4098 — Ensuring Primary Care Provider (PCP) Participation and Sustaining Renal-ECHO

Lead/Presenter: Bessie Young, COIN - Seattle/Denver
All Authors: Young J (VA Puget Sound) Helfrich CD (VA Puget Sound) Simons C (VA Puget Sound) Young BA (VA Puget Sound)

Objectives:
Specialty Care Access Network-Extension for Community Health Outcomes (SCAN-ECHO) is intended to improve access to specialty care for rural Veterans by using group telemedicine consultations and didactics with primary care providers (PCPs). Previous evaluations of SCAN-ECHO programs found high levels of provider satisfaction, but also suggested that SCAN-ECHO requires significant ongoing participant and system-level investment. We evaluated active renal SCAN-ECHO programs in order to understand the factors influencing program participation and program sustainability to guide program expansion.

Methods:
We interviewed 23 participants and key program personnel (7 Nephrologists, 11 PCPs, and 5 Program Administrators) from 4 national Renal SCAN-ECHO programs from 3 years as part of an ongoing program evaluation. Participants completed semi-structured phone interviews focused on their experiences with Renal SCAN-ECHO. Inductive content analysis was used to explore both a priori domains and emergent themes related to program participation and sustainability.

Results:
Program participation and sustainability were raised as significant salient issues among participants. PCPs and specialists described a lack of protected or dedicated time as a significant barrier to program participation. PCPs reported facilitators to participation including minimizing conflict between SCAN sessions and patient care, leadership support for SCAN, and control over one's own schedule, while specialists described facilitators including "sharing the effort" with colleagues. Specialists and program administrators also described the "future" of Renal SCAN-ECHO as a central concern. They described maintaining and growing Renal SCAN-ECHO as requiring considerable effort and resources, "proof" of program impact as necessary for demonstrating "return on investment", leadership support as essential to program survival, and financial instability as a major barrier to sustainability. Program flexibility was perceived as essential to sustainability and participants described local adaptations and variations to make best use of local resources and respond effectively to local needs and challenges.

Implications:
Ensuring provider participation in renal SCAN-ECHO and program sustainability were key issues among participants. Participants viewed Ensuring protected and dedicated time, financial stability, leadership support, and demonstration of program impact and value as central to the success of the Renal SCAN-ECHO program. Rigorous proof of the effect of SCAN-ECHO is needed and appears to be a necessary, but insufficient condition for sustaining the program.

Impacts:
SCAN-ECHO implementation varied across sites within VA but PCP and specialist perceive SCAN-ECHO as important, but barriers to sustainability exist and evaluation of program success needs to be documented.