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Making specialty care accessible

TeleECHOs transform care for hepatitis C

August 2017

AS TELEHEALTH makes inroads into American medicine, a project first launched in New Mexico in 2003 is transforming the treatment of hepatitis C (HCV) in underserved communities.

Project ECHO (Extension for Community Healthcare Outcomes) was designed to make medical knowledge and treatment much more accessible. Its founder, Sanjeev Arora, MD, is a liver specialist who—when the project first launched—ran one of only two hepatitis C clinics in that state.

ECHO’s model uses regular teleconferences (teleECHOs) to have specialists make treatment recommendations to primary care providers in outlying areas. That allows rural patients to be treated in their own communities.

Each Project ECHO hub connects with remote “spokes,” typically rural clinics that can’t offer specialty care.

Project ECHO now addresses dozens of diseases and conditions, and it operates more than 120 “hubs” in more than 20 countries. Each hub connects with remote “spokes,” typically rural clinics that can’t offer specialty care. Project ECHO receives federal and private funding.

Many hubs are in academic centers. But one hepatitis C hub is the Cherokee Nation W.W. Hastings Hospital in Tahlequah, Okla. The central hospital for the Cherokee Nation in northeastern Oklahoma, Hastings holds biweekly teleECHOs with eight different clinics, some of them two hours away.

Attending these sessions are several clinic physicians and pharmacists, NPs and a PA. In the hub, Jorge Mera, MD, the head of infectious diseases for the Cherokee Health System and the hospital, moderates the sessions. He is joined by a behavioral health provider, an NP, several RNs, and a case manager and a data manager.

“Each meeting is an hour long, which allows clinic providers to present three to five cases,” explains Jennifer Shade, MBA, Hastings’ HCV clinic and Project ECHO coordinator. Hub clinicians make treatment and management recommendations, while the case manager arranges assistance so patients can access expensive antivirals.

Each session also includes 15 minutes of didactics, with Dr. Mera or a colleague speaking on related topics including addiction and alcohol abuse. Since Hastings’ ECHO program began, around 600 patients in outlying clinics have been treated.

Because the clinics are part of the tribal health system, the teleECHOs are also used to discuss an ambitious initiative to eliminate HCV within the Cherokee Nation. That initiative is being led by many of the same Hastings clinicians in partnership with the University of Oklahoma and the CDC, among others.

With 3.5% of Cherokees infected with HCV, a prevalence several times higher than that in the U.S., the elimination project aims to screen all Cherokees age 20-69 and treat all cases found. As of March 2017, 43% of Cherokees in that age range had been screened, while 43% of those found to be positive were under age 50.

More information is available online.

Published in the August 2017 issue of Today’s Hospitalist
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