Extension for community Healthcare Outcomes (ECHO) chronic pain & opioid stewardship in northwestern Ontario: A thematic analysis of patient cases

ABSTRACT

Background

Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph’s Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas.

Aims

To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs.

Methods

We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics.

Results

Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs.

Conclusion

Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs’ knowledge and will guide future sessions.

RÉSUMÉ

Contexte: La douleur chronique est une maladie débilitante qui réduit la qualité de vie et diminue la productivité. En outre, elle est devenue une cause principale de consommation des ressources en soins de santé. Malgré cela, de nombreux médecins de famille canadiens ont reçu peu d'éducation conventionnelle sur la prise en charge de la douleur chronique, ce qui en fait l'un des domaines de pratique les plus difficiles en soins primaires.Le Projet de vulgarisation pour des résultats de santé communautaires – Gestion des opioïdes et de la douleur chronique du St. Joseph' s Care Group (projet ECHOSJCG) est un programme éducatif fondé sur les données probantes qui met les prestataires de soins de santé communautaires en relation avec une équipe interprofessionnelle par vidéoconférence pour en apprendre davantage sur la prise en charge de la douleur chronique dans les zones rurales, éloignées et mal desservies.Objectifs: Explorer les principaux points d'apprentissage à partir des cas présentés au projet ECHO-SJCG, recenser et analyser les thèmes et améliorer les futures sessions de développement professionnel continu pour les professionnels de la santé.Méthodes: Nous avons effectué une analyse thématique de quarante cas et points d'apprentissage clés à l'aide de la méthode de comparaison constante. Nous avons également résumé les statistiques descriptives pour le patient et le prestataire.Résultats: Quarante cas ont été présentés par 31 professionnels de la santé ayant reçu des suggestions axées sur l'évaluation et le diagnostic, la prise en charge des symptômes de douleur pharmacologique et non pharmacologique, la prise en charge interventionnelle, l'attention aux facteurs biopsychosociaux et l'orientation appropriée vers d'autres professionnels de la santé.Conclusions: Les cas du projet ECHO-SJCG permettent aux professionnels de la santé d'acquérir une large base de connaissances pour l’évaluation et la prise en charge de la douleur chronique dans leur pratique. Les thèmes recensés mettent en évidence les lacunes communes dans les connaissances des professionnels de la santé et orienteront les sessions futures.

KEYWORDS:

• Chronic pain
• opioids
• primary care
• continuing professional development
• pain assessment
• pain management
• qualitative research
• interdisciplinary team

Acknowledgments

The authors would like to thank the HCPs and specialists who participated in Project ECHO-SJCG, as well as the staff and research team.

Disclosure Statement

Author Poulin has a conflict of interest as they are funded by the Ministry of Health for their work with Project ECHO St. Joseph’s Care Group (MOH ECHO SJCG). Shergill has not declared any conflicts of interest. Grebowicz has not declared any conflicts of interest. Almeida has not declared any conflicts of interest. Cantave has not declared any conflicts of interest. MacLeod has a conflict of interest as they were funded by the MOH ECHO SJCG. Larocque has a conflict of interest as they are funded by the MOH ECHO SJCG. Fitzgerald has not declared any conflicts of interest. Garstin has a conflict of interest as they are funded by the MOH ECHO SJCG. Rash has not declared any conflicts of interest.

Informed Consent Statement

Participants registering in Project ECHO-SJCG are informed that the sessions are recorded and archived for educational purposes; that our team is continuously engaged in evaluation and quality improvement initiatives; and are asked to submit an online form indicating their agreement with recording and evaluation. All the data (deidentified case report form and summary of key learning points for each case) is in the public domain of the Project ECHO-SJCG participant web portal. The Chair of Ottawa Health Science Network Research Ethics Board reviewed the project and indicated that the project falls within the context of quality initiative, quality improvement, quality assurance, and/or program evaluation, as per the Tri-Council Policy Statement 2, Article 2.5. Consequently, the project was exempted from research ethics review. Nevertheless, our team has applied the same degree of rigor and protection of potentially identifying information to the project as it does with all its research projects.

Additional information

Funding

We would like to thank the Ontario Ministry of Health & Long-Term Care for funding the Project ECHO program. This project was also supported in part by a grant from the Northern Ontario Academic Medicine Association (NOAMA) Clinical Innovation Opportunities fund award. The views expressed in this publication are the views of the Recipient (SJCG) and do not necessarily reflect those of the Province or Northern Ontario Academic Medicine Association.