A new training program aimed at expanding access to rheumatology care for Native American communities has been described in research presented at the American College of Rheumatology’s (ACR) annual meeting, ACR Convergence 2023. The program focuses on training primary care physicians (PCPs) in the diagnosis and management of rheumatoid arthritis (RA) in communities where access to specialized care is limited. The study, titled “Rheumatology Access Expansion (RAE) Initiative – Abstract #2455” highlights the need to address the lack of adequate care for Native American populations despite the high prevalence of RA and other rheumatologic diseases.
The Rheumatology Access Expansion (RAE) Initiative launched the RA ECHO (Extension for Community Healthcare Outcomes) program in 2021, as a response to the critical shortage of rheumatologists and the resulting burden on PCPs. The 12-week training program specifically targets Navajo Nation PCPs, with the goal of improving outcomes and reducing healthcare disparities. Due to the success of the program, it has expanded to include tribes in 15 states.
Recruitment for the program was facilitated by partnering with an organization called Indian Country ECHO, which has established communication channels with tribes across the country. The response to the program was overwhelming, with over 100 healthcare providers expressing interest. Ultimately, 50 providers enrolled in the program, including PCPs, pharmacists, community health representatives, and providers from various medical specialties.
The program follows a virtual format, consisting of 12 weekly interactive classes. Each class includes didactic sessions on key aspects of RA diagnosis and management, followed by case-based discussions. Participants are encouraged to bring their own de-identified patient cases to the class. In addition to the weekly sessions, there are also virtual office hours where participants can interact with a panel of rheumatologists.
To assess the effectiveness of the training program, the RAE Initiative team collected data on PCP responses to tests and surveys. Participants completed an RA medical knowledge test and answered surveys about their confidence in RA diagnosis and management. The data revealed a significant improvement in test scores, with an increase of 26%, and an increase in PCP confidence on a Likert scale. Additionally, almost 80% of participants reported performing important clinical behaviors related to RA diagnosis and management more frequently after completing the program.
While the program shows promising results, one limitation is the lack of direct measurement of patient outcomes. The RAE Initiative team acknowledges the need to establish trust with the Navajo community before requesting access to private health records. Future steps include creating culturally and linguistically tailored patient education materials, hosting in-person training for community health representatives, and developing online training resources for PCPs interested in learning more about rheumatologic diseases.
The success of the RA ECHO program provides a potential model for creating similar rheumatology training programs in communities that face limited access to rheumatologists. The RAE Initiative team hopes to partner with others interested in expanding access to rheumatology care. The program was made possible through funding from the Bristol Myers Squibb Foundation.
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- Source: Coherent Market Insights, Public sources, Desk research
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