Building Access in the VA

The VA is funding 11 VA medical centers through grants to provide SCAN ECHO specialty training, with four centers providing it for HCV. Officials say they believe at least 300 ECHO consults have been completed, a number that includes not only HCV but all SCAN-ECHO specialty clinics, since the program has been expanded to other chronic diseases.

The VA’s use of the model is new and is one of multiple strategies being employed to make hepatitis C treatment more accessible. Jain pointed out that VA providers like to have a “menu of options” for care delivery, and this model might not fit the need of all rural providers or facilities.

“The only way, as a VA primary-care provider, where this would make sense is if I am practicing in a community where either the prevalence of hepatitis C in my community is relatively high, or in my panel I happen to have several patients with hepatitis C,” he said. “Then the motivation for me to understand and learn more about the management of hepatitis C is a lot more than if I had one patient or two amongst the 1,200 or 1,400 panel that I had.”

Jain noted that provider participation is optional. The biggest challenge so far in expanding the program is the healthcare providers’ full schedules. Finding time to allot for SCAN-ECHO sessions, which last about 90 minutes., might be difficult, Jain said.

Still, he said he is enthusiastic about this model because it can enhance the ability of primary-care providers to care for HCV patients without requiring difficult travel for patients.

Those using SCAN-ECHO also see its potential. The San Francisco VA is one of the centers currently launching SCAN-ECHO, and Rongey suggested the model has the potential not only to link providers in more rural areas with specialty knowledge, but also those in urban centers who have patients who would prefer to receive care from their primary-care providers instead of seeing a specialist they do not know.

“Many of our downtown or urban health clinic providers really do provide a unique environment that is very sensitive to veterans that are unstably housed or have mental-health conditions, so much so that those veterans would prefer to receive hepatitis C therapy at those urban centers rather than come to see us,” she said.

Across the country at the VA Connecticut, a team also is sharing HCV expertise with providers across the region.

One of the specialists involved with the program, Joseph Lim, MD, said he believes the providers and patients benefit from the program’s sessions that include a didactic portion as well as a discussion on specific patient cases that the providers submit.

“We review these cases in advance and then at the time of an actual SCAN session, the individual sites--whether they are in Idaho, Pittsburgh, Boston or here in Connecticut --they present the case to all participants. Then there will be discussion about management issues and questions. The moderator of the session will have reviewed the case in advance and, when appropriate, will provide contribution of experience to advise on patient care, as well as literature,when available.”

After the session, formal documentation of the recommendations is placed in the electronic medical record of the patient under discussion. For learning purposes, these cases are reviewed at later sessions to understand the patient outcomes or for further discussion or education, he said.

“I think this has increased satisfaction for providers where they feel like they can get input from other people to help them out, as well as for veterans who feel like they are getting access to quality of care from teams of physicians who advise on care,” he said.

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