Expanding Latent Tuberculosis Infection Testing and Treatment in Massachusetts Primary Care Clinics via the ECHO Model

Journal of Primary Care & Community Health (08/24/22) Szkwarko, Daria; Urbanowski, Michael E.; Thal, Rebecca; et al.

Researchers evaluated changes in primary care providers' (PCP) confidence in latent tuberculosis infection (LTBI) care management prior to and following an ECHO telementoring course in Massachusetts clinics. The six-session curriculum involved a one-day workshop held for two cohorts in January 2019 and February 2020, respectively. Attendees earned one American Medical Association Category 1 credit per session after completing a post-session assessment. Seventy-eight PCPs registered for either Cohort 1 or Cohort 2, and 45 participated in at least one session. Twenty PCPs attended at least three sessions and 24 completed at least one post-session survey. None of the PCPs who completed polls in Cohort 1 participated and completed polls in Cohort 2. Seventy-one percent of PCPs had an MD or DO, while 29% were nurse practitioners or physician assistants. Participants' confidence rose in selecting a test, gauging tuberculosis infection test results, and choosing a treatment regimen. Qualitative interviews with three PCPs indicated shifts in practice, including transitioning to interferon gamma release assays for testing and treating patients with rifampin. "Our program evaluation suggests that an LTBI ECHO increased PCPs' confidence in LTBI care management and enhanced clinical-care," the authors note. They add that ECHO continuing medical education courses can reduce health disparities in environments where PCPs' unfamiliarity about treatment topics exacerbates health outcomes.

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