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Telementoring improves children’s access to specialty care :

November 9, 2015

With hepatitis C patients facing an eight-month wait, Sanjeev Arora, M.D., FACP, had an idea to treat them faster. What if, rather than having patients make the hours-long trek to the University of New Mexico for care, their local clinician was trained to treat them? The solution cut patients’ waiting time to two weeks.

During his plenary address at the AAP National Conference & Exhibition, liver disease specialist Dr. Arora explained how the University of New Mexico’s Project Extension for Community Healthcare Outcomes (ECHO) has not only helped hepatitis C patients in his state but has become a model to treat complex diseases in rural locations and developing countries.

“At ECHO, our goal is to democratize knowledge and get best practice care to people all over the world,” said Dr. Arora. “In the U.S., we have two times the number of specialists than most of the world, yet rural doctors are saying they don’t have access to specialized expertise.”

Project ECHO solves this problem by using a telementoring process and guided practice, said Dr. Arora. Primary care physicians, including pediatricians, access the Internet via an iPad, mobile phone or computer with a web camera to join video conferences. During these two-hour “knowledge networks,” physicians present their patients’ cases, ask questions and discuss a care plan with the team of specialty experts at a hub such as a university or other institution. Participants also can earn continuing medical education credit as they present cases or learn from others.

“The strategy we have is to move knowledge not to move patients,” said Dr. Arora.

Hubs are being set up across the nation and internationally to offer teleECHO clinics on pediatric chronic diseases such as asthma, autism and epilepsy. The Academy is a Project ECHO superhub for children and youths with epilepsy.

The force-multiplication model aims to expand education of primary care physicians at a logarithmic rate, Dr. Arora said. About 63,000 have been trained on hepatitis C and 12 other diseases. Of the 550 clinics held on hepatitis C, for example, more than 5,500 patients have entered into care. The trained primary care physicians become local experts in chronic diseases.

Patients received safe, effective care from their rural primary care physicians, as well as other benefits, said Dr. Arora. “These cure rates were significantly higher than when they saw specialists in the U.S. treating hepatitis C.”

Another benefit is cost-effectiveness. “The current model of specialty care is highly defective. It’s based on knowledge monopolies,” he said.

“It’s not about building an organization,” he said. “We want to create movement to change the world for the better for children all over the world.”


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