Development of a Sleep Telementorship Program for Rural Department of Veterans Affairs Primary Care Providers: Sleep Veterans Affairs Extension for Community Healthcare Outcomes.
RATIONALE
Primary care providers (PCPs) frequently encounter sleep complaints, especially in regions with limited specialty care access.


OBJECTIVES
The U.S. Department of Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program (based on Project ECHO) has successfully provided rural PCP education in subspecialty areas, including hepatitis C. We describe the feasibility of an ECHO program for sleep medicine.


METHODS
ECHO creates a virtual learning community through video-teleconferencing, combining didactics with individualized clinical case review. We invited multidisciplinary providers to attend up to 10 stand-alone, 1-hour sessions. Invitees completed a needs assessment, which guided curriculum development. After program completion, we examined participant characteristics and self-reported changes in practice and comfort with managing sleep complaints. We surveyed participation barriers among invitees with low/no attendance.


MEASUREMENTS AND MAIN RESULTS
Of the 39 program participants, 38% worked in rural healthcare. Participants included nurse practitioners (26%), registered nurses (21%), and physicians (15%). Seventeen (44%) completed the summative program evaluation. Respondents anticipated practice change from the program, especially in patient education about sleep disorders (93% of respondents). Respondents reported improved comfort managing sleep complaints, especially sleep-disordered breathing, insomnia, and sleep in post-traumatic stress disorder (80% of respondents each). A follow-up survey of program invitees who attended zero to two sessions reported scheduling conflicts (62%) and lack of protected time (52%) as major participation barriers.


CONCLUSIONS
Participants in a pilot sleep medicine VA-ECHO program report practice change and increased comfort managing common sleep complaints. Future work is needed to identify objective measures of return on investment and address participation barriers.
['Parsons|Elizabeth C|EC|', 'Mattox|Elizabeth A|EA|', 'Beste|Lauren A|LA|', 'Au|David H|DH|', 'Young|Bessie A|BA|', 'Chang|Michael F|MF|', 'Palen|Brian N|BN|']
D020375:Education, Distance D006282:Health Personnel D006297:Health Services Accessibility D006801:Humans D011320:Primary Health Care D015397:Program Evaluation D012424:Rural Population D012891:Sleep Apnea Syndromes D013313:Stress Disorders, Post-Traumatic D011795:Surveys and Questionnaires D014481:United States D014493:United States Department of Veterans Affairs D058014:Veterans Health D049269:Videoconferencing
Veterans health distance education health services accessibility rural health sleep apnea syndromes