Rural Rx: A Program Developed in New Mexico May Change How Health Care Is Delivered in Rural America

By Ewing, Joshua | State Legislatures, May 2012 | Go to article overview

Rural Rx: A Program Developed in New Mexico May Change How Health Care Is Delivered in Rural America


Ewing, Joshua, State Legislatures


About 51 million Americans live in rural areas of the country, where obtaining medical care often involves long drives, long waits and extra expense.

In most rural counties, there are so few primary care physicians that many patients can't obtain care as quickly as they want or need. Some 77 percent of rural counties face a serious shortage of health professionals--they're called health professional shortage areas--and it's estimated they need 4,000 more primary care physicians just to meet basic health care needs. Specialists are even scarcer, which means people must travel a long way to get that care, usually spending more money than people in a city.

Rural Americans are, on average, older, less educated and earn less money than people in metropolitan areas. They also are more likely to smoke, be obese and inactive. The result is a rural population that is in poorer health, has higher rates of death, disability and chronic disease, yet is less able to obtain health care.

Hope in New Mexico

Several years ago, lawmakers in New Mexico--where 33 percent of the population lives in rural areas--supported one doctor's novel idea.

Dr. Sanjeev Arora, a professor at the University of New Mexico Health Sciences Center, developed a program in 2003 to deal with the growing problem of Hepatitis C in rural parts of the state. Of the estimated 34,000 people with the disease--many of them living in frontier and rural areas--only 1,600 had received any treatment. Hepatitis C is a viral disease that affects the liver and is most often contracted by sharing IV drug paraphernalia.

Arora set out to fix this problem and, along the way, created a model that has been replicated throughout the country and the world.

"I hope," says Arora, "that this becomes the future of health care in rural and underserved areas."

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Multiplying Expertise

Arora knew there weren't enough rural specialists trained to treat Hepatitis C. His patients often waited six months and drove up to 250 miles to his clinic. Many patients simply could not make the trip at all or afford the cost.

Arora turned to a telehealth--the delivery of health care using telecommunications technology--to bring treatment to the patients.

Most telehealth models pair a specialist in an urban area or at a university with a patient, using some type of videoconferencing software. The approach is still limited by the number of available doctors.

Arora's idea--which he calls Project Extension for Community Healthcare Outcomes (ECHO)--uses the same technology, but rather than connect one patient to one doctor, it connects the many rural primary care doctors with many disease experts at the University of New Mexico to present cases and seek advice about treatment options. The process is similar to medical rounds in a hospital. The ECHO "clinic" is broadcast securely over the Internet, allowing primary care clinicians statewide to watch and benefit from the expertise of a specialist or a team of specialists.

"Project ECHO promotes care in underserved areas, builds capacity for rural doctors and treats people where they live rather

than making them travel to the university in Albuquerque," says New Mexico Representative Danice Picraux (D).

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Expanded Reach, Growing Popularity

Lawmakers liked the idea and appropriated $700,000 a year to support Project ECHO in 2006, which grew to about $2.5 million before the recession hit in 2008. Since then, funding has been reduced to about $840,000 a year, Arora says.

Today, the project's clinics in New Mexico have expanded beyond Hepatitis C treatment. Weekly clinics now are conducted on asthma, chronic pain, diabetes, cardiovascular disease risk, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology, substance abuse disorders and mental illness. …

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