Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study

Carlin, Leslie; Zhao, Jane; Dubin, Ruth; Taenzer, Paul; Sidrak, Hannah; Furlan, Andrea D.

doi:10.1093/pm/pnx233

Cited by 75 publications

(101 citation statements)

References 31 publications

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“…39 These tension-filled patient-provider relationships in pain management can lead to increased feelings of HCP stress, depression, fear, guilt, anxiety, and despair. 31,[40][41][42] Based on the educational theories of deliberate practice, social cognitive theory, situated learning, and communities of practice, our study supports the growing body of evidence that demonstrates how ECHO PAIN may be an effective educational intervention to decrease the emotional toll of caring for patients with chronic pain. [43][44][45][46] Through weekly supportive, guided conversations, HCPs learn that they are not alone and how to leverage resources of other HCPs in their own practice and in the community.…”

Section: Discussionsupporting

confidence: 71%

“…[26][27][28][29][30] Previous research from our team has highlighted the impact of ECHO PAIN on HCPs' confidence, knowledge, and clinical practices, as well as the importance of the development of a community of practice. [31][32][33] Our results in this study suggest that HCPs recognize a knowledge gap in pain management. They were drawn to attend ECHO PAIN for a variety of reasons: to develop a specialized skillset, to share and discuss the management of patient cases, and to connect to other HCPs, both peers and specialists.…”

Section: Discussionmentioning

confidence: 61%

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Health care providers’ experiences and perceptions participating in a chronic pain telementoring education program: A qualitative study

Zhao

Salemohamed

Stinson

et al. 2020

Canadian Journal of Pain

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 61%

Health care providers’ experiences and perceptions participating in a chronic pain telementoring education program: A qualitative study

Zhao

Salemohamed

Stinson

et al. 2020

Canadian Journal of Pain

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“…In several instances, satisfaction was framed in terms of participation benefits, such as "Because of [EELM], I have expanded my practice to include new skills. 19 " In addition to structured surveys, several authors conducted focus group discussions 17,20,33,54 and semi-structured interviews 24,28,43,53 to solicit feedback on aspects of EELM that worked well or less well, often with a focus on acceptability of the technology platform utilized. Here, responses were also generally positive.…”

Section: Resultsmentioning

confidence: 99%

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

et al. 2019

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BACKGROUND: Extension for Community Health care Outcomes (ECHO) and related models of medical teleeducation are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical teleeducation models of healthcare delivery in terms of improved provider-and patient-related outcomes. METHODS: We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider-and/ or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria. RESULTS: Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates. DISCUSSION: The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.

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“…Aspects of program implementation were consistent with other programs including weekly didactics. Case discussions on highly relevant topics with the multidisciplinary team, and fellow PCPs facilitated learning and provided support to clinicians who otherwise had few interactions with other VHA PCPs or pain specialists (14,19). Respondents noted that maintenance of knowledge and skills occurred through continued relationships and contact with the multidisciplinary specialty care team members and fellow clinicians.…”

Section: Discussionmentioning

confidence: 99%

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

Ball

Stryczek

Stevenson

et al. 2020

Front. Public Health

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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.

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Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study

Cited by 75 publications

References 31 publications

Health care providers’ experiences and perceptions participating in a chronic pain telementoring education program: A qualitative study

Health care providers’ experiences and perceptions participating in a chronic pain telementoring education program: A qualitative study

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

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

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