Theme 4. Building the rural health care team: making the most of available resources
Presentation Materials (members only)
Project ECHO - Managing Complex Chronic Conditions without Sweating Bullets
Learning Objectives
Understand the basic ECHO principles:
- Leveraging telemedicine to move knowledge, not people and create a community of practice for continuing professional development
- Multiplying specialist expertise by connecting an expert team (HUB) with multiple primary care providers (SPOKES)
- Using case-based learning
- Sharing best practices to improve quality of care for complex patients.
Identify how ECHO addresses specialist shortages in rural and urban settings, raises primary care providers’ skills to their maximum scopes, and enhances interprofessional team performance. Review the MOHLTC-funded ECHO Ontario Chronic Pain/Opioid Stewardship demonstration project and other ECHO’s under development (Mental Health/Addictions, Hepatitis C, Rheumatology).
Summary
In 2003, Dr. Sanjeev Arora, a New Mexico hepatologist, developed ECHO (Extension for Community Healthcare Outcomes) to reach > 30,000 hepatitis C patients requiring treatment. By holding weekly video-conferencing rounds, distant primary care providers (SPOKES) managed their own hepatitis C patients with the support of an interprofessional expert team (the HUB). Cure rates were identical in both groups (NEJM 2011 364:23). There are now >20 complex chronic disease ECHO projects throughout the US and other countries. In April 2014, the MOHLTC announced funding for the first Canadian ECHO replication: ECHO Ontario chronic pain/opioid stewardship. ECHO sessions start with brief didactics on chronic pain management. Next, a de-identified case is presented by a community SPOKE following a standard template. Their “virtual” colleagues ask questions and provide advice first, with HUB experts acting as “guides on the side.” SPOKES’ knowledge and comfort levels rise and HUB experts also learn from the SPOKES. Hands-on “boot-camps” teach specific skills (the chronic pain sensory exam, myofascial pain, challenging conversations, and managing mental health problems or aberrant opiate behaviours). Curriculum themes include pain fundamentals, opioids and addictions, management (mind, movement, self-management, and medical) and special topics (e.g. medical marijuana). This presentation will educate attendees on the basic principles of ECHO, demonstrate how the model works, and discuss promising ECHO programs under development in Ontario for other complex chronic conditions such as Mental Health/Addictions, Hepatitis C, and Rheumatology.
Presenters
- Ruth Dubin, PhD, MD, CCFP, FCFP; Project ECHO Co-Chair, Asst Professor (adj), Dept of Family Medicine, Queens University; ECHO Ontario
- Leslie Carlin, PhD, Medical Anthropologist, University of Toronto
- Allison Crawford MD, FRCP, Medical Director Northern Psychiatric Outreach Program; Telepsychiatry Centre for Addiction and Mental Health; CAMH
- Other co-presenters TBD
Authors and Contributors
- ECHO Ontario
- Andrea Furlan, MD, PhD, University of Toronto
- Paul Taenzer PhD, Psychologist
- Jane Zhao MSc, Research Coordinator
- Eva Serhal, MBA, Manager, Telepsychiatry, Centre for Addiction and Mental Health