An old adage holds that out of crisis comes opportunity.
The crisis of substance use disorder and associated conditions such as Hepatitis C have raised new challenges for primary care providers in West Virginia, many of whom have had limited experience in caring for patients with these problems.
The West Virginia Primary Care Association has been pleased to partner with the Claude Worthington Benedum Foundation, West Virginia Clinical and Translational Science Institute and Cabin Creek Health Systems to recognize a unique opportunity in this crisis, leading to the replication of Project ECHO in West Virginia.
Project ECHO was first developed at the University of New Mexico in 2003 to address the shortage of providers caring for patients with Hepatitis C in that state. Rural primary care providers, the “Spokes” were linked via video conference with specialists at academic medical centers, the “Hub.”
The primary-care providers presented cases and received feedback on each patient, in addition to a short didactic presentation during each session. The model was a success in expanding the number of providers caring for patients with Hep C, thus increasing access for rural patients and expanding knowledge for rural providers.
In West Virginia, thanks to generous funding from the Benedum foundation, the W.Va. Clinical and Translational Science Institute has established successful hubs for Project ECHO sessions addressing both Hepatitis C and chronic pain cases.
Primary care providers participate from across the state and even some surrounding states. Since its inception in May of 2016, the Hepatitis C ECHO in West Virginia has had 32 cases presented for expert feedback during weekly or biweekly sessions.
Didactic sessions have covered details of Hep C diagnosis and treatment; Hepatitis B co-infection; HIV infection screening, prevention and treatment; and drug overdose prevention. Hub specialists have made themselves available to primary care clinicians in between sessions as well, creating a network of providers sharing knowledge about management of these treatable conditions.
ECHO sessions on chronic pain have covered a variety of topics including spinal stenosis, pain assessment tools, medical treatment of chronic pain and psychosocial factors influencing pain control.
Primary care providers have presented nine cases in biweekly sessions since January 2017.
Hub experts have provided evidence-based guidance on appropriate treatment for a variety of conditions causing chronic pain.
By expanding the knowledge base of primary care providers related to pain treatment, the ECHO sessions are assuring that West Virginia’s citizens are treated with evidence and compassion as we continue to learn to rely on methods other than chronic opioid medications for pain care.
A total of 55 individual health care providers have attended the Hep C and chronic pain ECHO sessions since the the launch in May 2016. Additional ECHO sessions are being planned.
Most recently, Unicare of West Virginia has provided support for expansion of ECHO sessions to address treatment of substance use disorder, including medication assisted treatment. ECHO for psychiatric topics and chronic lung disease are scheduled to launch this fall.
The W.Va. Primary Care Association is grateful for the many partners who have insured the success of Project ECHO in West Virginia.
We are excited to know that patients in the Mountain State now have expanded access to care, including specialty consultation, for patients with these and other chronic conditions.
While our communities are still facing dire consequences of the opioid epidemic, we see Project ECHO as one important opportunity in recovery.
Jennifer Boyd is director of clinical quality at the West Virginia Primary Care Association (www.wvpca.org).