Project ECHO: Bringing Specialty Knowledge to Primary Care

What is Project ECHO?

Have you ever gone to your primary care physician or a public clinic with a problem only to be referred to a specialist? Sometimes, this works out just fine—especially if you live in  a community with a variety of medical resources. But limited access to specialty care causes problems for patients in underserved communities all over the world. Project ECHO, developed by the University of New Mexico, is combating this problem in a unique way.

ECHO stands for Extension of Community Healthcare Outcomes. It is a training program for primary care physicians, with the end goal of empowering them to provide more specialty care in their own communities. While ECHO does not directly provide specialty care, according to its website, the program “…dramatically increases access to specialty treatment in rural and underserved areas by providing front-line clinicians with the knowledge and support they need to manage patients with complex conditions…” The model is a “hub and spokes” design, where ECHO provides training, led by specialists and experts, in the form of weekly teleECHO™ clinics.

These clinics provide multiple perspectives to participants, who present patient cases in order to determine the most effective treatment. During the clinic, “Specialists serve as mentors and colleagues, sharing their medical knowledge and expertise with primary care clinicians…” This allows participants to become “…more knowledgeable in a wide-range of complex conditions including diabetes, chronic pain, hepatitis C, HIV, addiction and mental health disorders, gastroenterology, and multiple sclerosis.”

Benefits to Patient and Provider

Patients benefit not only from increased specialty care, but from multiple improvements to their providers professional experience. The ECHO website reports that providers who take part in teleECHO™ clinics “…become part of a community of learners, increasing professional satisfaction and decreasing feelings of professional isolation. For a health center, this means that providers are more productive and stay in their positions longer.” Patients then benefit from more consistent care, which in turn “…enhances their adherence to treatment and follow-up care.”

The program itself is free to providers, though they do some form of technology to access it. ECHO has found that most offices already have what they need, as providers can participate in clinic using a laptop, hand-held device (mobile phones included) or tablet and the free software or app called “ECHO Zoom.” Zoom is a video conference program that complies with HIPAA guidelines and is used in other hospitals and doctors offices for other applications as well. ECHO also offers CME (continuing medical education) credits to participants at no cost.

How Project ECHO and Telemedicine are Related

While telemedicine, including telepsychiatry, is related to Project ECHO, they are technically different practices. Where telemedicine brings specialists directly to the patient using technology, ECHO can have a wider reach by training multiple providers in specialty care. The Behavioral Health and Addiction (BHA) ECHO program specializes in mental health disorders. BHA supports providers by “…disseminating best practice care to improve patient outcomes by conducting proper screening and initiating treatment, and when necessary, making the proper referral.”

BHA curriculum includes clinics in “depression essentials” and anxiety disorder, as well as bipolar and psychotic depression. Clinics also include relapse prevention, antidepressant medication management, referring for behavioral health consultation, and PTSD. ECHO also provides additional resource links right on their site, including wellness guidelines and breathing exercises which providers can use to inform their process in identifying and treating BHA concerns.

While specialty medicine is still a possible solution and, in some cases, a necessary step for treatment, Project ECHO is empowering primary care offices to expand their scope. Patients may be limited in several ways, including prohibitive cost and geographic distance from specialist offices. ECHO is helping break down these limitations by bringing expertise and training directly into underserved communities. The programming expands primary care physicians knowledge base allowing them to better serve their patients.

For more information, visit: Project ECHO online.

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