With help from telemedicine or physician assistants, primary care providers can deliver some kinds of specialty care without compromising quality, according to an evaluation of such tests in six states which are still in the early stages.
 
In fact, quality of care and patient outcomes were the same, if not better” than when patients were treated by specialty providers, an evaluation for the Commonwealth Fund by the Center for Studying Health System Change found. Patients whose experience was reviewed for the study were enrolled in the Medicare programs of Connecticut, Illinois, Minnesota, New Mexico, Oregon and Tennessee.
 
Each initiative had different ways of expanding access to specialty services.
 
Some of the early results included, for example, an increase in the Connecticut project in the percentage of diabetic patients that got retinopathy screening. The percentage grew from 10% to 40%. Medical assistants were taught to use retinal cameras to take images of patients. The images were then sent to ophthalmologists for diagnosis.
 
Using telehealth for diabetic retinopathy saved about $28 a patient, or about 35 percent of the cost per patient when compared to an exam by a specialist, according to the report. The project is run by Community Health Centers Inc., the Yale Medical Group and the University of Connecticut. The community health centers care for about 130,000 patients.
 
In New Mexico, waits for rheumatology appointments at the University of New Mexico fell from six months to one month after a videoconference-based project was created. In that program — known as Project ECHO (an acronym for extension for community healthcare outcomes) — primary care providers were trained to act as quasi-specialists.
 
Primary care doctors and other primary care providers ask specialists for advice on how to treat patients with specific conditions, and, over time, the primary care providers learn enough to treat many common concerns without having to refer the patients to specialists. One primary care provider in the project sent all patients with rheumatology needs to specialists before the training, but after the project was implemented, that rate of referral fell dramatically.