Arizona Telemedicine Program and Arizona Center for Rural Health Aim to Make Rheumatology Accessible in Arizona

If you need to see a rheumatologist in Arizona, chances are you’re going to have to wait—especially if you’re in a rural area. These specialists are in short supply in the United States, and the demand for them is high as the population ages.

To address this workforce issue without making patients travel long distances or wait months for an appointment to see a rheumatologist, the Arizona Telemedicine Program (ATP) at the University of Arizona College of Medicine – Tucson and the University of Arizona Center for Rural Health (AzCRH) at the UA Mel and Enid Zuckerman College of Public Health partnered to create a program in Arizona that will train primary care providers to treat rheumatic diseases.

The program will use the ECHO (Extension for Community Healthcare Outcomes) model™, developed at the University of New Mexico School of Medicine, which aims to increase workforce capacity by sharing knowledge. Primary care providers in local communities develop skills to deliver specialty-care services to their patients by meeting regularly via videoconferencing with specialists at an academic “hub” site. The specialists share their medical knowledge and expertise, serving as mentors and colleagues.

Unlike “traditional telemedicine,” where the specialist assumes care of the patient, Project ECHO programs provide front-line clinicians with the knowledge and support they need to manage their patients with complex conditions in the patients’ own communities. This dramatically increases access to specialty treatment in rural and underserved areas.

ATP Medical Director Amy Waer, MD, received a $17,700 grant from Lilly to launch a one-year rheumatology ECHO pilot program, based at the ATP and administered jointly with AzCRH. The program begins in September.

“We can leverage and enhance relationships with our primary-care providers, rural and critical access hospitals through our center,” said Dan Derksen, MD, AzCRH director.

Banner Health rheumatologist Dominick Sudano, MD, assistant professor of medicine and a member of the UA Arthritis Center at the UA College of Medicine – Tucson, will meet with as many as 40 primary-care clinicians throughout Arizona by multi-site video conferencing for two hours each month. About 20 minutes will consist of a lecture on a rheumatology topic; the remainder will comprise individual patient case presentations with protected health information removed. Dr. Sudano will advise local clinicians on how to proceed on a case-by-case basis.

“This represents an excellent opportunity to improve patient care across Arizona while simultaneously connecting with and educating primary-care providers about rheumatic diseases,” Dr. Sudano said.

As Arizona community-based clinicians attend more sessions and learn from Dr. Sudano, and each other, their knowledge and ability to treat rheumatologic conditions locally will increase. Less-severe cases will be treated locally; patients with severe disease still will be referred to a rheumatologist.

The ECHO model works, said Colleen Hopkins, telehealth coordinator at North Country Healthcare in Flagstaff. North Country Healthcare has participated in a hepatitis C ECHO program since 2012, linking its chain of 14 community health centers—extending across vast rural areas in Northern Arizona—with a hepatologist-educator at St. Joseph’s Hospital and Medical Center in Phoenix, 140 miles to the south.

“Our providers feel so much more confident and competent about treating their patients with hep C,” Hopkins said.

For more information about the UA rheumatology ECHO pilot program, visit the website, telemedicine.arizona.edu/echo

This activity is supported by an educational grant from Lilly. For further information concerning Lilly grant funding, visit www.lillygrantoffice.com

About the Arizona Telemedicine Program

Based at the University of Arizona Colleges of Medicine (Tucson and Phoenix), the Arizona Telemedicine Program (ATP) was established in 1996 by the Arizona State Legislature to help provide access to top-quality health care to rural Arizonans. ATP strongly supports the growth of telemedicine throughout Arizona and provides a suite of services to its member organizations, including clinical, administrative and information technology support; telemedicine training; and facility design. More than 60 clinical subspecialty services have been provided through the network, amounting to more than 1.3 million telemedicine cases. ATP is home to the federally funded Southwest Telehealth Resource Center, which serves Arizona, Colorado, Nevada, New Mexico and Utah. ATP has received many national awards for its innovative education and training programs. For more information: telemedicine.arizona.edu

About the University of Arizona Center for Rural Health

The University of Arizona Center for Rural Health, housed in the UA Mel and Enid Zuckerman College of Public Health, has been serving Arizona through its core mission to improve the health and wellness of rural and underserved populations since 1981. The Center is home to many programs including, the State Office of Rural Health, Rural Hospital Flexibility Program, Small Rural Hospital Improvement Program, Western Region Public Health Training Center, Navigator Consortium, Students Helping Arizona Register Everyone and the Prescription Drug Misuse & Abuse Initiative. For more information: crh.arizona.edu