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2015 HSR&D/QUERI National Conference Abstract

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1126 — Does the Specialty Care Access Network-Extension for Community Health Outcomes (SCAN-ECHO) Model Apply to HIV Care? Experience from Three Facilities

Moeckli J, Iowa City VA, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE); Ono SS, Portland VA, Center to Improve Veteran Involvement in Care (CIVIC); Stewart K, Iowa City VA, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE); Alexander B, Iowa City VA, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE); Ohl ME, Iowa City VA, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE);

Objectives:
SCAN-ECHO is a provider-level telemedicine model that seeks to improve Veterans' access to specialty care. Videoconferences link local primary care providers (PCPs) with distant specialists to form virtual communities of practice; the goal is to increase the capacity of PCPs to deliver aspects of specialty care. First developed for hepatitis C, it has been applied to diverse conditions. We sought to understand how SCAN-ECHO has been applied to HIV care in three VHA facilities.

Methods:
We used a mixed-methods, multisite, case study design. Veterans with HIV were considered eligible for SCAN-ECHO if they lived nearer to a primary care clinic than to the HIV specialty clinic. Corporate data warehouse (CDW) data were used to determine program adoption (i.e. proportion of primary care clinics participating) and reach (i.e. proportion of eligible Veterans with a SCAN-ECHO consult). Semi-structured interviews involved 31 staff (9-11 per site) from specialty care, primary care, and program leadership. Interviews addressed program evolution and applicability of SCAN-ECHO to HIV care. Transcripts and fieldnotes were analyzed in three concurrent stages: thematic content analysis; within-case narrative synthesis; and cross-case synthesis to identify generalizable themes.

Results:
Adoption and reach varied across sites, but were overall limited. Eight (32%) of 25 primary care clinics participated (range 7%-66% across sites). Fifty-one (5.9%) of 865 eligible Veterans participated (range 1.0%-13.5%). Most Veterans (87%) recieved care directly from HIV clinics. Two sites expanded HIV SCAN-ECHO to general infectious diseases, while one replaced SCAN-ECHO with a "shared care" model that combined local PCP care with clinical video telehealth (CVT) visits between Veterans and the HIV clinic. In interviews, participating PCPs were enthusiastic about HIV SCAN-ECHO and reported it expanded their scope of practice. Low participation was attributed to: 1) limited PCP comfort with HIV care; and 2) low HIV prevalence and extended care episodes that prevented rapid "learning loops" for PCPs.

Implications:
HIV SCAN-ECHO was enthusiastically embraced by some PCPs, but was not a solution to poor geographic access for Veterans with HIV.

Impacts:
Facilities should consider alternate telemedicine models for HIV, such as CVT and "shared care" programs.