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Tele-Treatments

ALBUQUERQUE, N.M. — A demanding treatment regime is all that can save Ry Parker, 25, from a slow, painful death from hepatitis C — a viral disease that eventually would destroy his liver.

Parker’s chances for a cure also rely on a University of New Mexico program, called Project ECHO, that allows Parker’s physician assistant in Española to discuss his treatment each week with a team of hepatitis C specialists in Albuquerque.

Parker, one of an estimated 32,000 New Mexicans infected with the illness, self-administered his first interferon injection on Dec. 16. He also takes daily doses of two other drugs with common side effects that include depression, anemia, fatigue and loss of appetite.

Only a week into treatment, side effects from powerful medications already are taking a toll, Parker told Debra Newman, a physician assistant at El Centro Family Health in Española.

“The nausea and dizziness have been kicking me pretty good at work,” Parker said recently during his weekly examination. Newman prescribes promethazine for his nausea and advises Parker to continue taking his medications faithfully, as he must for at least the next six months.

Any lapse could diminish his chances for a cure, Newman said. “You have a huge advantage because you’re young and healthy,” she told him. Parker’s treatment gives him about a 75 percent chance of a complete cure.

Each Wednesday, Newman joins a teleconference attended by up to a dozen other clinicians around New Mexico. They include physicians, physician assistants and nurse practitioners from clinics in Las Vegas, Carlsbad, Las Cruces, Albuquerque, and an out-of-state clinic in Connecticut.

The online meetings are led by Dr. Sanjeev Arora, a UNM hepatologist who created Project ECHO in 2003 to expand the reach of his hepatitis C expertise to patients throughout New Mexico.

Arora calls Project ECHO a “force multiplier” that allows a small group of specialists to recruit local clinicians in the treatment of hard-to-cure illnesses, he said.

“I wanted a methodology that would expand my expertise 10 times or more,” Arora said. “The goal of this model was to treat hepatitis C patients everywhere in New Mexico as well as they were treated at the university.”

Since 2003, Arora has applied the treatment model to other illnesses. Project ECHO now sponsors weekly clinics for 20 illnesses, including HIV/AIDS, diabetes, substance abuse, psychotherapy, chronic pain, high risk pregnancy, rheumatology and cardiac risk reduction. Clinicians at 255 sites statewide participate.

The program’s $4 million annual cost is supported by grants from the Robert Wood Johnson Foundation and other funders.

Project ECHO also serves as a training program, Arora said. His weekly online meetings include brief seminars about new developments in hepatitis C drugs and treatments.

Newman said physicians throughout northern New Mexico now refer hepatitis C patients to her. She has treated about 50 patients in the four years she has worked at the Española clinic.

Discussions in the weekly hepatitis C teleconference often deal with life-and-death issues for patients. In a recent teleconference, Newman described a man in his 74th week of treatment who was experiencing severe side effects.

Arora responded that ending treatment is not an option because patient has end-stage liver disease and will die or need a liver transplant if treatment fails. “We need to get this patient through the treatment and cure the virus.”

Dr. Risa Lavizzo-Mourey, president and CEO of Robert Wood Johnson Foundation, said Project ECHO model has the potential to expand the delivery of specialized medical care to people who otherwise lack access to specialists.

The Department of Veterans Affairs has adopted the model at a number of sites around the country, including Chicago and Washington state, with the intent of expanding it nationwide, she said.

“I think its a way that we can improve the value we get from our health care dollar, because (Project) ECHO has a way of multiplying the effect of a multidisciplinary team to a lot of locations,” Lavizzo-Mourey said.
— This article appeared on page C1 of the Albuquerque Journal

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