Assessing the feasibility and effectiveness of an established telehealth model to train primary care providers on hypertension management in free and charitable clinics

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PURPOSE: Determine the feasibility and effectiveness of “training up” free and charitable clinic (FCC)-affiliated primary care providers (PCPs) using the Extension of Community Health Outcomes (ECHO), an innovative telehealth model using interactive videoconferencing technology to connect university-based specialists with PCPs in medically underserved areas. ECHO uses peer education and support to empower PCPs to provide better care for common chronic diseases, including hypertension. BACKGROUND: FCCs are volunteer-based nonprofits that provide care to uninsured and underserved patients at no cost or a small fee. Hypertension affects ~30% of the U.S. adult population and is a common diagnosis at FCCs. Approximately half of hypertensive adults have controlled blood pressure, with higher rates of uncontrolled hypertension among minorities. ECHO has been shown to have equivalent outcomes for Hepatitis C patients treated by PCPs versus subspecialists, but less is known about its effectiveness for hypertension. METHODS: In this pre-post pilot study, 11 PCPs from 5 FCCs in Illinois participated in 12 weekly, one-hour trainings hosted by ECHO-Chicago and facilitated by a University of Chicago specialist. We use descriptive statistics to report participation levels and before/after changes in provider knowledge and confidence treating hypertension. We use a difference-in-differences approach to examine the effects of the ECHO-Chicago provider training on patients’ systolic blood pressure (SBP). RESULTS: Provider self-efficacy increased from 3.7 to 5.0 (of 7; p<.01) and mean SBP of patients seen by an ECHO-trained provider decreased by 10.2 mmHg (p<.05). CONCLUSION: ECHO is a promising model to improve hypertension in FCCs serving highly vulnerable populations.