Author: Gwen Ratermann, Associate Director of Outreach, Show-Me ECHO, Missouri Telehealth Network, University of Missouri
The nationwide opioid crisis is focusing attention on why pharmacists must be involved in interdisciplinary care, especially for patients suffering from chronic pain or addiction. Treatment for these patients is improving in Missouri because pharmacists, physicians and other health professionals are sharing their expertise and experiences through Show-Me ECHO.
ECHO (Extension for Community Healthcare Outcomes) uses videoconferencing to connect an interdisciplinary team of experts with primary care providers. They collaborate in case-based learning sessions to help primary care providers develop advanced skills and best practices, which in turn increases the availability and quality of patient care.
Pharmacists help lead the Chronic Pain Management and Opioid Use Disorder teams at the University of Missouri’s Show-Me ECHO program. More than 170 health professionals from across the state have already participated in these two ECHO teams. Both teams follow the latest federal recommendations, and they continuously examine the growing body of research on why and how to limit opioid use.
The University of Missouri launched one of the first ECHO programs in the country to focus on opioid use disorder. Supported by a Substance Abuse and Mental Health Services Administration grant awarded to the Missouri Department of Mental Health, Show-Me ECHO’s opioid program recommends a medication-first treatment strategy for addiction. On the other hand, the Chronic Pain Management ECHO emphasizes how to avoid addiction in the first place by examining alternatives to opioids and methods for limiting their use.
In addition to pharmacists, these complimentary ECHO teams include experts in psychiatry, psychology, addictionology, pain management, physical therapy and social work. The University of Missouri is the only university to also put health literacy experts on all of its ECHO teams. The teams meet every other week via videoconferencing to discuss real but de-identified patient cases that are particularly complex or problematic for primary care providers.
Participating pharmacists realize benefits to themselves, their health care colleagues, and ultimately patients. Like all participants, pharmacists are exposed to the rewards and challenges of working with a variety of experts who must collaborate to provide the best possible care. Pharmacists also become comfortable using telehealth technology that can help them collaborate on improving medication reconciliation, transitional care or follow-up interactions with patients.
Learning more about how pain intersects with mental, behavioral and psychosocial conditions is of particular interest to participating pharmacists. They’re very familiar with widely used psychiatric medications, but medicine is always learning more about the prevalence of depression in patients with chronic pain, or how pain can originate from trauma that occurred decades earlier in childhood. Show-Me ECHO experts recognize the value of behavioral health screenings for patients to help identify the true origins of pain and potentially avoid for unnecessary medication.
Every ECHO team is richer when it includes pharmacists because their knowledge base is both broad and unique. Pharmacists might be the only team members to figure out that a patient’s excruciating leg pain is caused by powerful statins. They might also be the first to suggest that peripheral neuropathy is related to untreated prediabetes. Whatever kind of case is discussed, pharmacists always have special insight into a wide variety of illnesses and conditions.
Registration for all Show-Me ECHOs – including dermatology, Hepatitis C, child psychology, asthma, autism, healthcare ethics and community health workers – is available at showmeecho.org. The state-funded programs are provided at no cost to participants, including no cost continuing education credits for health care professionals. A new Show-Me ECHO program addressing behavioral health for veterans will launch in 2018.
University of Missouri Show-Me ECHO is designated as an international SuperHub, meaning the founding ECHO program at the University of New Mexico has certified MU to train other organizations wanting to adopt the ECHO model. Show-Me ECHO immersion trainings and orientations have been provided to health professionals from California, Indiana, Kansas, Kentucky, Iowa, Nebraska, Tennessee and West Virginia, as well as Kenya, Thailand and Vietnam.