Continuing professional development for Australian rural psychiatrists by videoconference

Measuring impacts of continuing professional development (CPD): The development of the CPD impacts survey (CPDIS)

INTRODUCTION

Evaluating continuing professional development (CPD) programs is essential to demonstrate their value to participants and their institutions, and to inform the improvement and quality of CPD programs. Existing surveys measure a narrow range of impacts. This study developed a survey that can measure a broad range of impacts of CPD programs, not just those that are easily measured such as knowledge, skills, attitudes and confidence.

METHOD

The development of the CPD Impacts Survey (CPDIS) was informed by best practice guidelines. A systematic scoping review, qualitative interviews, and existing survey instruments were used to develop the initial survey items. Past participants from two international health professions education institutes completed the survey (n = 292). Principal component analysis (PCA) was used to refine the survey.

RESULTS

The PCA provided a three-component solution. Component 1 (learnings and self-efficacy), Component 2 (networking and building community), and Component 3 (achievement and validation) comprising 47, 14, and 13 items, respectively. The three components had high internal consistency (α = .98, α = .95, α = .92, respectively).

CONCLUSION

The CPDIS is the first survey to assess a broader range of impacts of CPD programs. Given the substantial financial and opportunity costs of participation in CPD, the CPDIS will allow more efficient and accurate evaluation of the utility and value of CPD programs.

Where do Peer Review Groups fit in the international Continuing Professional Development literature?

OBJECTIVES

To describe what is reported in the Continuing Professional Development (CPD) literature on small group learning formats in medicine, including the Royal Australian and New Zealand College of Psychiatrists (RANZCP) CPD Peer Review Groups (PRGs).

METHOD

A literature review of international peer-reviewed publications in relation to the use of small group learning formats for CPD in medicine.

RESULTS

Small groups are commonly used as a learning format in medical CPD, primarily in general practice, but are little researched. Such groups take differing forms and they are valued by participants for a range of purposes, having effects on professionalism, clinical performance and doctors' wellbeing.

CONCLUSION

We believe that the contribution of these groups to medical CPD should be further explored. To this end, this review forms the first part of a research project focussing on the RANZCP PRG model used by Australian and New Zealand psychiatrists.

Building Provincial Mental Health Capacity in Primary Care: An Evaluation of a Project ECHO Mental Health Program

OBJECTIVE

Project Extension for Community Healthcare Outcomes (Project ECHO©) addresses urban-rural disparities in access to specialist care by building primary care provider (PCP) capacity through tele-education. Evidence supporting the use of this model for mental health care is limited. Therefore, this study evaluated a mental health and addictions-focused ECHO program. Primary outcome measures were PCP knowledge and perceived self-efficacy. Secondary objectives included: satisfaction, engagement, and sense of professional isolation. PCP knowledge and self-efficacy were hypothesized to improve with participation.

METHODS

Using Moore's evaluation framework, we evaluated the ECHO program on participant engagement, satisfaction, learning, and competence. A pre-post design and weekly questionnaires measured primary and secondary outcomes, respectively.

RESULTS

Knowledge test performance and self-efficacy ratings improved post-ECHO (knowledge change was significant, p < 0.001, d = 1.13; self-efficacy approached significance; p = 0.056, d = 0.57). Attrition rate was low (7.7%) and satisfaction ratings were high across all domains, with spokes reporting reduced feelings of isolation.

DISCUSSION

This is the first study to report objective mental health outcomes related to Project ECHO. The results indicate high-participant retention is achievable, and provide preliminary evidence for increased knowledge and self-efficacy. These findings suggest this intervention may improve mental health management in primary care.

Rapid review of applications of e-health and remote monitoring for rural residents

BACKGROUND

E-health is increasingly being identified as a cost-effective method to deliver health services and remote monitoring in rural and remote areas. There is a paucity of research that identifies successful implementation of e-health and remote monitoring in rural communities.

OBJECTIVE

To identify the evidence relating to the impact of e-health on rural and remote communities and residents.

DESIGN

A systematic, rapid review of grey and published peer-reviewed literature using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI Health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms used included telemedicine, telehealth, e-health, regional, rural and remote communities; New South Wales, Australia, and other Organisation for Economic Co-operation and Development countries. Electronic health records and health informatics were excluded.

RESULTS

The search yielded 105 articles and reports. Following removal of duplicates, initial screening and full text screening, 19 articles remained: 16 peer-reviewed publications and three grey literature. This included two systematic reviews, one literature review, six descriptive reviews of services and nine reviews of specific interventions and identification of barriers and facilitators to implementation of an intervention. There was evidence that e-health can increase access to services across a range of medical specialties without any detrimental effects and improve opportunities for professional development.

CONCLUSION

E-health has the potential to increase access to services in rural and remote communities. The evidence shows that it is as safe, effective and reliable as most conventional methods for interacting with patients while enabling people to stay within their own communities.

Expanding Cessation Pharmacotherapy Via Videoconference Educational Outreach to Prescribers

INTRODUCTION

Smoking cessation pharmacotherapy is underutilized by people with mental illnesses, who smoke at high rates and die prematurely of smoking-related diseases. Educational outreach can improve prescribing, but distances impede widespread use of this practice. Little research has assessed whether videoconference can effectively deliver educational outreach. We conducted a randomized, controlled trial of in-person versus videoconference educational outreach for smoking cessation pharmacotherapy across a state mental health system.

METHODS

We randomly assigned clinics to receive in-person or videoconference educational outreach with audit and feedback for cessation pharmacotherapy. Prescribers completed brief questionnaires before and after the intervention. With segmented regression analysis of interrupted time series, we evaluated prescribing trends in Medicaid pharmacy claims for nicotine replacement therapy (NRT) and varenicline, with interaction terms for the effect of intervention type (in-person vs. videoconference).

RESULTS

With interaction terms in the model, filled NRT prescriptions increased after the intervention compared to before (p < .01). The pattern of fills after the intervention were different at centers receiving in-person compared to videoconference educational outreach (p < .02) without clearly favoring one over the other. Additionally, filled varenicline prescriptions increased after the intervention compared to before (p = .04), but type of intervention delivery did not influence varenicline fills. Prescriber satisfaction with the educational intervention was high and prescriber attitudes became more positive in both groups.

CONCLUSION

This study suggests that single session educational outreach with audit and feedback can increase cessation pharmacotherapy utilization, and that videoconference delivery could be an effective, scalable approach to improve workforce capacity in systems serving mentally ill smokers.

Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations

BACKGROUND

People living in rural and remote locations are disadvantaged in accessing palliative care. This can be attributed to several factors including the role diversity and the low numbers of patients with specific conditions, as well as the difficulties rural health practitioners have in accessing opportunities for professional education. A program of multidisciplinary palliative care video conferences was presented to health practitioners across part of northern Australia in an effort to address this problem.

METHOD

The educational content of the video conferences was developed from participant responses to an educational needs assessment. Following cycles of four consecutive video conferences, 101 participants completed evaluative on-line surveys. The quantitative data were analysed using frequencies and analysis of variance tests with post-hoc analyses where appropriate, and an accessibility and remoteness index was used to classify their practice location.

RESULTS

All participants found the content useful regardless of their remoteness from the tertiary centre, their years of experience caring for palliative care patients or the number of patients cared for each year. However, change in confidence to provide palliative care as a result of attending the video conferences was significant across all disciplines, regardless of location. Doctors, medical students and allied health professionals indicated the greatest change in confidence.

CONCLUSIONS

The provision of professional education about palliative care issues via multidisciplinary video conferencing increased confidence among rural health practitioners, by meeting their identified need for topic and context specific education. This technology also enhanced the networking opportunities between practitioners, providing an avenue of ongoing professional support necessary for maintaining the health workforce in rural and remote areas. However, more attention should be directed to the diverse educational needs of allied health professionals.

Continuing education to go: capacity building in psychotherapies for front-line mental health workers in underserviced communities

OBJECTIVE

To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers.

METHODS

Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus groups with 25 participants were also analyzed.

RESULTS

Significant pre- and postintervention changes in knowledge (P < 0.001) were found in course completers. Counselling self-efficacy improved in participants who took the first course offered (P = 0.001). Dropouts were much less frequent in peer-led, small-group learning than in a self-directed format. Qualitative analysis revealed improved confidence, morale, self-reported practice behaviour changes, and increased comfort in working with difficult clients.

CONCLUSION

This work-based, multimodal, interactive, interprofessional curriculum for knowledge translation of psychotherapeutic techniques is feasible and helpful. A peer-led group format is preferred over self-directed learning. Its application can build capacity of front-line health workers in helping patients who suffer from common mental disorders.

A framework for enhancing continuing medical education for rural physicians: A summary of the literature

BACKGROUND

Recruitment and retention of rural physicians is vital for rural health care. A key deterrent to rural practice has been identified as professional isolation and access to continuing medical education/continuing professional development (CME/CPD).

AIMS

The purpose of this article is to review and synthesize key themes from the literature related to CME/CPD and rural physicians to facilitate CME/CPD planning.

METHODS

A search of the peer-reviewed English language literature and a review of relevant grey literature (e.g., reports, conference proceedings) was conducted.

RESULTS

There is robust evidence demonstrating that the CME/CPD needs of rural physicians are unique. Promising practices in regional CME/CPD outreach and advanced procedural skills training and other up-skilling areas have been reported. Distance learning initiatives have been particularly helpful in increasing access to CME/CPD. The quality of evidence supporting the overall effect of these different strategies on recruitment and retention is variable.

CONCLUSION

Supporting the professional careers of rural physicians requires the provision of integrated educational programs that focus on specific information and skills. Future research should examine the linkage between enhanced CME/CPD access and its effect on factors related to retention of physicians in rural communities. A proposed framework is described to aid in developing CME/CPD for rural practitioners.

The reported benefits of telehealth for rural Australians

Objective.A literature review was conducted to identify the reported benefits attributed to telehealth for people living and professionals working in rural and remote areas of Australia. Data sources.Scopus and relevant journals and websites were searched using the terms: telemedicine, telehealth, telepsychiatry, teledermatology, teleradiology, Australia, and each state and territory. Publications since 1998 were included. Study selection.The initial search resulted in 176 articles, which was reduced to 143 when research reporting on Australian rural, regional or remote populations was selected. Data synthesis.A narrative review was conducted using an existing ‘benefits’ framework. Patients are reported to have benefited from: lower costs and reduced inconvenience while accessing specialist health services; improved access to services and improved quality of clinical services. Health professionals are reported to have benefited from: access to continuing education and professional development; provision of enhanced local services; experiential learning, networking and collaboration. Discussion.Rural Australians have reportedly benefited from telehealth. The reported improved access and quality of clinical care available to rural Australians through telemedicine and telehealth may contribute to decreasing the urban–rural health disparities. The reported professional development opportunities and support from specialists through the use of telehealth may contribute to improved rural medical workforce recruitment and retention. What is known about the topic?An extensive international literature has reported on the efficacy of telehealth, and to a lesser extent the clinical outcomes and cost-effectiveness of telemedicine. Systematic reviews conclude that the quality of the studies preclude definitive conclusions being drawn about clinical and cost-effectiveness, although there is some evidence of effective clinical outcomes and the potential for cost-benefits. Little attention has been paid to the benefits reported for people who live in rural and remote Australia, despite this being a rationale for the use of telehealth in rural and remote locations. What does this paper add?Patients in rural and remote locations in Australia are reported to benefit from telehealth by increased access to health services and up-skilled health professionals. Health professionals are reported to benefit from telehealth by up-skilling from increased contact with specialists and increased access to professional development. The review findings suggest that one strategy, the increased use of telehealth, has the potential to reduce the inequitable access to health services and the poorer health status that many rural Australians experience, and contribute to addressing the on-going problem of the recruitment and retention of the rural health workforce. What are the implications for practitioners?The use of telehealth appears to be a path to up-skilling for rural and remote practitioners.