Over a video screen, Dr. Andrea Furlan listens to a family doctor in Colborne, Ont., describe a case she has been grappling with—a patient living with chronic pain following a traffic collision. Joining Furlan are a team of specialists and frontline practitioners across a range of disciplines—including general physicians, nurse practitioners, psychiatrists, occupational therapists and pharmacists. They take turns asking the family doctor questions about her patient before offering a diagnosis and treatment recommendations, all the while acknowledging the case as both difficult to manage and all too familiar in their own practices.
In these sessions, everyone walks away having learned something—not just the practitioners on the frontlines but even the specialists leading the session, says Furlan, a scientist at the Institute for Work & Health (IWH).
I’ve heard people say they learn more in these sessions than they do from textbooks and journals. They discuss real-life cases, which can be messy and complicated. What they learn in these sessions, they don’t learn anywhere else, says Furlan, who also holds a staff physician and senior scientist post at the Toronto Rehabilitation Institute.
Since 2014, Furlan has been leading an initiative that connects medical specialists with practitioners across Ontario to share knowledge in the management of chronic pain and opioid stewardship. It’s based on a hub-and-spoke model of health-care mentoring and support called Project Extension for Community Healthcare Outcomes—also known as Project ECHO. The initiative uses videoconferencing technology to build health-care capacity, especially in remote and underserved communities, to reduce inequities in service delivery across different regions.
One of the mottos of the project is 'We move knowledge, not people,’ says Furlan.
She’s now starting a new Project ECHO focused on occupational and environmental medicine (OEM), in partnership with Dr. Anil Adisesh, the director of the occupational medicine division at the University of Toronto. The two-year pilot initiative, housed administratively at IWH, will launch September 2021. An assessment of learning needs was conducted in the spring of 2021, and over the summer, the project team is developing the training curriculum and recruiting specialists to form the “hubs”. They will consist of professionals in occupational medicine/nursing/therapy, environmental health, occupational health and safety, disability management, mental health and occupational hygiene, as well as experts in Ontario’s workers’ compensation system—i.e. the Workplace Safety and Insurance Board (WSIB). Frontline family medicine practitioners—"the spokes”—will be recruited near the end of summer.
Occupational medicine is a lot like chronic pain in that it can involve very complex situations. Treating patients with work-related injuries and illnesses can be time-consuming. And in family medicine, you don’t learn a lot about how to manage the more complicated cases, says Furlan.
Furlan and Adisesh point to research, conducted at IWH and elsewhere, that shows frontline health-care practitioners play a key role in supporting injured or ill workers in returning to work. But doctors and other frontline health professionals aren’t always familiar with how to communicate with workplaces about adjustments or work modifications, how to take a work history to determine whether an injury or illness is work-related, or how to communicate with workers’ compensation systems about medical diagnoses or recovery expectations. Research has also shone a light on the potential for mistrust and miscommunication across the different professions involved in return to work—whether that’s between disability managers and health-care providers or even among health-care providers of different disciplines.
These types of issues can really challenge our competence, and it’s not always easy for frontline providers to turn to a colleague for answers, says Furlan.
In this two-year pilot project, Furlan and Adisesh will run two 12-week cycles, each comprising up to 100 health-care practitioners with an injured or ill worker in their case load. Practitioners can include physicians, physician assistants, nurse practitioners, registered nurses, pharmacists, psychologists, social workers, chiropractors, registered massage therapists, physical and occupational therapists—whether in a team or solo practice. Participants will meet via videoconferencing once a week for 90 minutes.
Each session will consist of a training component and a case discussion component. Participation in the first 12-week cycle is limited to practitioners who have a patient with an active WSIB claim. Depending on the success of the first cycle, eligibility criteria may be expanded for the second cycle to include practitioners treating anyone whose return to work is not going as planned, whether the injury or health condition is work-related or not. The pilot project will also consist of a research component focused on evaluating the effectiveness of this model for building competencies in the field.
With months still to go before the program is launched, Furlan has already seen signs of enthusiasm for it. She was approached by a practitioner in Nunavut, who learned of the program when the needs assessment survey went out and wanted to take part. For now, the program remains restricted to professionals serving injured workers in Ontario, but the response indicates to Furlan how pent-up the need is for such a program.
For more about the project, see the project page. A website dedicated to this project will go up this summer.