2. How an E- mentoring system strengthens GPs respiratory performance in rural area Vietnam
Nguyen Nhu Vinh1 ,Pham Le An1 , Niels Chavannes­­­ 2 1Family Medicine Department, University of Medicine and Pharmacy, Hochiminh City, Vietnam 2 Department of Public Health and Primary Care LUMC, the Netherlands

3. Aim
Find the appropriated solution for improving performance of Primary care Doctor on asthma - chronic obstructive pulmonary disease in rural province, Vietnam

4. Medical Education in Vietnam
Montegut AJ et al Fam Med 2007

5. Situation analysis in VN for planning 2012-2020
Lack of rural and PC training in curriculum
Low competence of health providers
ACADEMIC INSTITUTE
Lack of CME
Low quality service in primary care/rural areas
Lack of opportunity for knowledge updated of health providers (CME/e-learning)
THE INTEGRATED GLOBAL AND RURAL HEALTH PROGRAMME
Lack of support & control
FM training program
Lack of devices essential medications and restricted scope of practice
Extremely overload at tertiary levels
FAMILY MEDICINE DEPT
CME/e-learning
EMR
Network
Low income of health providers
Low quality of care
GLOBAL CLIMATE
CHANGING
Global health contributors
Morbidity & mortality 5

6. Models and activities Rural health Global health
Integrated global and rural health programme
Global health
Rural health
WHO
MhGAP
WHO-IMCI
PC-Training
FM- EMR
WHO-IMPC
Control Center & hotline services
Research +
Clinical audit
WHO-NCD IMAI PEN
Mentoring
Improved morbility & mortality
Improved rural service delivery in model rural training site
health practice
Training course, distance learning and short course didactics for ‘common problems’
Improve access to rapid backup by using control center and hotline support for e-conferencing/telemedicine
Conduct research of health system clinical operations to evaluate effect on indicators and to inform changes in the medical education program itself
Disseminate the EMR for value in continuity and comprehensiveness of care and tool for research
Improved rural health services

7. UMP center for FP training
Control Center Idea:
UMP center for FP training
Control center
FM dept
Specialists
Skilllab
International level
Medical Education
local level
Surveillance
Mentoring
Tele-medicine
E-learning
Rural health
Digital data:
EMR
Stethoscopy
Thermometer
ECG
Spirometry
Imaging
Local MDs
Patients

8. COPD in Vietnam
The prevalence of COPD defined by the GOLD criteria was 7.1%; in men 10.9% and in women 3.9% (p = 0.002).
Of those 3.4% had a mild disease, 2.8% a moderate and 0.9% a severe disease. In ages >50 years, 23.5% of men and 6.8% of women had COPD.
Among smokers aged >60 years (all men), 47.8% had COPD. Increasing age and smoking, the latter among men only, were the most important determinants of COPD (Hoang Thi Lam 2011).
Patients safety is threaten by acute crisis.

9. COPD - Asthma situation in HCM city%
Emergency care
> 1 time/ year
4/83 cases (5%)
Admission to Hospital
32/83 cases (39%)
Asthma well-controlled
31%
COPD with Saint George Scale >4 points
58%
COPD non-compliance
60%
Asthma non-compliance
50%
Nguyen Van Tho, Le Thi Tuyet Lan; Applying GINA and GOLD for COPD at district level
Health care center in HCM city; Y hoc TP HCM* Vol 14 Sup :

10. Asthma control situation in Vietnam
Low rate for well-control
5-10%
Estimate: 5% adult and 10% children have got Asthma in VN. 1%
1% Asthma well-controlled in VN
Asthma
high burden disease
1 Hội Lao và Bệnh phổi Việt Nam. (2015). Hướng dẫn Quốc gia xử trí Hen và Bệnh phổi tắc nghẽn mạn tính. Nhà xuất bản Y học.
2 Tho NV, Loan HTH, Thao NTP, Dung NTT, Lan LTT. Implementation of GINA guidelines in Ho Chi Minh City: a model for Viet Nam. Public Health Action. 2012;2(4): doi: /pha

11. Clinical Case for evaluate in Primary care Doctor
Number of right Items
% Doctor answer
Internal Medicine
Family physician
Pediatrics
Different speciality
None
6.56%
0.00%
0.41%
6.97%
At least 1 items
13.11%
0.82%
7.38%
At least 2 items
15.57%
2.46%
10.66%
At least 3 items
1.23%
4.92%
At least 4 items
3.69%
At least 5 items
2.05%
1.64%
At least 6 items
All 7 items

12. SURVEY OF GPs CLINICAL PRACTICE TIENGIANG PROVINCE VN 2015

13. SURVEY OF GPs CLINICAL PRACTICE TIENGIANG PROVINCE VN 2015

14. SURVEY OF GPs CLINICAL PRACTICE TIENGIANG PROVINCE VN 2015

15. RESULT OF CASE-BASED SPIROMETRY TEST FOR 183 PRIMARY CARE DOCTORS IN TIENGIANG PROVINCE VIETNAM 2015
1.1% get 3 cases right
Case 1 COPD
only 4.9% get right answer

16. RESULT OF CASE-BASED SPIROMETRY TEST FOR 183 PRIMARY CARE DOCTORS IN TIENGIANG PROVINCE VIETNAM 2015
1.1% get 3 cases right
Case 2 Asthma
only 5.5% get right answer

17. RESULT OF CASE-BASED SPIROMETRY TEST FOR 183 PRIMARY CARE DOCTORS IN TIENGIANG PROVINCE VIETNAM 2015
1.1% get 3 cases right
Case 3 normal
only 26.8% get right answer

18. IRONIC SITUATION IN LMIC
PLAn-VN 2016

19. PLAn-VN 2016

21. EVIDENCE OF M-HEALTH
First time WHO Global Observatory for eHealth surveyed 114 members on mHealth
14 categories of mHealth services including:
health call centers
emergency toll-free telephone services
managing emergencies and disasters
mobile telemedicine
appointment reminders
community mobilization & health promotion
treatment compliance
mobile patient records
information access
patient monitoring
health surveys and data collection
Surveillance
health awareness raising
decision support systems

22. Evidence of Intergrated disease management in COPD

25. Proportion use smartphone in Vietnam

26. Proportion use smartphone per age group in VIetnam

27. PLA-VN 2016

28. Models and activities Rural health Global health
Integrated global and rural health programme
Global health
Rural health
WHO
MhGAP
WHO-IMCI
PC-Training
FM- EMR
WHO-IMPC
Control Center & hotline services
Research +
Clinical audit
WHO-NCD IMAI PEN
Mentoring
Improved morbility & mortality
Improved rural service delivery in model rural training site
health practice
Training course, distance learning and short course didactics for ‘common problems’
Improve access to rapid backup by using control center and hotline support for e-conferencing/telemedicine
Conduct research of health system clinical operations to evaluate effect on indicators and to inform changes in the medical education program itself
Disseminate the EMR for value in continuity and comprehensiveness of care and tool for research
Improved rural health services

29. UMP Hochiminhcity VN FM Ementoring Structure
E-mentoring approach – Trou Conf (ADSL speed) - Telemedicine
FM training – CME in primary care
Weekly contact - 30 minutes X 8 weeks by registered
Panel expert = Specialist + Family Physician ( Patient safety issue) + Clinical Pharmacist (Drugs interaction)
Case presentation +HER
WHO package + Patient safety issue 29

30. Models of Mentoring Forms of Mentoring
Active guidance – instructing and challenging the Mentee
Apprenticeship – working alongside the Mentee and allowing them to learn through your example
Forms of Mentoring
Mentoring communities – peer support groups
Online Mentoring – occurs via and / or web forum so is often convenient and less intimidating than face to face contact
There is a great ‘power’ imbalance in the first model, but this may be useful in a professional development or work situation where a team member (the Mentee) is required to learn new skills or perform in a new role very quickly. The latter models are more collaborative and encourage a sharing of information and rapport back and forth between the Mentor and Mentee. 30

31. EMENTORING HELP TO IMPROVE PERFORMANCE OF PRIMARY CARE DOCTOR
IN REMOTE AREA AFTER CME TRAINING BY FOCUS IN PATIENT SAFETY ISSUE IN COPD -ASTHMA
PLAn-VN 2016

32. ECHO project of University
New Mexico USA and E mentoring FM UMP HCM city VN

33. COMPARE TROUCONF AND SKYPE, ZOO
Source : WIKIPEDIA

34. E-Mentoring COPD care for Primary Doctor in HCM city Vietnam 2016
Case presentation with EHR – ADSL speed

35. E-HEALTH M-HEALTH AND E-LEARNING M-LEARNING
EMENTORING RELATE TO
E-HEALTH M-HEALTH AND E-LEARNING M-LEARNING
PLAn-VN 2016

37. E-mentoring is Effective and Cost Saving in Resource Limited Settings
Todd Pollack1, Vo Thi Tuyet Nhung1, Dang Thi Nhat Vinh1, Nguyen Thanh Liem1, Nguyen Hieu1,
Pham Le An2, Lisa Cosimi1
1The Partnership for Health Advancement in Vietnam, 2Ho Chi Minh City University of Medicine and Pharmacy
Program/Project Purpose
Clinical mentoring is recommended for building healthcare worker (HCW) capacity at HIV treatment sites. However, limited numbers of qualified mentors, staff turnover, and changes in clinical guidelines create the need for more sustainable models. Electronic mentoring (e-mentoring) is a novel way of delivering mentoring and case-based learning through the use of telehealth technology. This model has been shown to improve HCW capacity and lead to improved patient outcomes[1-2], but has not yet been shown to be feasible in resource-limited settings.
Outcomes and Evaluation
During the 6 month pilot:
24 e-mentoring sessions were organized
Mean of 51 participants joined per session
28 different provinces across Vietnam joined at least one session (Figure 1).
68 participants completed the evaluation
64% were doctors, 23.9% were physician assistants (Table 1).
51.5% reported not receiving regular clinical support prior to participating
73% rated the program as very or extremely relevant to their work
80.6% rated the quality of the technology as either good or excellent
95.6% want the program to continue.
Structure/Method/Design
We piloted e-mentoring to HCWs in HIV clinical sites in the southern provinces of Vietnam.
Experts in infectious diseases, HIV, and family medicine connected to clinical sites through videoconferencing with standard ADSL broadband.
Participants utilized clinic computers and were provided with webcams, microphones, and LCD projectors when needed.
Sessions were held every 2 weeks and included case discussion and didactic presentations.
Mentors provided recommendations on patient management following standard treatment protocols (e.g. Vietnam HIV guidelines)
Participants evaluated the program at the conclusion of the pilot by completing a short on-line survey.
The cost (per site reached) of e-mentoring was compared to that of traditional on-site mentoring.
Self assessed confidence in HIV care was higher following the pilot compared to baseline (Table 2).
Excluding start-up costs, the cost per site reached through e-mentoring was $17.5 per session compared to $535 for a traditional on-site clinical mentoring visit to a distant province in southern Vietnam costs (Table 3).
Figure 1: Screenshot of e-mentoring session
Acknowledgements
This work has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention under the terms of Cooperative Agreement number 1U2GGH The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Going Forward
E-mentoring is a feasible and cost-saving model for delivering HIV clinical mentoring and continuing medical education to HCWs in a resource limited setting. Lesson learned from this pilot will inform Vietnam’s national strategy for HIV technical assistance.

38. Webinar for Peakflow meter and Inhaler
E Learning
Webinar for Peakflow meter and Inhaler

39. Control center: E mentoring

40. E mentoring for group in Tiengiang Province Vietnam 2015

41. Ementoring with multi-place in collaboration with HAIVN-CDC VN 2015

42. E Mentoring COPD care for Primary Doctor in HCM city Vietnam 2016

43. E Mentoring COPD care for Primary Doctor in HCM city Vietnam 2016 Case presentation with EHR

44. E Mentoring COPD care for Primary Doctor in HCM city Vietnam 2016 Case presentation with EHR

45. E Mentoring COPD care for Primary Doctor in HCM city Vietnam 2016 Case presentation with EHR - TRUECONF

46. Lessons learnt
Good team work among Family Medicine and specialists – Clinical Pharmacist integrate in Telemedicine (ADSL speed) and Electronic health record of Family  Medicine that makes group mentors for group mentees in Vietnam rural areas to improve their performance in Asthma -COPD care.
Family Medicine + CME integrate WHO package such as IMAI-PEN also focus in Patient Safety issue on Asthma – COPD
E Mentor integrate E health – Mhealth; E learning- M Learning promising solution for LMIC.

47. Conclusion
These specific E mentoring promising to solve the problem of low performance after training in our FM residents in rural area, we have to evaluate this impact and cost in the next phase.