Title: Envision New Mexico
1- Envision New Mexico
- Telehealth Clinic
- Proposal
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.
2GOAL 1
- New Mexican children and youth who are overweight
or at risk of overweight will receive - Accessible, timely and high level care
- In their home community
3GOAL 2
- Community pediatric providers will be supported
and trained to treat patients with diagnoses of - Overweight and at risk of overweight
- Pre-diabetes
- Diabetes
- Dyslipidemia
- Hypertension
- Polycystic ovarian syndrome
4GOAL 3
- Providers participating in the Envision NM
Telehealth Clinic will - Form centers of excellence around the state
- Increase patient care capacity to confront this
growing epidemic of overweight.
5Epidemic of Overweight
Overweight
plus
Ethnicity
Pre-diabetes Diabetes
Associated morbidities High cholesterol
High blood pressure Polycystic ovarian
syndrome
Hispanics and Native Americans are at increased
risk of developing diabetes
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.
6Pediatric Specialty Care
- New Mexico has only 2.7 FTE pediatric
endocrinologists - UNM Patients with type 2 diabetes wait 2-3
months for an appointment. Those with
pre-diabetes will not be seen. - Presbyterian Patient with pre-diabetes will wait
is 6-8 weeks for an appointment. - Specialists are interested in our service to
alleviate their overwhelming caseloads. - Primary care providers are interested because
- They dont feel competent treating these patients
- They state they have no where to refer patients
for care
7Need for Specialized Medical Care
- Overweight is associated with a number of medical
conditions that community pediatric providers are
under-skilled in treating - Diabetes and pre-diabetes
- High cholesterol
- High blood pressure
- Polycystic ovarian syndrome
- Need for lifestyle modification (diet and
exercise) - These diagnoses were so rare in the pediatric
population until recently that most clinicians
were not trained to treat them. - Due to lack of standardized medical guidelines,
providers rely heavily on pediatric specialty
care.
8Envision NM Tele-health Model
Multi-disciplinary Team
9Multi-disciplinary Team
- Pediatric Endocrinologist
- Diabetes and pre-diabetes
- Polycystic ovarian syndrome
- Pediatric Nephrologist
- High blood pressure
- Pediatric Cardiologist
- Dyslipidemia
- Psychologist
- Motivational interviewing skills for clinicians
- Psychosocial evaluation for patients
- Dietician
- Lifestyle modification
- Adolescent Medicine Nurse Practitioner
- Clinic facilitator
- Program manager
10Clinical Sites Gallop
- Gallop Indian Medical Center
- Primary care providers will receive 15 mins. of
CME training/ session - Providers will present patients, alleviating the
need for many to travel to Albuquerque for
specialty care - 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. - More patients will be seen, earlier in their
illnesses. - Memorandum of Understanding is in process
11Clinical Sites Silver City
- Hidalgo Health Center Silver City SBHC
- Envision has teamed with Alberta Kong, MD, MPH
from UNM - In addition to the services at Gallop, all
students in 10th and 11th grades will be screened
for diabetes risk factors, acanthosis nigricans
and body mass index 85th - 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.)
12Conclusion
- The Envision Tele-health clinic will create
centers of excellence throughout the state for
the treatment of pediatric overweight. - These centers will increase access to care for
children and adolescents with medical
complications of overweight. - Patients will receive treatment in their home
community.