A Qualitative Evaluation of the Pain Management VA-ECHO Program Using the RE-AIM Framework: The Participant's Perspective

Abstract

Introduction: Veterans frequently seek chronic pain care from their primary care providers (PCPs) who may not be adequately trained to provide pain management. To address this issue the Veterans Health Administration (VHA) Office of Specialty Care adopted the Specialty Care Access Network Extension for Community Healthcare Outcomes (VA-ECHO née SCAN-ECHO). The VA-ECHO program offered training and mentoring by specialists to PCPs and their staff. VA-ECHO included virtual sessions where expertise was shared in two formats: (1) didactics on common pain conditions, relevant psychological disorders, and treatment options and (2) real-time consultation on patient cases. Materials and methods: VA-ECHO participants' perspectives were obtained using a semi-structured interview guide designed to elicit responses based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. A convenience sampling was used to recruit PCPs and non-physician support staff participants. Nonphysicians from rural VHA sites were purposively sampled to gain diverse perspectives. Findings: This qualitative study yielded data on each RE-AIM domain except reach. Program reach was not measured as it is outside the scope of this study. Respondents reported program effectiveness as gains in knowledge and skills to improve pain care delivery. Effective incorporation of learning into practice was reflected in respondents' perceptions of improvements in: patient engagement, evidenced-based approaches, appropriate referrals, and opioid use. Program adoption included how participating health care systems selected trainees from a range of sites and roles to achieve a wide reach of pain expertise. Participation was limited by time to attend and facilitated by institutional support. Differences and similarities were noted in implementation between hub sites. Maintenance was revealed when respondents noted the importance of the lasting relationships formed between fellow participants. Discussion: This study highlights VA-ECHO program attributes and unintended consequences. These findings are expected to inform future use of VA-ECHO as a means to establish a supportive consultation network between primary and specialty care providers to promote the delivery evidence-based pain management practices.

Qualitative Study of Health Care Providers' Uptake of the Project Extension for Community Health Outcomes for Chronic Pain

“…A study of Veterans Affairs ECHO Chronic Pain program found that many participants perceived a sense of community that developed throughout the program, which helped them to face the challenges of managing an uncurable, debilitating chronic health condition. 26 Other models geared at creating a community of practice also report that such management approach to chronic pain leads to improved clinicians' confidence in their ability to manage pain and communication skills. 25,26 In line with results from other Project ECHO programs, most of the identified challenges were related to inherent characteristics of existing treatment models.…”

“…26 Other models geared at creating a community of practice also report that such management approach to chronic pain leads to improved clinicians' confidence in their ability to manage pain and communication skills. 25,26 In line with results from other Project ECHO programs, most of the identified challenges were related to inherent characteristics of existing treatment models. For example, Moeckli and colleagues 46 found that when multidisciplinary or interdisciplinary settings are not in place, it might be difficult for ECHO programs to alter traditional, one-dimensional patterns of care in primary settings.…”

“…26 Other models geared at creating a community of practice also report that such management approach to chronic pain leads to improved clinicians' confidence in their ability to manage pain and communication skills. 25,26…”

“…15,[20][21][22][23][24][25] Using a qualitative methodology, some studies showed that participants in Project ECHO chronic pain found the program overall effective, perceived having improved their competence (patient engagement and care, evidenced-based approaches, appropriate referrals, and prescribing opioids), had the opportunity to engage in knowledge dissemination, and felt part of a community. 26,27 The study goal was to explore generic and chronic pain-specific factors that influenced the uptake of the Project ECHO CHUM Douleur chronique to inform other provincial and out of province care systems considering Project ECHO chronic pain. This knowledge could be useful to those who are looking to launch a Project ECHO or those looking to optimize its impact.…”

“…15,20–25 Using a qualitative methodology, some studies showed that participants in Project ECHO chronic pain found the program overall effective, perceived having improved their competence (patient engagement and care, evidenced-based approaches, appropriate referrals, and prescribing opioids), had the opportunity to engage in knowledge dissemination, and felt part of a community. 26,27…”