Extending Care through Project ECHO: Laura Barr

From the beginning of her career as a family physician in rural Millersburg, Ohio, Laura Barr, M.D., has had a connection with Northeast Ohio Medical University.

Early in her practice, Dr. Barr, now a clinical assistant professor of family and community medicine, served as a Primary Ambulatory Care Experience (PACE) preceptor for NEOMED College of Medicine students.

As time went on, Dr. Barr gained an interest in mental health —specifically in the areas of resiliency and physician well-being.

After having to take time away from her practice due to some advanced arthritis issues, Dr. Barr jumped at the opportunity to open a medical practice at Spring Haven Counseling Center, a counseling facility that serves a large Amish population near Mount Eaton, Ohio.

“They were looking for a primary care physician and I was looking for something that was a little slower paced physically, but also where I could coordinate mental health and primary health care,” says Dr. Barr.

Closing the gap with Project ECHO

It was at the same time Dr. Barr opened her Spring Haven Counseling Center practice that she discovered a new program at NEOMED: the Integrated Care @ NEOMED (IC@N) TeleECHO Program. NEOMED developed the program in alignment with Project ECHO®, a national program that began at the University of New Mexico in 2003 to equip primary care health providers in underserved areas with specialized training that their patients would have difficulty obtaining, given the shortage of specialists in these remote or otherwise underserved locations.

IC@N is a forum for providing didactic education and case-based learning related to patients with complex, co-occurring psychiatric and physical conditions. IC@N training promotes integrated, team-based care.

Here’s how it works. Every Friday, participating health care providers such as Dr. Barr call into the IC@N hub based at NEOMED to hear a case presentation and then collaborate online with psychiatrists, psychiatric pharmacists, physicians, counselors and more. The NEOMED faculty and staff, including Douglas Smith, M.D., interim chair of psychiatry, gather in a conference room and confer via Zoom with their colleagues, who can ask questions about specific patient cases related to that week’s topic.

One recent Friday, the topic presented by Dr. Smith was Munchausen Syndrome — a mental disorder in which a person reports factitious symptoms or – in Munchausen by Proxy – reports someone else (often a child) having made-up medical problems. Dr. Smith noted that while the condition is rare, the statistics are that 46% of people with the syndrome are in the health care profession. (Fun fact: The disease was named for a Baron von Munchhausen, who spelled his name with two h’s and was famous for telling tall tales about his supposed war exploits.)

Creating a community for health care providers

The value of the weekly gathering goes far beyond any single topic.

“It’s really become quite a community for me, especially going in this direction with my practice. I’ve been able to bring a lot of cases that were stumping me and get some really good tips on how to manage them,” says Dr. Barr.

She shared an example of when she was recently able to reach out to a fellow IC@N attendee who practices in the Canton area to get names of recommended counselors for a patient who needed care there.

“A lot of times in rural practice, it can be kind of isolating and you don’t necessarily have a lot of colleagues to reach out to and go over cases with. IC@N reduces that feeling of isolation by creating a virtual community,” Dr. Barr says.

Bringing communities together

Despite the barriers she has faced over the years, Dr. Barr continues to advocate for rural health care and programs, like IC@N, that can bring rural communities closer together.

“Rural medicine is special. One of my favorite parts about this specialty has been having the opportunity to be a part of the community and know entire families — multi-generations of families. I love seeing how everyone fits together in the community and being able to see people in different contexts, not just in my practice.”