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J Telemed Telecare. 2018 Jan 1:1357633X18782090. doi: 10.1177/1357633X18782090. [Epub ahead of print]

Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas.

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1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
2 Department of Medicine, University of Toronto, Canada.
3 Institute of Medical Science, University of Toronto, Canada.
4 Institute of Clinical Evaluative Sciences, Toronto, Canada.
5 Department of Family Medicine, Queen's University, Kingston, Canada.
6 Hospital for Sick Children, Toronto, Canada.
7 Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada.
8 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
9 Department of Physical Therapy, University of Toronto, Canada.
10 Centre for Addiction and Mental Health, Toronto, Canada.
11 Faculty of Health Sciences, Queens University, Kingston, Canada.


Introduction Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. Methods A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers' self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes Results From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy ( p < 0.0001) and knowledge ( p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group ( p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. Discussion This study shows that ECHO improved providers' self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.


Pain education; chronic pain management; community based education; continuing medical education; interprofessional medical education; primary care education; problem-based learning; project echo; quantitative research methods; remote; rural; tele-education; tele-mentoring; underserved


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