Andrea Furlan
​Dr. Andrea Furlan, a leader in chronic pain treatment and a physician at Toronto Rehab, at the computer where she hosts virtual sessions of the ECHO Ontario Chronic Pain and Opioid Stewardship program. (Photo: UHN)

In 2014, Dr. Andrea Furlan, a physician at Toronto Rehab and a leader in chronic pain treatment, had a vision: to bring together a group of experts who could equip health care professionals in the community with the knowledge they'd need to provide proper pain treatment.

"With one in five Canadians experiencing chronic pain, we have a responsibility to ensure we're providing the most effective treatments," says Dr. Furlan, a Senior Scientist at UHN's KITE Research Institute. "Without this, we risk contributing to the growing opioid crisis and the inappropriate prescription and use of medication."

Fast forward nearly a decade and Dr. Furlan's vision has grown into an award-winning collaboration that represents a sustainable solution for effective chronic pain treatment – and a host of other medical conditions – across Ontario and throughout Canada.

That collaboration is called Project ECHO, a guided practice model with the goal of increasing workforce capacity to provide best-practice specialty care and reduce health disparities. This works by linking interprofessional "hubs" of experts with health care providers in the community via weekly videoconferencing sessions.

The ECHO concept originated in the United States. Dr. Furlan was the first to bring it to Canada.

There are now 32 ECHO programs across Canada focusing on different areas of medicine. Each program is run through large health care organizations, with provinces picking up most of the funding. The Ontario Ministry of Health and Long-Term Care is the major funder here.

UHN currently has four ECHO programs, including Dr. Furlan's ECHO Ontario Chronic Pain and Opioid Stewardship.

And, the ECHO program led by Dr. Furlan is being recognized by The College of Family Physicians of Canada (CFPC), which recently gave it the 2023 CFPC Continuing Professional Development Award for its continual success and impact.

"We are honoured to be recognized through this prestigious award and to continue to make an impact in the health care system," Dr. Furlan says.

Some Members of the Interprofessional "Hub" Team for the ECHO Ontario Chronic Pain and Opioid Stewardship program at Toronto Rehab. (Photo: UHN)

Cultivating a community of professional support

What makes ECHO unique is that it allows the participants to bring forward their own de-identified patient cases for discussion.

After the participant presents their case, the hub will make their suggestions and then open the floor for discussion. A list of recommendations is also sent to the case presenter after the session.

With this model, Dr. Furlan says everyone has the opportunity to learn while also providing participants with specialist and community input to gain practical tips on how to best care for their patient.

"The ECHO model helps participants build a network of professionals to work with, even after the program is over," she says. "This is particularly valuable to members from rural communities who have less professionals in their area to receive input from."

Last month, Dr. Furlan and colleagues with Saskatchewan Health Sciences Research were awarded $2 million from the Canadian Institutes of Health Research to evaluate the impact of Project ECHO on the delivery of chronic care, which was part of a federal government announcement on integrated care.

Dr. Aileen Comerton, a retired family physician who was in practice for 40 years, participated in the ECHO program three years ago and now sits on the hub as an advisor.

"It's wonderful to have the opportunity to present," Dr. Comerton says. "The reality of medicine is that there's no one person that can manage everything.

"We all need many minds to help us and this is an opportunity to get that, all in one place."

Dr. Furlan says the ECHO program is just the start to finding more sustainable ways to provide chronic pain treatment.

"We know there are situations where opioids need to be prescribed, but we need to minimize the doses and suggest different solutions," she says. "This can overall limit the risks of dependency on this medication."

Toronto Rehab is dedicated to providing seamless rehabilitation experiences long after patients leave the hospital, including therapy groups and exercise programs.

"It's important for health care professionals to work with the government and with patients to look beyond quick fixes like prescribing medication," Dr. Furlan says. "Our ECHO program teaches participants these skills."

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