3181 — Perceptions of the VA Specialty Care Access Network-Extension for Community (SCAN-ECHO) Program Among Rural Providers

Johnson VT, VA Puget Sound Health Care System; Helfrich CD, VA Puget Sound Health Care System; Au DH, VA Puget Sound Health Care System; Kirsh SR, VA Office of Specialty Care; Young BA, VA Puget Sound Health Care System;

Objectives:
We sought to determine whether urban and rural providers reported different challenges in implementing a specialty care telementoring program (SCAN-ECHO) or perceived different effects from the program.

Methods:
A survey was administered to SCAN-ECHO program participants between February 11 and March 11, 2013 to evaluate perceptions of program efficacy and implementation. Approximately half of program participants (n = 450) were sent e-mail invitations. Respondent site rurality was assigned using primary and secondary rural-urban commuting area (RUCA) codes (Urban = 1.0, 1.1; Highly Rural = 10.0 or greater; Rural = all others). Site address, latitude and longitude were obtained from the VA Site Tracking (VAST) database. We compared proportions of all respondents from urban and rural sites agreeing with each of 43 survey items (Agree/Strongly Agree vs. Neither Agree Nor Disagree/Disagree/Strongly Disagree) using chi-squared to test for differences between groups. We then evaluated respondents according to provider type, including MD, nurse practitioner (NP) or physician assistant (PA) primary care provider (PCP) or specialist provider.

Results:
There were 198 responses (44% response rate), of whom 29 reported no facility affiliation and were excluded. 23 respondents (14%) were categorized as rural and 146 were categorized as urban (56%), while none were designated highly rural. Although 56% of rural respondents agreed that SCAN-ECHO had improved their ability to manage patients with the condition of focus, urban respondents were significantly more likely to agree (88%) (p < 0.012, 95% CI: -0.66, 0.01). When comparing all MD, NP and PA provider respondents, rural respondents were less likely to agree they had received adequate instruction and support regarding how to participate in SCAN-ECHO (p < 0.001, 95% CI: -0.77, -0.10). Compared to urban PCP respondents, rural PCP respondents were less likely to agree they had protected time for SCAN-ECHO participation (p < 0.034, 95% CI: -0.72, -0.13).

Implications:
Clinicians in rural sites were less likely to agree that SCAN-ECHO improved patient care.

Impacts:
SCAN-ECHO may improve access to specialty care for rural veterans. However, implementation may be more difficult in rural clinics, where clinicians may benefit from greater program training support and increased protected time for participation.