Missouri’s Call, ECHO’s Answer: Expanding Access to Psoriasis Care
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Psoriasis is a lifelong, immune-mediated disease characterized by an overproduction of skin cells, leading to pruritic, scaly patches on the body. While psoriasis is commonly recognized as a skin condition, it is actually a systemic disease that affects multiple organ systems, including the skeletal, endocrine, and cardiovascular systems. Additionally, it can have profound effects on mental health and body image.
Early diagnosis made by a skilled health care team is essential for effective psoriasis management. However, for many—especially those in rural areas—access to timely and specialized care can be delayed or unavailable. In fact, 75% of patients in rural areas sought psoriasis-related care outside their area; whereas only 2% of urban patients did so.1 This statistic is particularly concerning given that Missouri defines 99 of its 115 counties as rural, meaning they either have fewer than 150 people per square mile or do not contain any part of a central city in a Metropolitan Statistical Area. Patients in these rural regions face multiple barriers to receiving care, including the cost and time of travel, lack of health insurance or other financial resources, and a shortage of local specialists. Recognizing the urgent need for resources in these “dermatology deserts,” Missouri has taken steps to address this health care disparity through the implementation of a dermatology-centered ECHO (Extension for Community Healthcare Outcomes) program.
What Is an ECHO Program?
The first dermatology-centered ECHO program in the United States was pioneered by Dr Karen Edison in 2015 in Columbia, MO, in conjunction with the University of Missouri’s Missouri Telehealth Network. Show-Me ECHO programs are case-based telementoring initiatives designed to help community health care practitioners connect with specialists to improve their ability to evaluate, diagnose, and treat complex conditions encountered in their practice.
ECHO programs operate through a “hub-and-spoke” model, in which a group of dermatologists serves as the hub and community health care practitioners serve as the spokes. Each spoke submits a challenging case, and the hub responds to facilitate an open, nonjudgmental learning environment to assist with diagnosis and management recommendations. Dr George Han, the director of teledermatology for the department of dermatology at the Icahn School of Medicine at Mount Sinai in New York, NY, and well-established advocate for the telementoring approach, further explained the unique benefits, “I think ECHO represents a really elegant bridge between the 2 models of care because it provides a mixture of didactics in digestible chunks along with some specific case-based teaching.” This collaborative approach enables patients to receive specialized care locally without the need for extensive travel or long referral waiting times. Additionally, it allows multiple community practitioners from different rural areas to gain invaluable experience in managing a variety of dermatologic conditions.
When discussing the impact of ECHO programs on psoriasis care, Dr Edison emphasized the following: “The impact that these ECHOs have had for patients living in rural communities is tremendous. Dermatologic diseases are sometimes overlooked in medical curricula—not due to a lack of importance but rather due to time constraints within a 4-year medical education. These ECHOs can help fill in the gaps to give primary care providers the confidence and experience to better manage these diseases on their own.”
Transforming Barriers Into Opportunities
With new and cutting-edge medications and treatment regimens evolving at such a rapid pace, it can be daunting for primary care practitioners to manage various dermatologic conditions independently, given their already demanding workloads. However, the University of Missouri’s dermatology Show-Me ECHO program continues to transform barriers into opportunities.
One of the most significant challenges that ECHO programs face is in recruiting physicians willing to participate and trust that the telementoring model is effective. “It can be scary for physicians to put themselves in unfamiliar waters with specialists,” Dr Edison noted. However, one unexpected event helped ease this hesitation—the COVID-19 pandemic. “I think the transition of life from in-person to Zoom really helped show physicians that telementoring and telemedicine can be engaging and have a lasting positive impact on patients’ lives.”
To further encourage participation, Dr Edison’s team developed focused sessions on key dermatology topics, such as “Rashes, Rashes, and More Rashes!,” “Hidradenitis Suppurativa,” and “Dermatologic Emergencies.” This targeted approach allowed primary care physicians to gain specific, applicable knowledge that directly benefited their patients.
With these challenges in mind, the success of the University of Missouri’s dermatology Show-Me ECHO program has laid the foundation for future innovations, creating opportunities to expand their reach and further enhance access to specialized care.
National Psoriasis Foundation’s Collaborative Learning
Recently, the National Psoriasis Foundation (NPF) has adopted an ECHO approach for targeted psoriasis education to rural and resource-limited communities where dermatology care is difficult to access. Stephanie Corder, director of medical affairs for NPF hopes that a psoriasis-specific collaborative learning approach will provide a unique way to engage health care providers, including primary care providers and dermatologists, to improve access to specialized treatment, particularly for patients in rural and underserved areas. She stated, “By leveraging this well-established telementoring model, a psoriasis-focused ECHO can connect primary care clinicians to a network of trained specialists, equipping them with the knowledge and confidence needed to identify and manage psoriasis more effectively, minimizing long wait times and improving patient outcomes.”
Future ECHO sessions can explore emerging treatments, complex case management, and the comorbidities associated with psoriasis, ensuring a more comprehensive and up-to-date approach to psoriasis care. Dr Han further elaborated on the possible avenues that telementoring can take with technologic advancements. “I think a really nice future state would be combining these ECHO networks with some additional eConsult support with or without some component of AI.” To learn more about NPF’s Collaborative Learning opportunities, please visit www.psoriasis.org/collaborative-learning.
Reference
- Seigel L, Shoaib S, Maughn K, et al. Health disparities in psoriasis: geographic barriers to access in the United States. J Dermatolog Treat. 2024;35(1):2365820. doi:10.1080/09546634.2024.2365820
