An echo across the North

Dr. Bryan MacLeod has seen first hand how the shortage of doctors in Northern Ontario effects both patients and clinicians in the region.

That’s why when he heard the Ministry of Health and Long-term Care was looking to establish an ECHO Hub focused on chronic pain in Ontario, he knew he wanted to be a part of it.

“Chronic pain is such a common and debilitating condition, and there’s very few specialists or experts, so this is one way of providing care that hasn’t traditionally been available in rural communities,” says MacLeod, Medical Director of the Chronic Pain Management Program at St. Joseph’s Care Group in Thunder Bay and Associate Professor at the Northern Ontario School of Medicine (NOSM).

Project ECHO, which stands for Extension for Community Health Outcomes, uses a “hub and spoke” model. The ECHO SJCG Chronic Pain & Opioid Stewardship Hub connects primary care sites in Northern Ontario and across the province (the “spokes”) to chronic pain specialists at St. Joseph’s Care Group and the Ottawa Hospital (the “hub”) via teleconferencing. In weekly sessions, members bring forward patient cases that the group then reviews together. There is also time built in for teaching on topics relevant to chronic pain and opioid stewardship. Participants come from communities across the province with a focus on Northern Ontario, and include a range of health professions including physicians, nurses, physiotherapists, occupational therapists, social workers and more. They work in a number of different primary care settings, and bring learnings from ECHO back to their teams.

“Our pain management team at St. Joseph’s is a highly interprofessional primary care environment,” says MacLeod. “In smaller communities, people might not have access to a dietitian who specializes in pain-related issues. So this is a way we can share that expertise with a wider group of clinicians, and in turn a wider group of patients.”

ECHO also allows for relationship building, breaking down the professional isolation that often affects clinicians in the North, says Katrina Radassao, a physiotherapist at Nipigon District Memorial Hospital.

“Being a new grad in a small, rural hospital, it’s great to have that sense of community,” she says. “When you have a difficult case, it’s so valuable to have this ‘expert panel’ who all have different opinions and backgrounds, and can support you in making sure your patient gets the care they need.”

MacLeod and his co-chairs are also working to expand the hub’s offerings beyond participation in the weekly ECHO sessions, including hosting a series of NOSM-accredited evening sessions on opioid management for doctors, nurse practitioners and other opioid prescribers in the region.