According to a June 2017 Medicare Current Beneficiary Survey, 13 percent of Medicare beneficiaries age 65 or older report depressive symptoms. Because of their reluctance to visit mental health professionals, however, many older Americans seek out depression and alcohol abuse treatment through their primary care physicians. One concern of the medical community is the nondetection and misdiagnosis of alcohol use disorders (AUD) and depression.

To support primary care physicians, the TMF Quality Innovation Network, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Texas, Arkansas, Missouri, Oklahoma and Puerto Rico, partnered with the University of Texas Dell Medical School to implement Project ECHO (Extension for Community Healthcare Outcomes) in the four continental states it serves. Project ECHO is a nationally recognized program in which primary care physicians can learn to provide excellent specialty care to patients in their communities.

This set-up created a sense of mentorship between the experts and the primary care providers who wanted to make sure they were giving proper mental health care to their patients and to know when it was appropriate to refer them to a specialist.

From March 2017 to March 2018, the QIN used video conferencing technology to connect primary care providers with a team of specialists to engage in weekly didactic and case-based learning around depression and alcohol abuse. Over that year-long period, TMF convened four 12-week cohorts to train the clinicians.

During each virtual clinic, subject matter experts (SMEs) from Dell Medical School discussed topics like patient health questionnaires, depression and depression interventions, medication use, motivational interviewing, suicide prevention screening best practices, substance use disorder (SUD) and SUD interventions, as well as other mental health topics. Afterward, clinicians presented patient case studies via webcam. This set-up created a sense of mentorship between the experts and the primary care providers who wanted to make sure they were giving proper mental health care to their patients and to know when it was appropriate to refer them to a specialist.

The results proved how important this project was to providers and patients in both rural and underserved communities. Prior to the Project ECHO video training, participating doctors across all four cohorts had screened 844 patients for AUD and 424 for depression. Following the training, those numbers jumped to 2,119 AUD screenings and 640 depression screenings. That’s a 151 percent increase and 51 percent increase, respectively for each of the categories.

The third cohort’s results were particularly exceptional, with a 759 percent increase in alcohol abuse screenings and a 206 percent increase in depression screenings.

Due to this success, TMF is continuing with additional cohorts and training other QIN-QIOs on the ECHO model, so they can increase screening and care among primary care physicians in their own regions.