Teleconsultation efforts help fill gaps in specialty care access

“Move knowledge, not people” is the principle behind an innovative program that demonstrates the power of solving problems through collaboration among academic medical centers and community-based primary care physicians.

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Project ECHO (Extension for Community Healthcare Outcomes) was launched at the University of New Mexico Health Sciences Center in Albuquerque in 2003 to provide local primary care physicians with support from specialists to treat patients with hepatitis C.

The project uses adult learning techniques and video technology to connect community physicians—often located in remote or isolated areas—with specialists for collaborative sessions built on case-based learning and mentorship, according to the program’s website.

“Providers gain skills and confidence; specialists learn new approaches for applying their knowledge across diverse cultural and geographical contexts,” the website says. “As the capacity of the local workforce increases, lives improve.”

The effectiveness of the Project ECHO approach got a national spotlight when The New England Journal of Medicine published a report, “Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers.” It was written by University of New Mexico researchers and demonstrated that patients with hepatitis C virus infection seen by local physicians with remote specialist support achieved results comparable to patients seen by specialists at the academic medical center.

“ECHO represents a needed change from the conventional approaches in which specialized care and expertise are available only at academic medical centers in urban areas,” the authors wrote. “The ECHO model has the potential for being replicated elsewhere in the United States and abroad, with community providers and academic specialists collaborating to respond to an increasingly diverse range of chronic health issues.”

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The challenges patients faced at the time of the study were spelled out in an accompanying editorial, and are similar to the barriers to care many patients still encounter today.

“The lack of available specialists is particularly challenging,” wrote Harvard’s Thomas D. Sequist, MD, MPH. “It can be difficult to recruit specialists to work in remote or isolated settings, where resources are scarce, opportunities to interact with specialist colleagues are limited, and the clinical caseload may not justify the presence of a full-time subspecialist.”

There are nearly 500 ECHO programs operating in 48 states and supported by 215 “hubs” consisting of academic subspecialty experts who make themselves available to primary care physicians, according to the Project ECHO website. Internationally, there are 729 ECHO programs, supported by 339 hubs in 37 countries that help patients with cervical cancer, HIV-AIDS, tuberculosis and opioid-use disorder. Programs have also been developed to support and mentor physicians to provide behavioral health, pain management and palliative care services.

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Project ECHO and similar programs, such as the Massachusetts Child Psychiatry Access Project (CPAP), are effective ways to mitigate gaps in care.

CPAP was established in 2004 and has strong similarities to Project ECHO’s goals and methods. Child and adolescent psychiatrists in the program provide training and mentoring of primary care pediatricians through regional consultation teams to assist with medication, treatment and referral needs for children with behavioral health issues.

Consultation programs based on the CPAP model have been adopted by more than 30 states.

“These training models offer a unique solution to specialty physician shortages by expanding the competencies and skills of physicians who are already providing patient care in our communities, rather than looking exclusively at increasing the physician workforce as the answer,” AMA Board Member S. Bobby Mukkamala, MD, said regarding Project ECHO and CPAP.

Project ECHO principles are integrated into the American Society of Addiction Medicine’s Fundamentals of Addiction Medicine ECHO (FAME), a 16-week video conference series that kicked off this month and continues through March 6, 2020.

The AMA partnered with the University of New Mexico to create an AMA STEPS Forward™ open-access module for its AMA Ed Hub™, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

The module offers instruction on connecting with Project ECHO, identifying patients who would benefit by increased access to specialty care, and presenting their cases in a TeleECHO clinic session.

Learn more about AMA CME accreditation.