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Project ECHO® Case Report: Su Clinica

Rose Gowen, M.D., is an obstetrician-gynecologist and Medical Director at the Brownsville Women's Health Center at Su Clinica, a non-profit community health center serving two counties in the Rio Grande Valley region of Texas. She was one of the first participants in the MD Anderson ECHO for Cervical Cancer Prevention.

Working at the Brownsville Women's Health Center, Dr. Gowen felt a desire to learn more about the loop electrosurgical excision procedure (LEEP) and to gain more training in colposcopy for her patients who have abnormal Pap smear results. Week after week, she would see women in the clinic who had abnormal Pap smears and she felt restricted because she simply did not have the tools or resources to provide follow-up care. Instead, she was faced with referring patients to a specialist at a clinic approximately one hour away from Brownsville and who was available only once per month to provide follow-up care. Many patients were unable to make the trip: they did not have transportation, or they did not have the financial means to be able to visit the clinic. Those who were able to visit the specialist's clinic often had to wait weeks or even months to obtain an appointment.

Feeling frustrated, Dr. Gowen began looking for LEEP training online and in her own community, but could not identify any training that would help her learn the hands-on techniques required to feel comfortable performing LEEP in her own clinic. She began first by searching for training opportunities online, but found few that seemed applicable for an experienced physician. Next, Dr. Gowen approached several physicians in and around the Brownsville community to inquire about potential opportunities to shadow those experienced in this area. Despite several attempts, no one would offer to assist her in her desire to obtain additional training.

That's when she met Kathleen M. Schmeler, M.D., from MD Anderson Cancer Center by chance at a public health meeting in Houston. During the meeting, both Dr. Gowen and Dr. Schmeler commented on the need for additional access to cancer prevention care in remote, rural communities. Immediately, Dr. Schmeler and Ellen Baker, M.D., M.P.H., who leads the MD Anderson ECHO for Cervical Cancer Prevention and is now the Director of Project ECHO at MD Anderson, offered to help. They traveled from Houston to Brownsville to offer hands-on training in LEEP, and assist with purchasing colposcopy equipment to increase local access to colposcopies within Brownsville and Harlingen. Now, armed with the knowledge and the equipment, Dr. Gowen, a nurse practitioner, and a nurse midwife can provide LEEP and colposcopy care for their patients.

Patients no longer need travel long distances for the monthly clinic and patients with limited resources can have more peace of mind knowing that their abnormal Pap smear results can be followed up quickly and locally. In fact, participation in the MD Anderson ECHO for Cervical Cancer Prevention has led to an increase in the number of women obtaining preventive care Pap smears in the clinic and a decrease in the number of women who are referred to cone biopsy.

Dr. Gowen and her colleagues at the clinics in Brownsville and Harlingen now participate in the weekly MD Anderson teleECHO™ clinic sessions, which were started right after the hands-on LEEP training was provided. Physicians and other health care professionals in the clinic feel greater professional satisfaction knowing that they can provide the care for their patients and that they have the opportunity to connect with experts in an area that they feel very passionate about. Participants earn CME credits, which is also a tremendous benefit because the training is free and they can immediately relate what they have learned to actual patient care. The MD Anderson ECHO for Cervical Cancer Prevention has also been very helpful in increasing clinicians' adherence to recent changes in clinical guidelines. Clinicians previously might have been more resistant to making a change, but with the help of the Project ECHO experts, they learn firsthand how the changes in guidelines and clinical recommendations improve care for their patients.

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