Achieving More Equitable Complex Concussion Management: Lessons from ECHO Concussion, a Telemedicine Education Program

CONTEXT: Concussions, a form of mild traumatic brain injury, are diagnosed in 150,000 Ontarians annually, resulting in disruptions to work, school, and sport. Concussion management is complex: addressing and correcting misinformation, variable onset of symptoms, urban/rural health service disparities, and the number of healthcare and non-healthcare professionals involved in case management. The ECHO (Extensions for Community Healthcare Outcomes) model provides an ideal platform for dissemination of existing best practice guidelines and standards of care in common, chronic, and complex conditions. ECHO Concussion aims to teach Primary Care Providers (PCPs) a comprehensive approach to concussion diagnosis and management across the continuum.

OBJECTIVE: To illustrate complex concussion management and how ECHO Concussion supports PCPs and patient management in Ontario, Canada.

METHODS: An in-depth case study of ECHO Concussion was performed through analysis of videoarchived weekly sessions and program implementation and evaluation documents. All documents were reviewed for content relating to complex concussion management and ECHO-generated support and recommendations. Thematic content analysis was conducted on all recorded sessions and program documents to deeper understanding and framework for concussion management. The study team discussed and reconciled discrepancies in themes until consensus was reached.

RESULTS: Successful program outcomes from the ECHO Concussion program include increased PCP self-efficacy, increased knowledge, and high participation satisfaction rates. Since ECHO sessions are interprofessional and PCPs participate from a variety of practice settings, they also gain insight and empathy regarding the roles and responsibility for concussion management among other professions, thus impacting the management of concussion in the community. Through the navigation and negotiation of information which is not always evidence-based, clinicians also observe how to tactfully address misinformation in the clinical setting.

CONCLUSION: Concussion management is complex for a number of reasons and a telemedicine education program like ECHO Concussion may be beneficial for frontline PCPs. Not only does ECHO Concussion foster interprofessional collaboration and address important concussion misinformation, ECHO sessions also foster a community of practice, a critical part in developing PCPs’ confidence in clinical management of complex conditions.