Building Capacity in Integrated Care using a Collaborative Approach: Comprehensive Education for Healthcare Professionals on Digitally-Enabled Integrated Pain Management

Background: In Canada, chronic pain (CP) patients are mainly treated by primary care providers. However, the clinical management of CP is complicated by inadequate continuing interprofessional development across disciplines, with significant knowledge gaps in both pre- and post-licensure contexts. Pain education for health professionals is needed for improving and enabling prevention and treatment practices. Educational content also typically lacks integration of biological aspects with the psychosocial factors that contribute to the experience of pain. With the release of Canadian and provincial recommendations, there is an impetus to understand the knowledge gaps faced by primary care providers. The aim of this study is to elicit primary care providers’ views about enhancing knowledge of healthcare professionals in the assessment of pain management to provide effective CP care.

 

Approach: An explanatory sequential mixed-methods design was used to identify knowledge gaps and determine learning objectives for online learning modules to equip primary care providers in Quebec with the necessary competencies to manage adult chronic pain. Using a provincial database of primary care providers, we conducted a cross-sectional online survey (N-450) of continuing interprofessional development needs and perceived knowledge. Results from the survey were used to inform semi-structured focus-group interviews (3) conducted with a convenience sample primary care providers who had complete the survey (N=22) to determine preferred learning objectives.

 

Data were analyzed using content analysis and categorized in themes and subthemes. Results were shared independently with participants to verify the accuracy and relevancy of the data prior to knowledge dissemination.

 

 

Results: Survey respondents were primarily nurses (43%), physiotherapists (13%) and social workers (22%), university educated (90%), working in primary care clinics (92%). Most respondents (80%) had not received any form of training in the last 3 years, with over 50% self-identifying as beginners in the areas of neuroplasticity, assessment and treatment of pain, organization of service delivery, management of patient trajectories, and continuity and coordination of integrated care. Five themes and 14 subthemes focused on learning priorities emerged from the thematic analysis: whole-person care (assessment, pharmacological and nonpharmacological approaches, neuroplasticity); interdisciplinary integrated care (interdisciplinary care, provider roles, principles of integration, care coordination, care transitions, organization of care trajectories); digitally-enabled care; patients’ roles (shared decision-making, self-management); vulnerable populations (Immigrants, Indigenous people); and barriers to care.

 

Implications: Primary care providers shared their perspectives on knowledge gaps in managing CP including broader systemic priorities. Primary care providers require greater access to continuing interprofessional development to build knowledge and confidence in pain management and care delivery using patient-centred approaches. The next phase of the project is to co-design, with patients and primary care providers, asynchronous modules in interprofessional CP management that provide comprehensive knowledge aligned with best practices and learners’ needs. This collaborative approach will integrate an equity-based lens, ensuring modules are culturally responsive and inclusive. Finally, the notion of interdisciplinarity will be integrated across all modules to balance socialization within and across professional and organizational boundaries, enhance knowledge among different health professions and facilitate the implementation of gold-standard care, mainly team-based, integrated care and shared collaborative care.