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.
2
GOAL 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

3
GOAL 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

4
GOAL 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.

5
Epidemic 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.
6
Pediatric 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

7
Need 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.

8
Envision NM Tele-health Model
Multi-disciplinary Team
9
Multi-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

10
Clinical 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

11
Clinical 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.)

12
Conclusion

• 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.