October 29, 2009 | Read Time: 2 minutes
The scarcity of nearby medical specialists, inadequate insurance, and the time and expense required to travel to Albuquerque or Santa Fe makes it difficult for many people in rural New Mexico to get treatment for complex, chronic diseases. But a university program is trying to bridge the distance with technology.
Project ECHO — which stands for Extension for Community Health Outcomes — uses secure, Web-based videoconferencing to link doctors, nurse practitioners, and physician assistants across the state with specialists at the University of New Mexico Health Sciences Center to discuss patients’ illnesses and design treatment plans.
The weekly teleconferences act as virtual patient rounds to help rural clinicians develop expertise in treating difficult conditions, such as asthma, HIV/AIDS, chronic pain, and mental illness, says Sanjeev Arora, who started the program in 2003.
“When a doctor goes to medical-school residency fellowships, they learn on real patients with mentors,” he says. “We said, ‘Why could we not bring the same kind of case-based learning back into the life of a rural physician?’”
The project grew out of Dr. Arora’s frustration with how few of the estimated 32,000 people in New Mexico with hepatitis C were receiving treatment. A physician at the University of New Mexico Hospital and one of the few hepatitis specialists in the state, Dr. Arora’s clinic could see only 90 patients annually.
Hepatitis C infection can lead to cirrhosis, liver cancer, and even liver failure, but with treatment, the disease can be cured in as many as 60 percent of patients.
Project ECHO makes treatment more accessible by increasing the pool of clinicians who can provide care, says Dr. Arora. He says that as rural health-care providers interact with specialists, they become more skilled and confident in their ability to treat patients, usually with a combination of drugs for six months to almost a year.
“They become experts over time,” he says. “They’re treating these patients, and they are getting feedback on a regular basis.”
Project ECHO has provided more than 4,000 consultations for patients with hepatitis C, and rural health-care providers have received 3,500 hours of continuing medical-education credit. According to Dr. Arora, an outside study of the program found that the quality of care that patients receive is as safe and effective as that in a university-based clinic.
In August, Project ECHO won a three-year, $5-million grant from the Robert Wood Johnson Foundation, in Princeton, N.J., to bolster its videoconference programs for other chronic conditions and to start a similar hepatitis C program at the University of Washington.
Dr. Arora hopes that the approach also can be applied to improving medical care in rural parts of developing countries. Project ECHO is planning a test project in India to help health-care providers treat HIV/AIDS.
The current level of treatment is negligible, says Dr. Arora.
“There are about three million patients with HIV in India,” he says, “and only about 200,000 are receiving treatment.”
