Mixed‐Methods Study of Uptake of the Extension for Community Health Outcomes (ECHO) Telemedicine Model for Rural Veterans With HIV

Moeckli, Jane; Stewart, Kenda R.; Ono, Sarah S.; Alexander, Bruce; Goss, Tyler; Maier, Marissa; Tien, Phyllis C.; Howren, M. Bryant; Ohl, Michael

doi:10.1111/jrh.12200

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…The potential for the ECHO model to improve access to high-quality HIV care in nonurban settings is as yet untested, with one study indicating that uptake by primary care providers and patients was very low in settings where PLWH had historically traveled to distant HIV specialty clinics for care. 104 …”

Section: Future Directions For Research and Demonstration Projectsmentioning

confidence: 99%

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

Schafer

Albrecht

Dillingham

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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107

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The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural–urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.

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Section: Future Directions For Research and Demonstration Projectsmentioning

confidence: 99%

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

Schafer

Albrecht

Dillingham

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

107

View full text Add to dashboard Cite

show abstract

“…Infectious diseases physicians have provided HIV training to primary care and rural locations through the VA Specialty Care Access Network-Extension for Community (SCAN-ECHO) program. 19 Optimal stewardship activities. Prospective audit-andfeedback and preauthorization are both effective strategies for antimicrobial stewardship within inpatient settings.…”

Section: Inpatient Antimicrobial Stewardshipmentioning

confidence: 99%

“…, 18 For example, local personnel at a resource-limited hospital could interact with an ID specialist based at a different location. Infectious diseases physicians have provided HIV training to primary care and rural locations through the VA Specialty Care Access Network-Extension for Community (SCAN-ECHO) program 19 …”

Section: Recommendationsmentioning

confidence: 99%

Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

Suda

Livorsi

Goto

et al. 2018

Infect. Control Hosp. Epidemiol.

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See introductory commentary by Livorsi et al, pages 186-188.) Antimicrobial use is a key contributor to increasing antimicrobial resistance. 1 Antimicrobial stewardship has been shown to decrease inappropriate antimicrobial use and, in turn, may reduce antimicrobial resistance and Clostridium difficile infection (CDI). 2 Antimicrobial stewardship can also improve clinical outcomes for patients. 3 The Veterans Health Administration (VHA) is a leader in promoting antimicrobial stewardship. 4-7 Since 2011, the VHA National Antimicrobial Stewardship Taskforce (ASTF) has provided guidelines and resources for stewardship implementation at individual VHA facilities. In 2014, the VHA mandated that every facility develop and maintain an antimicrobial stewardship program (ASP). The VHA ASP Directive tasked every VHA facility to have an ASP policy, to conduct an annual evaluation of ASP activities, and to have a provider and a pharmacist champion. 6 There were no requirements for facilities to adopt any specific set of ASP activities, allowing individual facilities to decide which elements to implement based on their own focus areas and available resources. This mandate was among the first in the United States, preceding similar directives from the Joint Commission and the Centers for Medicare and Medicaid Services. 8,9 Recently, VHA investigators have partnered with the Centers for Disease Control and Prevention (CDC) to make use of novel antimicrobial usage metrics, including the standardized antimicrobial administration ratio (SAAR). They have also utilized the robust VA Corporate Data Warehouse (CDW) to determine the effectiveness of ASPs, to evaluate outcomes, and to identify high-impact targets. 6,7,10-12 As the largest integrated healthcare system in the United States, the VHA provides a unique opportunity to study a Authors with equal contribution.

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“…Implementation of an ECHO model to support buprenorphine prescribing was associated with a marked increase in DATA 2000-waiver buprenorphine prescribers in rural New Mexico [74]. Similarly, ECHO demonstrations have been used to support HCV [75–78] and HIV [79] treatment among rural primary care providers.…”

Section: Models Of Care For Medication Treatmentsmentioning

confidence: 99%

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

et al. 2018

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Purpose of review: To describe the epidemiology opioid use disorder in the rural United States as it pertains to HIV and hepatitis C transmission and treatment resources. Recent findings: Heroin and fentanyl analouges have surpassed prescription opioids in their availability in rural opioid markets adding to HIV and hepatitis C (HCV) and overdose risks. Only 18% of rural individuals live in towns with inpatient services which are of limited quality and utiity. Opioid treatment programs that provide methadone are not located in rural areas and only 3% of the primary care providers have the ability to prescribe buprenorphine. National models and resources have been established but lack implementation in rural areas leading to ongoing HIV and HCV transmission and overdose. Summary: Addressing the adverse impact of opioids in the rural U.S. will require a concerted effort to implement effective treatments according to national standards.

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Mixed‐Methods Study of Uptake of the Extension for Community Health Outcomes (ECHO) Telemedicine Model for Rural Veterans With HIV

Abstract: There was limited uptake of HIV ECHO telemedicine programs in settings where veterans historically traveled to distant specialty clinics. Other telemedicine models should be considered for HIV care.

Cited by 19 publications

References 19 publications

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

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