Individuals with co-occurring mental health and substance use disorders (i.e., concurrent disorders [CDs]) often experience poorer physical health, greater psychological distress, and less-than-optimal health care than do people with a single disorder. In Canada, primary healthcare professionals manage most people experiencing CDs with limited training and resources to do so, and this situation is further exacerbated in remote areas. The Extension for Community Healthcare Outcomes (ECHO®) Model is an innovative educational intervention based on social learning theory that uses videoconference technology to share evidence-based practice and support healthcare professionals as they manage complex and chronic health conditions. Our objective was to evaluate the impact of an ECHO program for CD management (ECHO-CD) on healthcare professionals’ outcomes in the province of Quebec, Canada.
ECHO-CD was implemented in 2018, and it involves pairing a team of expert from an academic tertiary health center with other healthcare professionals across the province in bi-weekly 1.5-hour videoconference sessions over a 10-month period curriculum. An observational prospective cohort study design was employed, and data was collected over a 12-month period using repeated online surveys. All healthcare professionals who registered for ECHO-CD between 2018 and 2020 were invited to participate in the study (N=332). The primary outcome was self-efficacy in CD management, and secondary outcomes included knowledge about CDs, attitude towards CDs, as well as satisfaction with and acceptability of the program. Sociodemographic variables and practice characteristics were also collected at baseline.
174 healthcare professionals participated in this study (85.6% female gender), with a mean age of 39.8 years (SD=10.1). The most frequently reported profession was social worker (25.9%), followed by psychologist (21.3%), and nurse (16.1%), and slightly over half (55.2%) of the sample had over 10 years of clinical experience. The majority of participants worked in primary care settings (55.2%), including primary mental healthcare services and community-based addiction treatments. Participants were highly satisfied with the program’s educational material, and most of them appreciated the technology, including its ease of use and flexibility. Compared to baseline, participants (n=90) showed significant improvement in self-efficacy, knowledge and attitude scores, with respective effect sizes of change of 0.20, 0.56 and -0.34 at 6-month post-ECHO, and 0.33, 0.87 and -0.70 at 12-month follow-up.
ECHO-CDs appears to be a promising knowledge translation tool to build capacity among healthcare professionals in the management of CDs. Further research is needed to formally assess the longitudinal impact of ECHO on practice-level outcomes and patients’ health status.Gabrielle Chicoine slides