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Video Counseling Can "Upskill" PCPs, Bringing Specialty Knowledge to Rural Patients


Not all telehealth is direct-to-patient. Video counseling for providers can be a force multiplier...and potentially, a life-saver.

There’s already ample evidence that telemedicine has great potential for improving outcomes and saving patients and healthcare organizations money. Saving lives, however, is a different proposition.

But not all telehealth is direct-to-patient. Video counseling for providers can act as a force multiplier for medical knowledge. And according to researchers from University of Michigan Medical School and the Ann Arbor Veterans’ Affairs Medical Center, such peer-to-peer videoconferencing might have helped survival rates among a cohort of more than 62,000 patients with liver disease.

>>READ: For Hypertension Patients, Virtual Visits Might Be as Effective as In-Person Care

Their new report, published in Hepatology, focused on a program called SCAN-ECHO, which stands for Specialty Care Access Network-Extension of Community Healthcare Outcome. The original ECHO program is a videoconferencing program first developed in New Mexico that works to “upskill” physicians by connecting them with specialists to inform care of patients with unique needs (rather than connecting a patient directly with a doctor via video).

"Primary care providers really want to do the right thing, but they may not have all the necessary tools," Grace Su, MD, chief of gastroenterology at the VA Ann Arbor Healthcare System, said in a statement. "This research shows an excellent way to impart specialty knowledge to them. The learning is mutual. They are not just learning; they are teaching us."

The Ann Arbor VA was an early adopter of the SCAN-ECHO program, and was among the first to apply it for chronic liver disease. For Su, that’s personal—she was apparently motivated by the death of one of her patients which may have been preventable with specialist intervention. The area that surrounds Ann Arbor—central Michigan and Northern Ohio and Indiana—has large rural populations, which can make specialist access tricky. A program that passes those skills along to primary care physicians is especially appealing there.

The new research observed 5 years of clinical data from 62,237 veterans with liver disease in the region. Only 513 of them had a primary care physician participating in SCAN-ECHO. Physicians discussed their individual patient cases with the specialists, and then brought their conversations and advice back to their appointments. The individual cases likely to be discussed were those of younger veterans with more severe disease who also lived in rural areas.

Su said that the program creates, in a way, “mini-specialists.” And despite the extreme minority that patients treated by SCAN-ECHO physicians represented, they seemed to fare far better than the rest of the cohort even when adjusted for other variables: Based on the Cox Proportional Hazard Model, those patients had a 54% higher survival rate.

There are limitations to the study, of course: Participation was voluntary, which means the doctors who received video consultation might have had a more significant investment in learning and treating the condition at a higher level, but it was impossible to compare specifics with providers who did not participate. There’s also the matter of VA data, which recent examples have shown can be flawed or incomplete.

Still, the team is confident in the project and the new study, believing that the patients who participated exhibited better treatment habits than those who did not.

"It seems that primary care providers who participated in the SCAN-ECHO were more likely to follow the guidelines for cirrhosis and perform the screening for esophageal varicose veins and liver cancer in the patients who need it,” she said. "I think it is the behavior of the provider that's the reason patients lived longer."

The study complements the findings of one presented a year ago at an endocrinology meeting, which found that after months of ECHO-based “upskilling,” primary care providers reported far higher confidence levels in treating another key chronic disease—diabetes.

“What if instead of moving these patients into the diabetes specialty clinic, we move medical knowledge out to the underserved communities?” one of the University of New Mexico researchers behind that report asked at the time.

Speaking of the new study, Su essentially answered that query: "Our only other alternative is to send specialists to rural areas, and that's not going to happen,” she said, adding that, “video consultation is the future of medicine.”

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