title: ECHO Ontario Chronic Pain & Opioid Stewardship: Providing Access and Building Capacity for Primary Care Providers in Underserviced, Rural, and Remote Communities.
abstract: Chronic pain is a prevalent and serious problem in the province of Ontario. Frontline primary care providers (PCPs) manage the majority of chronic pain patients, yet receive minimal training in chronic pain. ECHO (Extension for Community Healthcare Outcomes) Ontario Chronic Pain &amp; Opioid Stewardship aims to address the problem of chronic pain management in Ontario. This paper describes the development, operation, and evaluation of the ECHO Ontario Chronic Pain project. We discuss how ECHO increases PCP access and capacity to manage chronic pain, the development of a community of practice, as well as the limitations of our approach. The ECHO model is a promising approach for healthcare system improvement. ECHO's strength lies in its simplicity, adaptability, and use of existing telemedicine infrastructure to increase both access and capacity of PCPs in underserviced, rural, and remote communities.
authors.affiliation: Department of Family Medicine, Queen's University, Kingston, Canada.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Dubin
authors.affiliation: Musculoskeletal (MSK) Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Flannery
authors.affiliation: Department of Physical Medicine and Rehabilitation, Faculty of Health Sciences, Queen's University, Kingston, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Taenzer
authors.affiliation: Pain and Addiction Medicine, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Continuing Professional Development, Faculty of Health Sciences, Queen's University, Kingston, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Outpatient Services - ECHO, Musculoskeletal (MSK) Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
authors.forename: Ralph
authors.initials: R
authors.lastname: Fabico
authors.affiliation: Outpatient Services - ECHO, Musculoskeletal (MSK) Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Continuing Professional Development, Faculty of Health Sciences, Queen's University, Kingston, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Cameron
authors.affiliation: Centre for Global eHealth Innovation, University Health Network, Toronto, Canada.
authors.forename: Dana
authors.initials: D
authors.lastname: Chmelnitsky
authors.affiliation: Ontario Telemedicine Network, Canada.
authors.forename: Rob
authors.initials: R
authors.lastname: Williams
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Carlin
authors.affiliation: Outpatient Services - ECHO, Musculoskeletal (MSK) Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Sidrak
authors.affiliation: Project ECHO, Department of Internal Medicine, University of New Mexico School of Medicine, United States of America.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Arora
authors.affiliation: Outpatient Services - ECHO, Musculoskeletal (MSK) Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods*; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008507:Medically Underserved Area; D009864:Ontario; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control; D059408:Pain Management / Q000379:methods*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration
chemical_list: D000701:Analgesics, Opioid