VHA’s comprehensive women’s health SCAN-ECHO program: Lessons learned

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NEEDS AND OBJECTIVES: Although women are among the fasting growing segment of the Veterans’ Health Administration (VHA) patient population, many VHA primary care providers’ (PCPs) have relatively small female caseloads, making it challenging for them to build and maintain their women’s health knowledge and skills. Therefore, as part of VA’s SCAN-ECHO (Specialty Care Access Network - Extension for Community Healthcare Outcomes) program, we implemented a Comprehensive Women’s Health SCAN-ECHO program with the objective of building and maintaining VHA women’s health PCPs’ knowledge in the evaluation and management of conditions specific to, more common in, or with special considerations relevant to women (e.g., gynecology, breast issues, depression, osteoporosis).

SETTING AND PARTICIPANTS: Our participants included women’s health PCPs across three VHA healthcare systems.

DESCRIPTION: The program consisted of monthly group PCP-specialist clinical tele-videoconferencing sessions in which PCPs obtained virtual specialist consultation on their cases and received serial patient-based education. Prior to each session, PCPs submitted consultation requests on patients for whom they wanted diagnostic and/or therapeutic management advice. During sessions, the specialist at a “hub” facility and PCPs at multiple “spoke” sites engaged in real-time group discussions about the cases. In addition to giving recommendations, the specialist discussed the underlying evidence or rationale. Content also included patient communication strategies (e.g., explaining contraceptive options). The PCP who submitted the consult, as well as other PCPs participating in the session, interacted with the specialist and with each other, asking clarifying questions. The specialist also provided a brief didactic relevant to the cases. Continuing Medical Education credit was provided. Each session was held at the noon hour in the hosting site’s time zone.

EVALUATION: We used participation logs, participant surveys, semi-structured interviews, and field notes from key stakeholder meetings to evaluate our program. We conducted 14 sessions over 16 months. Overall, 65 PCPs in three VHA health care systems participated in one or more sessions, with an average of 11 participants per session. Participation rates were much higher in the one healthcare system where providers were provided with time protected from their clinic responsibilities (rather than meeting over lunch). Attempts to expand to two additional VHA healthcare systems, where the session would have been in the lunch hour, were not successful secondary to conflicting meetings or educational programming. Of the 58 post-session surveys received, in 45 (78 %) the participant strongly agreed, and in 7 (12 %) the participant agreed, that the information provided in the session would influence their patient care. Of these 52, 74 % indicated that the information would change their ordering of diagnostic studies; 83 % their treatment plans; 58 % their prescription of medications; and 68 % their overall interactions with patients. Among the 10 PCP interviewees, all reported that they found SCAN-ECHO to be useful for building and maintaining their knowledge on women’s health topics. However, all interviewees also reported that the session being conducted during their lunch hour was a limiting factor for consistent participation, with morning clinics often running late and participants having competing clinical, administrative, educational and personal priorities for that time. Interviewees and discussions with key stakeholders revealed that the rotating specialists and topics across the breadth of women’s health, although appealing in its comprehensiveness, also limited submission of cases as PCPs were unlikely to have active case-based questions coincident with the monthly specialist’s area of expertise.

DISCUSSION/REFLECTION/LESSONS LEARNED: VA’s SCAN-ECHO program is a promising modality for building and maintaining PCP knowledge on women’s health topics, with attendees indicating that it influences their patient care. However, PCPs receiving time protected from clinical responsibilities is essential for robust and consistent participation. Further, narrowing in on a consistent women’s health area, such as gynecology, although sacrificing the program’s comprehensiveness, may facilitate PCPs having active cased-based questions for the sessions.