Project ECHO Brings Pain Expertise to Rural Docs

LAS VEGAS—Rural areas typically are underserved by pain specialists, so primary care doctors may be on their own when caring for patients with chronic pain or may have to refer patients long distances for a pain consultation. To address this problem in New Mexico, doctors at the University of New Mexico in Albuquerque created a telementoring program in 2009 called Project ECHO (Extension for Community Healthcare Outcomes) Chronic Pain.

Project ECHO Chronic Pain Program is co-directed by Joanna G. Katzman, MD, a neurologist, and George D. Comerci, Jr., MD. Dr. Katzman, Director of the UNM Pain Center, spearheaded creation of the program “as a way to leverage scarce pain resources for primary care providers working in rural and underserved areas” where their patients had to wait many months for a specialty pain consultation.

The program consists of an interdisciplinary team of pain specialists that includes, in addition to Drs. Katzman and Comerci, an addiction psychiatrist, family physician, psychologist, and clinical pharmacist. “We have the full make up of a best practices interdisciplinary pain team,” Dr. Katzman said.

The two doctors provided details of the program at a session titled, “Pain Management Telementoring for Remote Providers: Project ECHO Chronic Pain Program.” Dr. Comerci presented an actual case to the interdisciplinary team at UNM, with attendees watching on video monitors.

The UMN team meets every Thursday from 12:00 pm to 2:00 pm Albuquerque time to hear case presentations from doctors throughout New Mexico. The doctors and Project ECHO team communicate via teleconference. All doctors need to participate is a $50 web cam, iPad, or iPhone, Dr. Comerci said. Physicians contact a nurse manager in the program who will facilitate presentation of a case. The UNM team and participating clinicians ask presenting doctors questions related to the case and then make recommendations regarding patient care—all at no cost to the presenting physician.

In addition, Project ECHO members give lectures on various pain topics. In fact, Drs. Katzman and Comerci emphasize that the primary mission is education. Dr. Comerci, who led the curriculum development process, observed: “When I initially started with Project ECHO, I thought it would be nice if we could formalize our teaching in some way, so we developed a general pain curriculum to actually give little talks. Every week, we give a talk, and it's usually thematic.”

According to the UNM Project ECHO website, the goals of the chronic pain curriculum are to meeting individual goals for taking care of patients with chronic non-malignant pain; increase access to evidence-based chronic pain care; improve pain care for New Mexicans; and prepare for the certification examination of the American Academy of Pain Management.

 “We really want to see this as an educational [forum] rather than a service,” Dr. Comerci added. The UNM team wants clinicians to upgrade their skills and perhaps become a “pain champion,” someone who assumes expertise as a pain clinician. Although this doctor would not be a pain specialist, he or she would be the “go-to person” in their clinic for pain problems, Dr. Comerci said.

“We feel that we're really enabling clinicians in rural New Mexico to take care of pain patients,” Dr. Comerci said. Dr. Katzman noted that around 100 unique clinicians signed on to participate in the Project ECHO teleconferences in 2009. This rose to around 400 in 2012. In addition, the Project ECHO team has educated the Veterans Affairs on developing and replicating the Project ECHO model (which the VA calls SCAN (Specialty Care Access Network)-ECHO. The University of Washington in Seattle also replicated Project ECHO Pain. Called TelePain, it serves five states.

Dr. Katzman noted that the Department of Defense is collaborating with UNM to develop a similar program to address a problem of too few pain specialists in the military.

Another benefit of Project ECHO Chronic Pain and other institutions that have replicated the program is the social component, Dr. Katzman said. “Rural clinicians, they love the fact that every Thursday at noon, they can come on with their sack lunch, be in their office, and connect with other like-minded individuals.”

Doctors who want to present a case must register at the Project ECHO Provider Profile (echo.unm.edu/providers-partners/index.html) and indicate their interest in the Chronic Pain TeleECHO clinic. Doctors will receive an e-mail notification that will have a link to the program's standard case presentation form.