Training the trainer to increase health care access

“I was inspired by my father, a U.N. diplomat. I told him I wanted to be a doctor someday, and he took me to refugee camps and the Doctors Without Borders compound to see doctors there. And, that was one of my first experiences understanding how important health care access is.”

Her first medical school application was unsuccessful, but Dr. Wari Allison, MD, PhD, says she knows now what she did not know back then – failure is an opportunity to learn. She pressed on eventually receiving her medical degree, a doctorate in public health and specialty board certification in internal medicine and infectious disease.

Her studies took her across the world and eventually to San Antonio where she is an assistant professor of infectious disease at UT Health San Antonio, director of the Extension for Community Healthcare Outcomes (ECHO) program, and medical director at the San Antonio AIDS Foundation.

Building on these experiences, Dr. Allison has championed Project ECHO at UT Health San Antonio, in collaboration with the ReACH Center and local partners such as the South Texas Area Health Education Center. The focus of this program is to train providers via telementoring through guided practice and shared learning and increase access to health care for underserved communities.

The success of this regional effort has now culminated in a $3 million grant, the only award given by the Health Resources and Services Administration (HRSA), to establish a Rural Telementoring Training Center.

Through national and local collaborations, the new center will provide training to centers of excellence and academic medical institutions while evaluating various models for telementoring.

“The models we are using, like Project ECHO, are not new. What is new is understanding how different models work in different areas for different populations and developing these as best practices to help others create these programs,” she said.

UT Health San Antonio ECHO program features communities of practice and learning across a range of health care needs including treatments for opioid use disorders, HIV, Hepatitis C, Chagas disease and telemedicine technical assistance.

The goal is to establish evidence-based national standards in telementoring. Outreach efforts for the program will include nurse practitioners, physician assistants, community health workers and other rural health care workers.

Attention will be paid to those with medical specialty experience. Casting a wide net is critical to address the workforce shortage in rural areas where there are 39 physicians to every 1,000 people compared to 53 to every 1,000 people in urban areas.

Reaching out to a variety of health care workers will expand access in these geographically isolated areas.

A key component of the grant is adapting community health clubs (CHC) for health care providers. Typically, CHCs are used in community settings where members share with researchers key health areas they want to focus on improving.

Working with CHC expert Jason Rosenfeld, PhD, assistant director for global health at the Center for Medical Humanities and Ethics, the project will innovate these clubs by adding a telementoring format, utilizing them as a forum for peer-to-peer learning and support for rural health care workers.

“I am passionate about health care access for marginalized people,” Dr. Allison shared. “That’s what led me to public health research and integrating telemedicine into my medical practice where I treat people living with HIV. Access is limited without knowledgeable providers equipped with a toolbox of strategies for reaching their communities.”

Planning for the project began in September and will continue over the course of the next three years.



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