Dermatology ECHO - an innovative solution to address limited access to dermatology expertise

Abstract

ABSTRACT:Introduction: The present maldistribution of dermatologists in the USA may make it difficult for patients to access timely and quality care. Access to specialty care may be even more challenging for rural and underserved patients due to geographical limitations and other socioeconomic hardships. With over one-third of primary care patients seeking care for at least one skin problem, it is important to follow the American Academy of Dermatology Special Positioning Workgroup's core areas of impact regarding treatment of conditions that affect millions of patients by using a team-based approach and telemedicine technologies. The objective of this study was to demonstrate the Dermatology Extension for Community Healthcare Outcomes (ECHO) project approach in multidisciplinary telementoring and education of primary care providers (PCPs) in treatment and management of complex, costly, and common skin diseases via live interactive video technologies.Methods: Dermatology ECHO is a distance education telementoring platform that uses a multidisciplinary case-based approach in a non-judgemental environment. A team of specialists, including general dermatologists, pediatric dermatologists, a dermatopathologist, a clinical psychologist, and a nurse practitioner, meets via video with a number of PCPs from isolated, rural, or underserved areas to discuss de-identified patient cases and present dermatology-specific continuing medical education (CME)-approved didactic presentations. The University of Missouri, Department of Dermatology, leads the first Dermatology ECHO in the USA. They partner with various primary care clinics across Missouri to provide mentoring in the treatment of skin conditions. Missouri Telehealth Network provides operational support through the Show-Me ECHO project. The network also assists with provider recruitment activities. Results: The authors describe a patient case to illustrate the effect of ECHO on provider distance learning and patient outcomes. A 69-year-old woman from rural Missouri was spurred by a rooster. She presented to her primary care clinic six times over a 2-month period.She was prescribed several different medications and underwent tests and one procedure, including vaccination. After the patient's case was presented during the Dermatology ECHO session, she was correctly diagnosed with a Mycobacterium skin infection, and new recommendations were made. The patient improved significantly within 2 weeks. Conclusions: As specialty medical evidence-based recommendations continue to increase, providers practicing in isolated rural and underserved areas may find it challenging to keep up with the new knowledge. Dermatology ECHO creates a community of practice that allows participating providers to discuss complex cases, receive specific guidance and mentoring, and participate in CME presentations. The case presented here supports the authors' observations that Dermatology ECHO is an appropriate platform for learning evidencebased medical knowledge via videoconferencing technology.

Extension for Community Healthcare Outcomes-Palliative Care in Africa Program: Improving Access to Quality Palliative Care

“…Since its inception, the reach of Project ECHO has expanded beyond New Mexico and the United States 25,27 and has addressed a multitude of conditions beyond hepatitis C. 29-36 Project ECHO has been used to successfully educate primary care clinicians in treating both chronic and acute diseases worldwide by effectively expanding patient access to specialist care and by disseminating knowledge and experience regarding PC to specialists. 25,27…”

“…Indeed, participants have reported that their participation in Project ECHO is valuable to their practice on many levels. Positive outcomes for patients have also been reported, 29-36 and in the case of hepatitis C, outcomes of the care provided by ECHO-trained, rural primary care clinicians rivaled that of academic medical center specialists. 24 A meta-analysis of publications that investigated Project ECHO concluded that it can be a cost-effective means of improving both provider competence and patient outcomes.…”

Project ECHO: The Specialist Will See You Now

“…Remarkably, rates of sustained virological response were identical in patients treated at UNM and those treated by primary care providers at 21 ECHO sites and dermatology …”

“…(1) Project ECHO has since proven effective in a number of other medical specialties, including drug addiction (2) and dermatology. (3) In 2011, the Veterans Health Administration adopted the ECHO program to innovate specialty care delivery and renamed it SCAN-ECHO (Specialty Care Access Network-Extension for Community Healthcare Outcomes). The VA Ann Arbor was one of the first to implement SCAN-ECHO for chronic liver disease.…”

Building HIV healthcare worker capacity through telehealth in Vietnam

“…Telehealth has multiple benefits for institutions and participants. It reduces travel and time away from work, improves access to consultation and mentoring from experts, facilitates peer-to-peer learning, 32 reduces professional isolation 33 and helps health workers fulfil their CME requirements. 19 Our experience demonstrates the feasibility, scalability and acceptability of this approach in a resource-limited setting and provides a model for other countries.…”