></ul>
  • 3. GOAL 2 <ul><li>Community pediatric providers will be supported and trained to treat patients with diagnoses of: </li></ul><ul><ul><ul><li>Overweight and at risk of overweight </li></ul></ul></ul><ul><ul><ul><li>Pre-diabetes </li></ul></ul></ul><ul><ul><ul><li>Diabetes </li></ul></ul></ul><ul><ul><ul><li>Dyslipidemia </li></ul></ul></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Polycystic ovarian syndrome </li></ul></ul></ul>
  • 4. GOAL 3 <ul><li>Providers participating in the Envision NM Telehealth Clinic will </li></ul><ul><ul><ul><li>Form “centers of excellence” around the state </li></ul></ul></ul><ul><ul><ul><li>Increase patient care capacity to confront this growing epidemic of overweight. </li></ul></ul></ul>
  • 5. Epidemic of Overweight • 24% of NM HS students and 22% of low income kids aged 2-5 years are overweight of at risk of overweight • Twice as many Native Americans are overweight as whites in NM. Overweight plus Ethnicity Hispanics and Native Americans are at increased risk of developing diabetes — » Pre-diabetes &amp; Diabetes Associated morbidities: • High cholesterol • High blood pressure • Polycystic ovarian syndrome
  • 6. Pediatric Specialty Care <ul><li>New Mexico has only 2.7 FTE pediatric endocrinologists </li></ul><ul><li>UNM: Patients with type 2 diabetes wait 2-3 months for an appointment. Those with pre-diabetes will not be seen. </li></ul><ul><li>Presbyterian: Patient with pre-diabetes will wait is 6-8 weeks for an appointment. </li></ul><ul><li>Specialists are interested in our service to alleviate their overwhelming caseloads. </li></ul><ul><li>Primary care providers are interested because </li></ul><ul><ul><ul><li>They don’t feel competent treating these patients </li></ul></ul></ul><ul><ul><ul><li>They state they have no where to refer patients for care </li></ul></ul></ul>
  • 7. Need for Specialized Medical Care <ul><li>Overweight is associated with a number of medical conditions that community pediatric providers are under-skilled in treating </li></ul><ul><ul><ul><li>Diabetes and pre-diabetes </li></ul></ul></ul><ul><ul><ul><li>High cholesterol </li></ul></ul></ul><ul><ul><ul><li>High blood pressure </li></ul></ul></ul><ul><ul><ul><li>Polycystic ovarian syndrome </li></ul></ul></ul><ul><ul><ul><li>Need for lifestyle modification (diet and exercise) </li></ul></ul></ul><ul><li>These diagnoses were so rare in the pediatric population until recently that most clinicians were not trained to treat them. </li></ul><ul><li>Due to lack of standardized medical guidelines, providers rely heavily on pediatric specialty care. </li></ul>
  • 8. Envision NM Tele-health Model Multi-disciplinary Team Pediatric Endocrinologist Psychologist Pediatric Nephrologist Registered Dietician Pediatric Cardiologist Adolescent Medicine NP Primary Care Providers (GIMC) Primary Care Providers (Silver City) Patient Patient Patient Patient Patient Patient
  • 9. Multi-disciplinary Team <ul><li>Pediatric Endocrinologist </li></ul><ul><ul><ul><li>Diabetes and pre-diabetes </li></ul></ul></ul><ul><ul><ul><li>Polycystic ovarian syndrome </li></ul></ul></ul><ul><li>Pediatric Nephrologist </li></ul><ul><ul><ul><li>High blood pressure </li></ul></ul></ul><ul><li>Pediatric Cardiologist </li></ul><ul><ul><ul><li>Dyslipidemia </li></ul></ul></ul><ul><li>Psychologist </li></ul><ul><ul><ul><li>Motivational interviewing skills for clinicians </li></ul></ul></ul><ul><ul><ul><li>Psychosocial evaluation for patients </li></ul></ul></ul><ul><li>Dietician </li></ul><ul><ul><ul><li>Lifestyle modification </li></ul></ul></ul><ul><li>Adolescent Medicine Nurse Practitioner </li></ul><ul><ul><ul><li>Clinic facilitator </li></ul></ul></ul><ul><ul><ul><li>Program manager </li></ul></ul></ul>
  • 10. Clinical Sites: Gallop <ul><li>Gallop Indian Medical Center </li></ul><ul><ul><ul><li>Primary care providers will receive 15 mins. of CME training/ session </li></ul></ul></ul><ul><ul><ul><li>Providers will present patients, alleviating the need for many to travel to Albuquerque for specialty care </li></ul></ul></ul><ul><ul><ul><li>Over time, providers will gain the necessary skills to work-up and treat patients in the community setting. Telehealth services will not be a permanent need. </li></ul></ul></ul><ul><ul><ul><li>More patients will be seen, earlier in their illnesses. </li></ul></ul></ul><ul><ul><ul><li>Memorandum of Understanding is in process </li></ul></ul></ul>
  • 11. Clinical Sites: Silver City <ul><li>Hidalgo Health Center &amp; Silver City SBHC </li></ul><ul><ul><ul><li>Envision has teamed with Alberta Kong, MD, MPH from UNM </li></ul></ul></ul><ul><ul><ul><li>In addition to the services at Gallop, all students in 10 th and 11 th grades will be screened for diabetes risk factors, acanthosis nigricans and body mass index ≥85 th % </li></ul></ul></ul><ul><ul><ul><li>Those at risk will receive a full work-up for pre-diabetes and diabetes and be followed at six month intervals for 18 months (as part of a research study.) </li></ul></ul></ul>
  • 12. Conclusion <ul><li>The Envision Tele-health clinic will create “centers of excellence” throughout the state for the treatment of pediatric overweight. </li></ul><ul><li>These centers will increase access to care for children and adolescents with medical complications of overweight. </li></ul><ul><li>Patients will receive treatment in their home community. </li></ul>

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