Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study
Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study
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DOI：
10.1093/pm/pnx233
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发表时间：
2018-06-01
期刊：
影响因子：
3.1
通讯作者：
Furlan, Andrea
中科院分区：
文献类型：
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作者：
Carlin, Leslie;Zhao, Jane;Furlan, Andrea
Objective.加拿大的家庭医生在慢性疼痛管理方面几乎没有接受过培训;同时，他们面临着越来越大的压力，要求减少阿片类药物的处方。安大略ECHO慢性疼痛/阿片类药物管理项目（ECHO）是一项针对初级保健从业人员的远程监护干预措施，旨在提高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ECHO. Design的评估。参加三个住宅周末讲习班之一的多学科初级保健提供者的机会主义样本参加了焦点小组讨论。加拿大安大略多伦多、雷霆湾和金斯顿的大学或医院设施。17名医生和20名专职医疗人员。2014年和2015年期间，在三个不同地点进行了六次焦点小组讨论。转录本进行了分析，使用qualitativedescriptive的方法，涉及分析沉浸在数据，反思，并达成共识，从转录的讨论辨别的主题。研究结果分为五个主题：1）在初级保健中管理慢性疼痛的挑战; 2）ECHO参与和改善患者-提供者互动和参与者知识; 3）通过ECHO获得的知识扩散到参与者的同事和患者; 4）ECHO参与产生社区意识;和5）与参与ECHO相关的缺点。在初级保健中管理慢性疼痛患者可能很困难，特别是在偏远或服务不足的实践中。ECHO项目为初级保健医生提供指导，帮助他们治疗最具挑战性的病人，促进知识的获取和传播，并促进“实践社区”的发展。"
Objective. 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.Design. An opportunistic sample of multidisciplinary primary care providers attending one of three residential weekend workshops participated in focus group discussions.Setting. University or hospital facilities in Toronto, Thunder Bay, and Kingston, Ontario, Canada.Subjects. Seventeen physicians and 20 allied health professionals.Methods. Six focus group discussions were conducted at three different sites during 2014 and 2015. Transcripts were analyzed using a qualitativedescriptive approach involving analytic immersion in the data, reflection, and achieving consensus around themes discerned from transcribed discussions.Results. 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.Conclusions. 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."