Project ECHO Chronic Pain: A Qualitative Analysis of Recommendations by Expert Faculty

Thies, Kathleen M.; Anderson, Daren; Beals-Reid, Colin

doi:10.1093/pm/pnz024

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…Rather, this intervention provided continuing education and training more broadly and used cases to support and reinforce role-specific core competencies rather than to provide upskilling in a more specialized area. Though initially developed to improve access to evidence-based treatment for hepatitis C (Arora, Kalishman, & Thornton, [25] [35]), less is known about the model's efficacy to provide broader training not focused on a particular illness. Similarly, although one prior study evaluated the use of Project ECHO to train CHWs, it was focused specifically on diabetes (Zurawski, Komaromy, Ceballos, McAuley, & Arora, [17]).…”

Section: Challenges In Validating Chw's Added Value To Care Teammentioning

confidence: 99%

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Damian

Robinson²,

Manzoor³

et al. 2020

Pilot Feasibility Stud

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Background Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations. Methods An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. Results There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. Conclusions This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.

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Section: Challenges In Validating Chw's Added Value To Care Teammentioning

confidence: 99%

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Damian

Robinson²,

Manzoor³

et al. 2020

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

show abstract

“…Together, this study and our previous work 15,21 indicate that the expert faculty taps the knowledge in the CDC Guidelines for Prescribing Opioids 9 and their own experiences to make recommendations to PCPs about better management of patients' chronic pain, using a familiar clinical decision-making process in a shared social–cultural–historical context. Most importantly, our previous work 15 indicates that these same providers acted on this knowledge with greater confidence than providers who had not participated in the sessions.…”

Section: Resultsmentioning

confidence: 60%

“…Within this phase, faculty recommendations model a familiar clinical process—assess the patient, determine treatment, and evaluate treatment effectiveness. Moreover, the expert faculty goes beyond the CDC Guidelines for Prescribing Opioids for Chronic Pain 9,21 to draw on their knowledge and experience of how psychosocial risk factors and patient engagement and behavior shape their treatment decisions for managing chronic pain.…”

Section: Resultsmentioning

confidence: 99%

“…Details of the Project ECHO Chronic Pain intervention for this study have been previously described, 15,21 including approval for this study by the institutional review board of the sponsoring organization. The intervention consisted of two concurrent series, each of which involved twice monthly 2-hour video conference sessions over a 10-month period, between April 2016 and November 2016.…”

Section: Methodsmentioning

confidence: 99%

“…15 These findings suggest that knowledge is being acquired through ECHO participation and applied more broadly in clinical practice. In addition, through content analysis of ECHO session transcripts, 21 we demonstrated that the content of guidance provided by expert faculty in Project ECHO Chronic Pain aligned with the CDC Guidelines for Prescribing Opioids. 9 In the study reported here, we conducted a secondary analysis of the same transcripts to examine faculty guidance through the lens of the KTA framework.…”

mentioning

confidence: 87%

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Project ECHO Chronic Pain: A Qualitative Analysis of Recommendations by Expert Faculty and the Process of Knowledge Translation

Thies

Anderson

Beals-Reid

2019

J Contin Educ Health Prof

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Introduction: Previous studies of the same Project ECHO Chronic Pain cohort demonstrated that recommendations to primary care providers (PCPs) by expert faculty follow CDC Guidelines for Prescribing Opioids and that participating PCPs change their practice accordingly. The purpose of this study was to identify how expert faculty translates knowledge, so that PCPs can act on it. Methods: One hundred ninety-seven PCPs from 82 practices in 14 states attended at least one Project ECHO Chronic Pain session over 10 months, hosted by a large federally qualified health center. Expert faculty was a multidisciplinary panel of six clinicians. Recommendations for 25 randomly selected case presentations were transcribed, yielding 406 discrete units of data. A thematic analysis contributed to a concept map for knowledge translation. Results: Expert faculty addressed psychosocial issues in 40% of recommendations. Three themes represented a familiar clinical decision-making process: recommendations for treatment accounted for risk factors and patient engagement and behavior. A concept map placed the recommendations for selected cases in the first phase of the action cycle in the Knowledge-to-Action framework, where knowledge is shared but not yet acted on. Discussion: Project ECHO Chronic Pain is an example of iterative guided practice, wherein expert faculty use published guidelines and professional experience to make recommendations for patient care to PCPs. This occurs using shared social–cultural–historical language and context consistent with social constructivist theories of learning.

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Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes

Flynn

Doorenbos²,

Steffen

et al. 2019

Pain Medicine

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Objective Benefits of primary care provider (PCP) participation in pain management telementoring have been reported; however, no studies have examined within-patient changes in dose or discontinuation of long-term opioid therapy (LOT). The objectives of this nonrandomized study were to evaluate the relationship between telementoring participation and 1) LOT dose reduction and 2) LOT discontinuation and to 3) explore the relationship between LOT dose changes and patient-reported outcomes. Methods PCPs were recruited from a US Army medical center. Intervention group PCPs (N = 12) attended telementoring sessions; control group providers (N = 13) did not. Morphine equivalent daily doses (MEDD) for patients of study providers (N = 396) were extracted from the study site’s opioid database. The intervention group was subdivided based on number of sessions attended (i.e., active and low participation). Intent-to-treat and as-treated analyses were conducted using generalized estimating equations. Separate analyses evaluated the association between within-patient changes in MEDD and pain impact, depression, and anxiety (N = 40). Results Intent-to-treat analysis revealed no significant difference in MEDD reduction; however, a higher proportion of patients of intervention PCPs discontinued LOT (25% ± 3.6%) compared with control PCPs (16% ± 3.6%, P < 0.05). As-treated analyses revealed differences in MEDD reduction between active (13.2 ± 3.0) and low-participating (2.6 ± 3.0) PCPs (P < 0.01). Further, a higher proportion of patients of actively participating PCPs discontinued LOT (29% ± 4.9%) compared with control PCPs (16% ± 3.6%, P = 0.01). We found no evidence that decreased MEDD was associated with poorer self-reported outcomes within patients. Conclusions Pain management telementoring supports PCPs’ efforts to reduce reliance on LOT for chronic pain management and highlights the need for actively engaged PCP pain champions.

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Project ECHO Chronic Pain: A Qualitative Analysis of Recommendations by Expert Faculty

Cited by 4 publications

References 3 publications

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Project ECHO Chronic Pain: A Qualitative Analysis of Recommendations by Expert Faculty and the Process of Knowledge Translation

Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes

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