Substance Use and Chronic Pain Management: Understanding the Learning Needs of Primary Care Clinicians Through Project ECHO

Background: In 2022, more than 107,000 people died in the US from an opioid overdose. The Opioid Rapid Response and Pain (ORRP) ECHO was developed to educate primary care clinicians on best practices in pain and substance use management consistent with the 2016 Guideline for Prescribing Opioids for Chronic Pain. Methods: Six 1 h virtual sessions consisting of didactics and case discussions focusing on pain and substance use were delivered by a multidisciplinary hub team to four diverse US regions. The authors utilized qualitative analyses, including a modified Delphi Technique and thematic analysis, to assess participant questions during the sessions, focus groups with participants, and post-session survey responses for ORRP ECHO training between 14 October 2021 and 15 November 2022. Results: One hundred and eighteen primary care clinicians performed 627 chat responses and were eligible to receive 648 continuing education unit credits. The majority of chat questions were related to Patient-Centered Care (28%, 170 total responses) and Knowledge (27%, 178 total responses). The focus groups revealed five core themes: (1) there was a clear need for the ECHO trainings, (2) the program fostered a unique and supportive community, (3) the content was applicable, (4) the administration of the program was effective, and (5) it had a meaningful impact on practice. The participants who completed the post-session surveys reported that they would apply their knowledge (range across cohorts: 85.7% to 100.0% of survey respondents agreed or strongly agreed) and communication skills gained (range: 71.4% to 98.6%). Conclusions: Through didactics and interactive case discussions, the ECHO model holds promise as a useful training model to support the appropriate use of clinical practice guidelines by informing individualized, patient-centered care and clinical judgment.