A decade ago, about 34,000 New Mexicans had hepatitis C, but fewer than 1,600 were receiving treatment. Why so few?
Two-thirds of New Mexicans live in rural areas but two-thirds of the state’s physicians are in urban areas, so taking advantage of new treatments required patients driving hundreds of miles for up to 18 sessions of treatment. That was impractical, and put treatment out of reach for most.
Enter Project ECHO (Extension for Community Healthcare Outcomes).
Unlike traditional telemedicine, where doctors meet with patients one-on-one, Project ECHO’s “teleclinics” bring general practitioners and specialists together to review individual cases and to provide training for healthcare workers across the globe.
Dr. Sanjeev Arora at the University of New Mexico has shared his knowledge of hepatology with primary care physicians across his state. The project provides training not just for doctors, but also for nurses, nurse practitioners, and others in the healthcare field.
“There were thousands of people with hepatitis C, and he couldn’t treat them all,” Dr. Karla Thornton, associate director of Project ECHO and an infectious disease specialist, told Healthline.
With specialists concentrated in urban hubs, it became vital for many rural doctors in The Land of Enchantment to become conversant in the treatment of infectious diseases.
Led by Arora, a pharmacist, a psychiatrist, and a nurse, ECHO’s televised training sessions helped bring hundreds of doctors up to speed with the fundamentals of treating and preventing hepatitis C. The project is at the forefront of the state’s task force to combat these infection rates.
Spreading the Wealth of Knowledge
The U.S. healthcare system is experiencing unprecedented demand since the passage of the Affordable Care Act. An estimated 32 million Americans now have health insurance, and the aging Baby Boomer population is living longer with more chronic conditions.
This has experts everywhere looking how to efficiently deliver quality care to everyone who needs it, no matter where they live. Project ECHO could offer a model for others to follow.
The organization now has 70 participating hubs in 12 countries with more than 45 specialties being addressed. These include an hub focused on antibiotic stewardship at the University of Nevada, and one to train military physicians in women’s health with the Department of Veterans Affairs.
Rural Docs Required to Know More
These days, the family doctor is expected to know a little bit about everything.
These family physicians are especially important in rural areas where they perform nearly twice as many patient visits as urban doctors.
The problems — especially in sparsely populated states like New Mexico — arise when patients have complicated symptoms or conditions and no access to the specialists that treat them. There often aren’t even enough qualified medical professionals in the vicinity for patients to get a second opinion or for doctors to talk shop.
Project ECHO is designed to bridge that gap.
With as little as a laptop and an Internet connection, a rural doctor can present anonymous cases to panels of specialists, whether it be for help in diagnosing or advice on what medications would best suit the patient.
There are also training seminars on the latest treatments, guidelines, and research findings. While it can take up to nearly a decade for the latest research to translate into new treatment guidelines, Project ECHO helps speed up that process and keep clinicians up to date.
“As experts, it’s hard to keep up,” Thornton said. “For people in the primary care field, it’s impossible.”
Besides knowledge, rural doctors have access to a larger network through ECHO, which can help doctors from burning out from the inherent stress involved in their professions.
“They feel isolated and not like they’re learning much,” Thornton said. “With Project ECHO, they learn from each other. They achieve the ability to treat their patients.”
An ECHO survey in 2010 found that after 12 months of training, a participating physician described themselves as competent or very competent in a particular subject.
A Shared Response to Crisis
News may travel fast in a small town, but the latest medical findings don’t always reach rural doctors quickly. The ECHO network has been able to identify and respond to emerging situations and information.
For example, when a small study out of an Israeli medical college found that vitamin D supplements helped antiviral therapy in hepatitis patients, ECHO experts quickly spread the news through the network.
Member doctors quickly began supplementing treatments, as 85 percent of their patients on antiviral medication had vitamin D deficiencies.
That little observation changed protocol in days, not years. When cases of Rocky Mountain spotted fever began showing up in some of their hub areas, ECHO doctors were able to confer and share information with the U.S. Centers for Disease Control and Prevention (CDC).
In 2009, during the H1N1 outbreak, ECHO teams led teleclinics for respiratory therapists, nurses, and clinicians at community hospitals on best practices for ventilator treatment.
ECHO is also now creating hubs overseas. One such hub is combating HIV in Namibia in southern Africa. There, ECHO trained specialists for 10 newly created HIV clinics to treat tens of thousands of infected people.
“The goal is to have the knowledge located at the hub,” Thornton said.
Using the ECHO Model
Rural doctors are more likely to be in private practice or inside small healthcare systems. They get paid per patient seen, so it’s not always easy to take time away from patients for extra training.
Under single-payer systems like Canada, Thornton said, the model is easier to implement. But in the United States, reimbursement models don’t encourage the kind of collaboration Project ECHO represents. Nonetheless Missouri and Colorado have funded Project ECHO through legislative measures.
The main hub for Project ECHO in New Mexico gets its money through a combination of grants, including from the Center for Healthcare Innovation and the Robert Wood Johnson Foundation, as well as taxpayer dollars.
Having fewer patients see expensive specialists would save on healthcare costs.
In addition, an expanding network of experts would continue to share knowledge across boundaries in a coordinated effort to improve the healthcare of millions of people.
“The specialists who decide to do it are more mission-driven and see the public good in this,” Thornton said.