Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut.
Integrative Pain Center of Arizona, Tucson, Arizona.
Pain Med. 2017 Oct 1;18(10):1882-1889. doi: 10.1093/pm/pnx187.
Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers.
Quasi-experimental, pre-post intervention, with comparison group.
Two large, multisite federally qualified health centers in Connecticut and Arizona.
Intervention (N = 10) and comparison (N = 10) primary care providers.
Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals.
Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group.
Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes.
疼痛是初级保健中极其常见的投诉，患者的治疗效果往往并不理想。本项目评估了基于案例的 ECHO 疼痛项目视频会议对两个联邦合格健康中心的疼痛护理知识和质量的影响。
准实验、干预前后、有对照组。
康涅狄格州和亚利桑那州的两个大型、多站点联邦合格健康中心。
干预组（N=10）和对照组（N=10）初级保健提供者。
初级保健提供者于 2013 年 1 月至 12 月期间参加了 48 次每周一次的 ECHO 疼痛项目会议，由多学科疼痛专业团队领导。调查和焦点小组评估了提供者的疼痛相关知识和自我效能。电子健康记录数据用于评估阿片类药物的处方和专科转诊情况。
与对照组相比，干预组的初级保健提供者在疼痛相关知识和自我效能方面的增长显著更高。与对照组相比，参加 ECHO 的提供者更有可能使用正式的评估工具和阿片类药物协议，并转介给行为健康和物理治疗。与对照组相比，干预组的阿片类药物处方显著减少。
疼痛是一个极其常见和具有挑战性的问题，特别是在美国 1200 多家以上联邦合格健康中心所照顾的弱势患者中。在这项研究中，每周参加 ECHO 疼痛会议不仅提高了知识和自我效能，而且改变了处方和转诊模式，这表明在 ECHO 会议期间获得的知识转化为实践的改变。
