ECHO rheumatology programs increase access, improve care

September 27, 2017|Rheumatology News

Rheumatology and the ECHO model

The volume of rheumatic conditions encountered by primary care physicians and the shortage of specialists make rheumatology a logical fit for the ECHO model, Dr. Arora said. Rheumatoid arthritis, osteoarthritis, osteoporosis, fibromyalgia, and joint pain account for as many as one in five visits to primary care doctors, he noted.

“Osteoporosis and rheumatoid arthritis produce massive disability in the world,” he said. “Treatment exists, but it’s not getting to patients. ECHO can fundamentally transform the field of rheumatology if it’s adopted widely.”

However, compared with other specialty ECHO models, there are not many rheumatology ECHO programs in operation. Dr. Arora is hopeful that as word spreads about how well rheumatology fits into the ECHO structure, more programs will develop, he said.

UNM has operated its own ECHO rheumatology program since 2006. The Rheumatology TeleECHO Clinic has trained more than 30 clinicians at distant sites to diagnose and care for rheumatic cases in their communities, said Arthur Bankhurst, MD, medical director for the clinic and division chief of rheumatology at UNM. Training for remote providers occurs through weekly teleconferences and clinic visits where they learn about diagnoses and physical findings for the most common rheumatic conditions. The program also helps clinicians earn advanced rheumatology training certification through the American College of Rheumatology.

“We have found over the years that with our training these providers – both physicians and nonphysician – are able to function as well as a specially trained [rheumatologist],” Dr. Bankhurst said. “We help them as needed by our weekly teleconference where they present cases to us and those cases which appear to be most difficult, we see immediately in our clinics.”

The program has led to decreased referrals to the university from outlying areas and more care access for patients in rural areas, Dr. Bankhurst said. A university study is underway to analyze clinical outcomes for rheumatoid arthritis as conducted by distant provider sites compared with treatment at the university clinic.

“It’s my perspective, based on 12 years of experience, that they’ll be identical,” he said.

Setting up such ECHO programs is not without challenges. Financial support for telecommunication equipment in all needed areas can be difficult, Dr. Bankhurst said. Recruiting individuals who are well motivated to participate in the program can also be a challenge.

“It needs a commitment by the administration,” he said. “It does take time from other activities. It requires dedicated time away from a busy clinic.”

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