University of New Mexico Health Sciences Center
| By Cathleen Rineer-Garber, Office of the Executive Vice President |
As a physician at UNM Hospital and one of the few hepatitis specialists in New Mexico in 2002, Sanjeev Arora, MD, had become increasingly frustrated with his inability to provide care to the thousands of New Mexicans who suffer from hepatitis C.
“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 says, adding that there was a six-month waiting list for patients to see him. And these were the lucky patients—the ones who lived near Albuquerque or could afford the luxury of traveling to see a specialist on a monthly basis for the year-long treatment.
Treating hepatitis C is a complicated process; it takes many years to develop this special 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.
To Arora, this was unacceptable. “I asked myself if there was something I could do to make a difference,” he says. The answer he came up with was simple: A significant change in the way we treat common, chronic, complex diseases was needed.
Arora’s not the first person to recognize the need for change. “Many people have tried to bridge the gap between rural patients and access to specialty care,” he says. 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.
“Most primary care physicians have received little or no education in treating these diseases,” explains Arora, who is Executive Vice Chair of the UNM Department of Internal Medicine. 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.
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