Presented at the 2013 AAPM Annual Meeting « Back

Innovation in Specialty Care Delivery to Rural Areas

Ali S. Mchaourab, MD, ali.mchaourab@va.gov¹, Scott Ober, MD¹, Christine P. Gaudino, MHSA², (1) Case Western Reserve University, Cleveland, Ohio, (2) Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio

Introduction: The purpose of establishing a specialty care access network in a large tertiary Veterans Affairs medical facility is to increase primary care provider's (PCPs) knowledge and expertise in specialties like pain management, and hence improve access to such specialties. Methods: A core group of PCPs (n=13) from remote outpatient clinics participated in a year-long pilot whereby they dialed into a weekly 90-minute V-tel session with the pain management specialty team at the main hospital. PCPs presented patients, and co-management with the specialty team was accomplished while other PCPs listened to the method of management. Case-based learning allowed sharing of best practices and enhanced the skills of PCPs over time in managing chronic pain conditions. Case presentations were followed by a 20-minute didactic on common chronic pain conditions. Results: PCPs’ confidence in managing chronic pain patients improved over the course of the year. This was ascertained through surveys that were administered prior and at pilot completion. An example of the 18 questions asked include: “Confidence in my ability to assess and manage substance abuse co-morbidity in patients with chronic pain.” Conclusions: This pilot demonstrates that knowledge transfer from specialists to primary care providers of complex clinical topics is possible through case-based learning. We also assert that this model of knowledge sharing enhances professional interaction and reduces isolation of the rural PCP. It also improves access to specialists for patients living in rural areas through this tele-health based knowledge network. References: 1) Arora, Sanjeev et al. Academic Health Center Management of Chronic Diseases through Knowledge Networks: Project Echo. Academic Medicine, Vol. 82, No 2/February 2007. 2) Arora, Sanjeev et al. Project ECHO: Linking University Specialists with Rural and Prison-Based Clinicians to Improve Care for People with Chronic Hepatitis C in New Mexico. Public Health Reports/ 2007 Supplement 2/Volume 122. 3) Arora, Sanjeev et al. Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. N ENGL J MED 364:23 June 9, 2011.

Funding: Funding Source: Veterans Health Administration; Office of Specialty Care Transformation--Project SCAN-ECHO. (Specialty Care Access Network). 2011-2013.

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