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

• Published in: Pain medicine (Malden, Mass.) Mass.), 2018-06, Vol.19 (6), p.1140-1146
• Main Authors: Carlin, Leslie, Zhao, Jane, Dubin, Ruth, Taenzer, Paul, Sidrak, Hannah, Furlan, Andrea
• Format: Article
• Language: English
• Subjects: Analysis; Chronic pain; Clinical competence; Continuing education; Education; Family medicine; Family physicians; Focus groups; General practitioners; Medical personnel; Narcotics; Online instruction; Opioids; Pain; Pain management; Physicians; Prescription writing; Prescriptions; Primary care; PRIMARY CARE & HEALTH SERVICES SECTION; Qualitative research; Workshops (Educational programs)
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx233

Abstract Objective Family physicians in Canada receive little training in chronic pain management; concomitantly, they face increasing pressure to reduce their prescribing of opioids. Project ECHO Ontario Chronic Pain/Opioid Stewardship (ECHO) is a telementoring intervention for primary care practitioners that enhances their pain management skills. This qualitative study reports participants’ experiences and assessment of ECHO. Design An opportunistic sample of multidisciplinary primary care providers attending one of three residential weekend workshops participated in focus group discussions. Setting University or hospital facilities in Toronto, Thunder Bay, and Kingston, Ontario, Canada. Subjects Seventeen physicians and 20 allied health professionals. Methods Six focus group discussions were conducted at three different sites during 2014 and 2015. Transcripts were analyzed using a qualitative-descriptive approach involving analytic immersion in the data, reflection, and achieving consensus around themes discerned from transcribed discussions. Results Findings resolved into five main themes: 1) challenges of managing chronic pain in primary care; 2) ECHO participation and improvement in patient-provider interaction and participant knowledge; 3) the diffusion of knowledge gained through ECHO to participants’ colleagues and patients; 4) ECHO participation generating a sense of community; and 5) disadvantages associated with participating in ECHO. Conclusions Managing patients with chronic pain in primary care can be difficult, particularly in remote or underserved practices. Project ECHO offers guidance to primary care practitioners for their most challenging patients, promotes knowledge acquisition and diffusion, and stimulates the development of a “community of practice.”