WASHINGTON — Army officials are taking steps to replicate an innovative telehealth project to enhance the Army’s pain-medicine care and treatment.
Telehealth initiatives generally have been used to allow a doctor at one location to connect with a patient at another location to provide care. Developed by the University of New Mexico Health Sciences Center (UNMHSC), Project Extension for Community Healthcare Outcomes (ECHO) is instead using telehealth to connect primary-care providers in rural areas with medical specialists.
Officials say the beauty of this telehealth program is that it allows medical specialists to train and mentor clinicians from rural and underserved areas who treat patients with chronic diseases. Patients, therefore, need not travel to a distant medical center to visit a specialist, and primary-care providers benefit from the specialists’ expertise.
This model of telehealth could have great benefits for the Army as it implements a comprehensive pain strategy to address how pain is treated across the system, explained Col. Kevin T. Galloway, AN, chief of staff for the Army Pain Management Task Force. Galloway was among a team of military officials who recently visited UNM to learn more about ECHO.
“We are looking at adjusting that model for our system,” he said.
UNMHSC launched ECHO to improve access to care for underserved populations infected with Hepatitis C. The program was developed by UNM hepatologist Dr. Sanjeev Arora to address the shortage of providers equipped to treat the more than 30,000 New Mexicans who had the infection.
As one of the few hematologists in the heavily-rural state, patients often drove long distances multiple times a year to receive treatment from Arora. In addition, there was a waiting list to see him.
“Unfortunately, in 2004, when I started this project, there were no specialists in rural areas that could treat this disease, and people would have to travel 200 to 250 miles each way to see me for treatments that consisted of injections on a weekly basis,” he told U.S Medicine.
Now, through the ECHO telehealth initiative, primary-care providers receive didactic teachings weekly from UNMHSC specialists on better ways to care for Hepatitis C patients. During the sessions, providers have the opportunity to present specific patient cases for discussion with specialists.
ECHO programs have been expanded to include chronic diseases, including asthma, mental illness, chronic pain, diabetes and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology and substance abuse.
An article Arora and his colleagues published in a June issue of the New England Journal of Medicine suggests that ECHO sites may be able to produce results statistically identical to those of specialists at a university medical center.
The prospective study compared the treatment for HCV infection at the UNMHSC HCV clinic with treatment by primary-care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. Cure rates were 58.2% for patients treated through Project ECHO and 57.5% for the group treated at UNM.
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Replicating the Program
As the Army seeks to improve pain management for wounded warriors by establishing a more uniform approach, ECHO could be a good model, said Galloway.
“You can have a huge conference and bring in 800 people and really impact them for four days, and then they go back,” he said. “What this allows us to do is reach out from our specialty centers on an ongoing continual basis to start influencing the care and understanding and create what we called in the Army Pain Management Campaign, ‘pain champions’.’’
In addition, the ECHO model would allow the military to address the problems of supply and demand of specialty care for pain in remote areas.
“For us to build confidence and competence in our primary-care centers to be more effective in keeping things at the proper level if they can be handled effectively at the primary-care level, that is good. It decreases the backlog of specialty waiting currently. That queue for specialty care, even in our system, is tough,” Galloway said.
ECHO also can be a way for DoD to synchronize pain care with the VA, which has developed its Specialty Care Access Network (SCAN) program based on the UNMHSC model.
“We are working as part of the pain campaign to synchronize pain care across DoD and VA,” said Galloway. “So as they create for their ECHO didactic content, we are partnering with them, so it is the same stuff.”
Joanna Katzman, MD, associate professor of neurology at the UNM School of Medicine and the medical director of the chronic pain Tele ECHO Project, said the UNM program is working with Army pain experts to help them replicate the program.
“We are sharing our didactic information, our model, and they are coming on a weekly basis to us,” she said. “We are also working with them in developing outcomes, in developing the most appropriate research tool that can also be used clinically to measure how effective this model is in the military.”
In addition to the Army and VA, the ECHO model is being implemented at other sites. The University of Washington in Seattle received a grant from the Robert Wood Foundation to replicate the model to treat conditions including diabetes, substance-abuse and mental-health problems, asthma, rheumatology, chronic pain and high-risk pregnancy.
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