Tracking the Results
The program began in 2021 with 16 providers. So far, the initiative has had five cohorts of providers from across the Navajo Nation.
Much of the initial recruitment was based on word of mouth and through connections from Dr. Grant. There was a good amount of tracking down the right people through phone and email to let them know about the initiative and ask for help spreading the word.
“The level of dedication from the participants is really exciting,” Dr. Mandal says. “They’re not being paid to do this. … They’re truly doing this out of the goodness of their hearts and a deep desire to better serve their patients.”
To help assess how the information has helped, participants take a pre-training and a post-training test, as well as test a year later. The questions asked include self-reported confidence in diagnosing and managing RA, such as confidence in starting methotrexate without guidance from a rheumatologist and confidence in performing a joint exam. Other questions include how often participants are using an RA disease activity score, such as RAPID3, and how often they are looking at vaccine records for patients who are on immunosuppression medications.
What the initiative is not tracking yet are patient data. The main reason for this choice is the previous exploitation of members of the Navajo community by the Western medical system. This history has resulted in a hesitation within the community to participate in research. Instead, initiative leaders have focused on establishing trust and a long track record with patients on Navajo Nation.
“Eventually, collecting … patient outcome data would clearly be important,” Dr. Mandal says.
The Future & Funding
In the future, Dr. Mandal and Dr. Grant would like to host a one-day event open to participants to cover critical in-person skills, such as the in-person patient exam.
Other projects in the works include creating patient education materials for the Navajo community, training more community health representatives and thinking about other ECHO projects, including one for spondyloarthritis.
Funding for the program for the first three years came from the BMS Foundation. With that grant ending soon, they are looking for additional funding.
Editor’s note: A new resource for primary care physicians interested in learning more about rheumatology is available from the ACR. And Workforce Expansion Grants for fellows pursuing rheumatology are available from the Rheumatology Research Foundation.
