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Multicenter Study
. 2017 Oct 1;18(10):1882-1889.
doi: 10.1093/pm/pnx187.

Improving Pain Care with Project ECHO in Community Health Centers

Daren Anderson  1 , Ianita Zlateva  1 , Bennet Davis  2 , Lauren Bifulco  1 , Tierney Giannotti  1 , Emil Coman  3 , Douglas Spegman  4
Affiliations
Multicenter Study

Improving Pain Care with Project ECHO in Community Health Centers

Daren Anderson et al. Pain Med. .

Abstract

Objective: 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.

Design: Quasi-experimental, pre-post intervention, with comparison group.

Setting: Two large, multisite federally qualified health centers in Connecticut and Arizona.

Subjects: Intervention (N = 10) and comparison (N = 10) primary care providers.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Federally Qualified Health Center; Opioids; Pain; Primary Care; Project ECHO.

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Figures

Figure 1
Figure 1
Percent change in KP50 scores: Control and intervention primary care providers (PCPs). This figure shows the percent change in knowledge scores pre- and post-intervention for providers in the intervention and the control. Percent change was calculated using the formula ((X2-X1)/X1) *100, where X1 is the baseline score and X2 is the follow-up score. Note: Individual PCP changes in KP-50 displayed; PCPs ordered in both groups from largest decrease to largest increase.
See this image and copyright information in PMC

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