Access to healthcare expertise is critical for people with drug use disorders, who are at high risk of numerous complex health problems including Hepatitis C and HIV. In rural areas and other locations that have limited health care resources, meeting patients’ needs is particularly challenging when expertise is unavailable locally and patients lack the means to travel to specialized clinics.
To close this expertise gap and improve patient outcomes, Joan Duwve, through IU’s Responding to the Addictions Crisis Grand Challenge, is using video conferencing to help local providers build greater capacity to treat addiction-related health problems.
Through twice-monthly conference calls organized by the IU Fairbanks School of Public Health, the project, "Echo Center," links healthcare providers throughout Indiana with leading experts to discuss critical topics, review patient cases and develop a professional network. This increased capacity means that patients get the care they need, from providers they trust, close to home.
The teleconferencing model, known as Extension for Community Healthcare Outcomes (ECHO), was developed at the University of New Mexico to improve statewide capacity to treat Hepatitis C. Its use in New Mexico has not only improved patient outcomes but also increased job satisfaction among participating healthcare providers, helping improve retention of the healthcare workforce in underserved areas.
Duwve and her team are building ECHOs to address three areas of care associated with addictions: HIV, Hepatitis C and pain management. Providers throughout the state are invited to participate; numerous rural counties are represented among the project’s ECHO networks in addition to physicians in underserved urban areas of Indiana.
For each ECHO, Duwve’s group established a curriculum that highlights a different key topic at each gathering, ranging from stigma to drug interactions to helping patients afford care. Each session begins with introductions of all participants (usually 20-30 people), followed by an expert presentation on the day’s topic (often by IU faculty members), and closing with discussions of real-world cases (with all identifying information removed to protect patient privacy). All materials and resources, including video recordings of the discussions, are made available to participants.
In addition to the information and guidance obtained by participating providers, the process also improves IU’s teaching and research in the health sciences as presenters learn about the current problems and barriers that healthcare providers encounter.
Duwve first learned about the ECHO model during the 2015 HIV outbreak among people who inject drugs in Indiana’s Scott County. At that time, although individuals were being diagnosed with HIV and Hepatitis C on a daily basis, there were no infectious disease doctors in the county with the expertise to treat these problems.
One doctor in Scott County joined an ECHO based in Connecticut to develop these skills and was subsequently able to help hundreds of local residents. After sitting in on an ECHO session, Duwve recognized that IU could provide similar services for the state if startup support became available.
Now that the Grand Challenges award has enabled the launch of the ECHO platform and several addictions-related ECHOs, Duwve’s group has obtained additional funding to launch ECHOs to improve other areas of Indiana healthcare including cancer and prison peer health education.