Raising Capacity to Address Mental Health Concerns in Costa Rica.

Background A family medicine team based out of Mayo Clinic, Rochester assembled in 2019 to provide home visits and direct care to underserved populations of patients in La Cruz, Costa Rica. In addition to the provision of direct patient care, our team was interested in conducting a community needs-based assessment to identify an area for provider education efforts and the local providers on a chronic health issue using local feedback and physician data. Suicide awareness and prevention were identified as a priority based on rising suicide rates as well as limited psychiatry services in the area, with some major providences having ~0.60 psychiatrists available per 100,000 people. Our group provided a half-day educational course on mental health topics related to suicide awareness for local health workers. The primary objective of this study was to evaluate any lasting changes in practice, confidence, and knowledge among local health workers attributable to our training and add to the limited research on this topic. Methods Two groups of participants (81) from local hospitals were recruited via local providers and divided into two morning and afternoon groups on a single day. Each group comprised primary care providers, nurses, social workers, and finance officers. Both were given the same educational presentation that could be broadly applied to each various role. Our team provided lectures on mental health, as well as how to improve personal resilience. Locally medically trained translators were used. Pre and post-lecture surveys gathered demographic data, experience with these mental health issues, and confidence in addressing mental health concerns. Pre and post-lecture surveys, including open-ended as well as Likert scale and multiple-choice questions, were handed out at the beginning and end of each lecture to all participants. A four to six months follow-up survey was delivered by email using SurveyMonkey to evaluate retention and impact of educational materials. Results The initial two groups of participants (n = 81) were aged 23-60 years (mean: 43), and 67% (39) were female. Work experience ranged from 0 to 37 years (mean: 14) with 64% (37) doing direct patient care. Preliminary lecture content data from participants (n = 44) demonstrated an overall increase in correct responses by +15.4% from the pre-test (percent correct, 38.1%) to post-test (53.5%, p < 0.01). Individuals (n = 55) with past exposure to suicide were much more likely to report asking patients about suicide than those with no prior exposure (56.3% vs. 8.3%; p < 0.01). At the six-month follow-up with participants (n = 11), when asked about their confidence in learning objectives from the lecture given prior, the rates of low confidence decreased as well as the level of high confidence improved but was not statistically significant. The rate of low confidence of respondents' confidence in asking about mental health concerns decreased from 35.2% to 0% (p < 0.01). Conclusions Our group was able to successfully deliver lectures to a mixed audience of health workers in a region self-identified as struggling with mental health issues in Costa Rica. The surveys suggested learning occurred. A trend suggestive that the educational content improved the participants' confidence and knowledge components over time was noted. Future service trips may be able to build on this initial experience to improve on ways to raise capacity while delivering direct care to regions in need.

Can a low-cost exercise monitor provide useful heart rate monitoring for use in low-resource emergency departments?

OBJECTIVE: Our objective was to study the clinical monitoring capabilities of a low-cost fitness wristband while measuring patient satisfaction with a mobility permitting device in the emergency department. METHODS: Patients enrolled were on continuous three-lead telemetry monitoring in a high acuity zone of the emergency department. Patients were given a fitness band to wear while simultaneously monitored with standard three-lead monitor. A brief survey was conducted upon study end, and data was compared between wristband and three-lead telemetry. Median heart rate (HR) values were calculated, a Bland-Altman plot was generated, and sensitivity and specificity were calculated for comparison of the formal telemetry and the inexpensive wristband. RESULTS: Thirty-four patients with an average age of 61.5 years were enrolled. From June to October 2019, over 100 hours of data were collected. In comparison for comfort, participants scored 9.5 of 10, preferring wristband over telemetry. Using a correlation coefficient graph, we found a significant disparity of HR readings within a telemetry range of 40 to 140 beats/min. An R-value of 0.36 was detected. Using a Bland-Altman plot, we observed a significant difference in HR between the telemetry monitor and the wristband. The sensitivity and specificity of the wristband to detect bradycardia (HR <60 beats/min) were 76% and 86%, respectively, while the sensitivity and specificity of the wristband to detect tachycardia (HR >100 beats/min) were 92% and 51%, respectively. CONCLUSION: Inexpensive fitness bands cannot be a suitable tool for monitoring patient's HR because of inaccuracy in detecting bradycardia or tachycardia.