Family physician Thushiyanthy Sriharan runs a two-doctor practice in the suburbs of Toronto. Her caseload of about 2,000 patients means work-related matters—for example, sickness absences—comes across her desk about two or three times a month. Most of the cases are straightforward, but she is sometimes challenged with more complex issues. Often, when a specialist’s care is needed, the wait times can run up to six or eight months, and Sriharan has to help her patients manage during those long waits.
Such were her challenges that, when Sriharan heard of the Institute for Work & Health (IWH)’s ECHO Occupational and Environmental Medicine (OEM) program for Ontario health-care providers, she didn’t hesitate to sign up. “Even WSIB [Workplace Safety and Insurance Board] forms make me feel anxious, so I thought, ‘Why not. Let’s see what extra help I can get.’ My hope was I would make new connections and gain new knowledge,” says Sriharan.
ECHO, short for Extension for Community Health Outcomes, is designed to help health-care providers do just that. Developed by Dr. Sanjeev Arora in 2003 at the University of New Mexico, the ECHO model uses a hub-and-spoke approach to knowledge exchange and building health-care capacity—especially in rural and remote regions. In virtual meetings held once a week, primary health-care providers and expert specialist teams come together to share knowledge. During each session, a specialist (a "hub" member) gives a short didactic presentation on a topic and health-care providers (the “spokes”) present their most challenging cases for discussion and recommendations.
This model has been replicated in over a thousand ECHO projects worldwide. In Canada, the first such project was started up by Dr. Andrea Furlan, clinician and senior scientist at the University Health Network and an IWH scientist. The ECHO OEM project that Furlan developed at IWH and co-leads with Dr. Anil Adisesh is the first ECHO of its kind in the world.
In the first two ECHO OEM cycles, held in the fall of 2021 and spring of 2022, the types of cases that participants brought up ran the gamut. “We don't ask participants what to present. They bring the cases that are a burden to them,” says Furlan. “These could be about post-traumatic stress disorders, musculoskeletal disorders or environmental exposures. We had cases about mental health, concussions, vision loss and pregnancy. Participants brought cases where they didn't know what to do and they wanted the experts’ opinions. It's almost like getting a consultation for your patients who are kept anonymous.”
Indeed, a scoping review conducted by Furlan to support content development for ECHO OEM found a range of learning needs among primary care physicians. Some were related to specific knowledge gaps about work capacity assessments, environmental exposures, disclosure of information, or prognoses for low-back pain, concussion or cancer. Other learning needs were related to administrative tasks, physicians’ attitudes and beliefs, and awareness of services and tools in the workers’ compensation and disability management systems.
For Sriharan, the discussions and didactic presentations were crucial in helping her reassess her approach to a patient with complex needs—someone whose issues have often left Sriharan feeling like they were “beyond my capacity to deal with,” she said. Worried about privacy issues, Sriharan held back from discussing her patient as a case. But all the same, just by listening to the other cases that were discussed, Sriharan finished the 12 weekly sessions brimming with new ideas to try out.
“I learned that I hadn’t recognized some of the yellow flags. I hadn’t taken a deep enough work history and had missed a lot of information,” she says. “I now have a clear idea of the path forward with this patient. And as the patient’s primarily care physician, I feel like I’ve fulfilled my responsibility to find out what else can be done for her.”
It was not just general practitioners who found the ECHO OEM program useful. Dr. Carlan Stants, a chiropractic specialist with more than 30 years of experience, has taken part in several ECHO programs, starting with the ECHO on chronic pain, the one that Furlan introduced to Ontario.
Despite going in with a good knowledge about treating work-related injuries and navigating the workers’ compensation system, Stants said his involvement in the recent ECHO OEM session gave him greater understanding about environmental factors that contribute to work disability.
A past president of the Canadian Chiropractic Specialty College of Physical & Occupational Rehabilitation who continues to be involved in the college’s continuing education committee, Stants is recommending that ECHO OEM be one of the four ECHO programs that are integrated in the college’s post-graduate curriculum.
“What I like about ECHO is you’re essentially giving up one and a half hours a week for continuing education in a particular subject—and you don’t have to attend every session; you can pick and choose the sessions you want to attend, depending on the topic,” said Stants. “What you’re going to get in that short period of time is a didactic on a body of knowledge, and a chance to have an anonymized real patient case discussion. That’s really important.”
Like Stants, Debbie Corrigan is an established practitioner with more than 30 years of experience. She signed up for ECHO OEM partly to tap into a community of practice, and partly to seek out answers for new issues that emerge in her line of work.
“With every profession, you want to keep yourself fresh and current. I thought this program would help me connect with others in the field,” says Debbie Corrigan, a Sudbury, Ont.,-area occupational health nurse now providing disability management services to various employers across Canada, mostly in industrial settings.
An example of a new issue she has had to grapple with is related to the use of medication by workers to treat their addictions, says Corrigan. “We were getting employees coming to work with treatment modalities that would normally not be allowed in our industrial worksite,” she explains. “We had never experienced those types of issues before, and I needed a better understanding of what experts recommended.”
Corrigan presented her challenges as a case and received what she said was great feedback. “I was able to connect with other participants who had more experience on the issue,” she adds. “And this allowed me to go back to the employer and look at the processes and procedures—to look at their fitness-for-work requirements and make some policy changes.”
The learning she gained from ECHO OEM was so valuable that Corrigan signed up again for the second cycle. Even if the presentation topics are the same from cycle to another, the cases presented always offered new learning for her. “If it’s coming back a third time, I probably would participate again,” she says.
ECHO OEM is back for the third cycle in the fall of 2023, with weekly sessions beginning September 22. To register for ECHO OEM, go to: https://echooem.iwh.on.ca/.
Also being offered in the fall of 2023 is an ECHO Public Safety Personnel (PSP) program, aimed at Ontario care providers who treat or support firefighters, paramedics, police, corrections and communications personnel with mental injuries that affect their ability to work. To register for ECHO PSP, which starts weekly sessions on September 20, go to: https://echopsp.iwh.on.ca/.