- Year In Review
Back in 2003, Dr. Sanjeev Arora discovered that patients were waiting six to eight months to get into his Hepatitis C clinic at UNM Hospital. As one of the few hepatologists or gastroenterologists addressing the physical, psychological, pharmacological and social implications of the disease, he knew that he would not himself be able to treat the 28,000 to 32,000 New Mexico patients afflicted with the disease. And so, ECHO – Extension for Community Healthcare Outcomes – was born.
“I could only treat 70-90 hepatitis C patients per year in my clinic—and there were more than 30,000 people with the disease in the state,” he said, adding that there was a six-month waiting list for patients to see him. Many of the people waiting to see him were not in Albuquerque or within easy travel distance of the city. Many of those people couldn’t afford to make the trip, even if they had the resources. And treatment requires monthly visits for a full year.
Treating hepatitis C is complicated; taking medical professionals years to develop the expertise—and very few physicians in New Mexico have it. In rural and medically underserved areas, proximity to specialists, a limited number of specialty providers and inadequate medical insurance severely limit a patient’s ability to seek specialty care. This meant that thousands of rural patients across the state—who did not have access to a specialist or the means to gain access—would largely go untreated.
Arora thought this was unacceptable. “I asked myself if there was something I could do to make a difference,” he said. The answer he came up with was simple: A significant change in the way we treat common, chronic, complex diseases was needed.
Arora is not the first person to recognize the need for change. “Many people tried to bridge the gap between rural patients and access to specialty care,” he said. Because most specialists are located in urban areas, the most widely used method is telemedicine, where patients are seen by specialists via videoconferencing or similar technology.
But, for diseases where the treatment is complicated and difficult to manage and the shortage of experts severe, another solution was needed. Arora’s idea put a twist on the traditional use of telemedicine by bringing the physicians—not the patients—to the experts in order to provide them with the tools and resources they needed to care for their patients.
Arora, executive vice chair of the UNM Department of Internal Medicine, said, “Most primary care physicians have received little or no education in treating these diseases.” But, with training and a strong support system, Arora believed that community-based physicians could gain the necessary skills to provide this specialized care in their own communities.
Using the treatment of hepatitis C as the pilot program for Project ECHO, Arora, in partnership with the New Mexico Department of Corrections, the New Mexico Department of Health, the Santa Fe Indian Hospital and a handful of community-based physicians, held the first hepatitis telemedicine clinic in June 2003.
Each Monday, participating health care professionals from 14 sites around the state meet with Arora and other UNM physicians via interactive video to discuss cases and determine treatment. Since its inception two-and-a-half years ago, 70 hepatitis C clinics have been conducted, reviewing a total of 810 case presentations. Currently, there are 80 patients in rural New Mexico on active treatment for hepatitis C via Project ECHO.
Arora is pleased with the success of the hepatitis C pilot project. Patients in rural areas and in the state’s correctional facilities are receiving the care they need, while physicians are expanding their capabilities and knowledge. But, says Arora, equally important is that Project ECHO has established a new model for care that addresses the needs of New Mexico’s underserved populations. The model also provides specialty access to uninsured patients who are cared for by federally qualified health centers.
Arora believes Project ECHO will prove to be an effective model for treating New Mexicans with various common, chronic, complex diseases. He has identified several specific conditions—hepatitis C, cardiovascular risk prevention (diabetes, obesity, hypertension, high cholesterol), and mental health disorders—that are especially burdensome to New Mexicans, from both a quality of health and financial perspective. He plans to implement similar programs to address these diseases.