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ECHOES OF PAIN



Chronic pain is a common problem in the United States. Health care professions training at the undergraduate and graduate levels in managing chronic pain is insufficient. The Chronic Pain and Headache Management TeleECHO Clinic (ECHO Pain) is a telehealth approach at Project ECHO (Extension for Community Healthcare Outcomes), which supports clinicians interested in improving their knowledge and confidence in treating patients with chronic pain and safe opioid management. It is a vehicle for educating practicing clinicians (at the "spoke") based on work-place learning with cases selected by participants from their patient panels combined with short lectures by experts (at the "hub"). ECHO Pain has designed an innovative, interprofessional longitudinal curriculum appropriate for individual and team-based clinicians which includes relevant basic and advanced pain topics. The specific design and delivery of the curriculum enhances its relevance and accessibility to busy clinicians in practice, yet also satisfies statutory requirements for CME in New Mexico. Specific features which balance hub-and-spoke needs are presented in this descriptive article, which is intended to serve as a guide to other clinician educators interested in developing or implementing similar telehealth curricula.




ECHOES OF PAIN



UC Davis ECHO-Pain Management is a peer-to-peer video conference mentoring program designed to support community-based primary care clinicians in their mission to provide high quality, safe and effective pain care. Through weekly videoconference learning and support sessions, the program provides primary care providers with the opportunity to increase their specialized knowledge in pain management.


Providers at participating clinics and health centers convene once a week for 10 months for a one-hour video conference that features didactic presentations on essential pain topics combined with in-depth case discussions. Each interactive educational session empowers primary care providers with the tools to safely identify and understand pain and deliver safe, compassionate and effective care. All clinical staff members are encouraged to participate.


Based on the University of New Mexico model, the BC ECHO for Chronic Pain is a free, virtual community of practice for BC health care providers that leverages specialist knowledge to support community providers to provide appropriate care to people living with chronic pain. Through our ECHO, health care providers can gain the knowledge, resources, and interprofessional support to provide immediate care to patients with chronic pain in their home communities.


Our ECHO provides a significant opportunity for practitioners to improve their competence in chronic pain care by gaining help with complex cases, receiving support and mentorship, and helping to reduce disparities in the quality of care for rural and underserved areas.


Introduction: Project ECHO Pain, the innovative telementoring program for health professionals, was developed in 2009 at the University Of New Mexico Health Sciences Center to fill considerable gaps in pain management expertise. Substantive continuing education for clinicians who practice in rural and underserved communities convenes weekly by means of telehealth technology. Case-based learning, demonstrations, and didactics are incorporated into the interprofessional program that helps to improve pain management in the primary care setting.


Discussion: Project ECHO Pain is a successful continuing professional development program. The telementoring model closes the large knowledge gap in pain education seen in primary care and other settings. Expertise is delivered by implementing effective, evidence-based, and work-based education for diverse health professionals. Project ECHO Pain serves as a model for interprofessional collaborative practice.


Keywords: Project ECHO; chronic pain; community of practice/knowledge networks; evaluation-educational intervention; innovative educational interventions; interdisciplinary; interprofessional education; mentoring; workforce development/issues; workplace learning.


When you join an ECHO program, you use videoconferencing technology to regularly connect to a community of learners. There are many opioid- and pain-related ECHO programs that offer no-cost teleECHO sessions.


Objective: The Specialty Care Access Network-Extension for Community Health Outcomes (SCAN-ECHO) is a video teleconferencing-based training program where primary care providers are trained by a specialty care team to provide specialty care. A multidisciplinary team of pain management specialists at the Cleveland Veterans Affairs Medical Center established such a program for pain management; a description and preliminary effectiveness assessment of this training program is presented.


Design: Primary care provider participants in the Specialty Care Access Network program in pain management completed pre- and post-training questionnaires. A subset of these participants also participated in a group session semistructured interview.


Subjects: Twenty-four primary care providers from Cleveland, South Texas, or Wisconsin Veterans Affairs Medical Centers who regularly attended pain management SCAN-ECHO sessions during 2011, 2012, 2013, or 2014 completed pre- and post-training questionnaires.


Methods: Pre- and post-training questionnaires were conducted to measure confidence in treating and knowledge of pain management. Questionnaire responses were tested for significance using R. Qualitative data were analyzed using inductive coding and content analysis.


Results: Statistically significant increases in confidence ratings and scores on knowledge questionnaires were noted from pre- to post-pain management SCAN-ECHO training. Program participants felt more knowledgeable and reported improved communication between specialty and primary care providers.


Conclusions: This pilot study reveals positive outcomes in terms of primary care providers' confidence and knowledge in treating patients with chronic pain. Results suggest that involving primary care providers in a one-year academic project such as this can improve their knowledge and skills and has the potential to influence their opioid prescribing practices.


Learn to improve outcomes and reduce risk of harm for people with chronic pain through an interdisciplinary model of care. Participants will share their expertise on such subjects as deepening the understanding of pain as a complex phenomenon with biological, behavioral, social and psychological elements, expanding a repertoire of evidence-based tools for managing pain, and facilitating collegial consultations and relationships among participants to improve pain management in the community. This ECHO meets on every 2nd and 4th Thursday of the month from 9:30-10:30 a.m.


Participants will join an interactive online video conference twice per month. The interdisciplinary panel includes clinicians in pain management, behavioral health and pharmacy. Together with a team of experts, participants will:


Opiates include prescription pain medications, such as Vicodin and Oxycontin, as well as street drugs like heroin. Addiction often begins when individuals with chronic pain receive a prescription for an opiate from their physician, despite the fact that there is no evidence to demonstrate the benefit of such treatment on long-term outcomes for chronic pain. Many of these individuals become dependent on, and then addicted to, the prescribed opiate. In addition, a percentage of those who become addicted will go on to use heroin because it is cheaper and stronger than prescription opiates. According to a 2015 study by the Centers for Disease Control and Prevention, 45% of people nationwide who used heroin also were addicted to prescription opiates.


Pediatric pain is a complex health challenge requiring a multi-modal management approach. It is critical that healthcare providers (HCPs) have access to ongoing, flexible education and mentorship specific to pediatric pain. However, there are significant gaps in available pain education and a need for more opportunities to support interprofessional training. Project Extension for Community Healthcare Outcomes (Project ECHO) is a model for delivering online HCP education and cultivating a virtual community of practice. Within the pediatric pain setting, ECHO has potential to improve local access to specialized pain knowledge, particularly among the physicians, nurses, and allied health providers who primarily manage these cases in community and hospital settings across rural and urban environments. The purpose of this study was three-fold. First, to evaluate the feasibility (participation levels, acceptability) of implementing Project ECHO in the context of pediatric pain. Second, to measure preliminary program impacts on HCP knowledge, self-efficacy, and clinical practice. Third, to characterize HCP program engagement levels before and after onset of the COVID-19 pandemic.


Pediatric pain is a significant health problem that can impair all aspects of life, including sleep, mood, physical functioning, peer and family relationships, and school attendance [1,2,3,4]. Pediatric acute pain commonly results from surgery, trauma (e.g. burns, motor vehicle accidents, sports injuries), diseases (e.g. sickle cell crises, juvenile idiopathic arthritis), and procedures (e.g. vaccinations, blood draws) [5]. Examples of chronic pain in children include headache, abdominal pain, musculoskeletal pain, and neuropathic pain [6]. Chronic pain impacts 1 in 5 children and youth in Canada, and disproportionally affects Black, Indigenous, and other racialized individuals [7]. Early pain management intervention is critical to reducing pain-related disability, duration, and healthcare costs [3, 4]. However, wait times to access specialized pain treatment can often extend for months or even years [8, 9]. Therefore, as recommended by the Canadian Pain Task Force, it is pivotal to engage health professionals from primary and secondary care settings in the management of pediatric pain [7, 10]. 2ff7e9595c


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