Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Outpatient Services -Project ECHO, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
Pain Med. 2018 Jun 1;19(6):1140-1146. doi: 10.1093/pm/pnx233.
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.
An opportunistic sample of multidisciplinary primary care providers attending one of three residential weekend workshops participated in focus group discussions.
University or hospital facilities in Toronto, Thunder Bay, and Kingston, Ontario, Canada.
Seventeen physicians and 20 allied health professionals.
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.
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.
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."
加拿大的家庭医生在慢性疼痛管理方面接受的培训很少；与此同时，他们面临着越来越大的压力，要求减少开具阿片类药物的处方。安大略省 ECHO 慢性疼痛/阿片类药物管理项目（ECHO）是一种针对初级保健从业者的远程辅导干预措施，可增强他们的疼痛管理技能。这项定性研究报告了参与者的经验和对 ECHO 的评估。
参加三个周末住宅研讨会之一的多学科初级保健提供者的机会样本参加了焦点小组讨论。
加拿大安大略省多伦多、桑德贝和金斯顿的大学或医院设施。
17 名医生和 20 名联合保健专业人员。
2014 年至 2015 年期间，在三个不同地点进行了六次焦点小组讨论。使用定性描述方法分析转录本，该方法涉及对数据进行分析沉浸、反思，并就从转录讨论中辨别出的主题达成共识。
研究结果分为五个主要主题：1）在初级保健中管理慢性疼痛的挑战；2）ECHO 参与以及改善医患互动和参与者知识；3）通过 ECHO 传播到参与者的同事和患者的知识；4）ECHO 参与产生社区感；以及 5）参与 ECHO 相关的劣势。
在初级保健中管理慢性疼痛的患者可能会很困难，尤其是在偏远或服务不足的实践中。ECHO 项目为初级保健从业者提供了针对最具挑战性患者的指导，促进了知识的获取和传播，并激发了“实践社区”的发展。
