Primary Care Nursing and Liver Management: A Qualitative Study from a Telemedicine Education Program (ECHO Ontario Liver)

CONTEXT: Nursing primary care providers (PCPs) are well-positioned to address central gaps in screening, linkage to care, and treatment of liver diseases within their teams. The Extension for Community Healthcare Outcomes (ECHO) Model™ is a telementoring education program that connects PC providers from underserved areas to an interprofessional specialist team. Each session includes a didactic lecture and a patient case presentation. ECHO Ontario Liver launched in 2017 with the goal of disseminating hepatology best practices appropriate for PC and improving PC providers’ knowledge and self-efficacy.

OBJECTIVE: This study aims to explore the impact of ECHO on nursing PCPs and their role in interprofessional liver care.

STUDY DESIGN: We conducted a qualitative study with nursing PCPs who attended ECHO sessions from 2017 to 2021. Focus groups were conducted virtually, recorded, and transcribed.

ANALYSIS: Transcripts were analyzed using thematic content analysis. Researchers met regularly to discuss themes until consensus was reached.

SETTING: Ontario, Canada

POPULATION STUDIED: Nursing professionals (nurse practitioners, NPs, registered nurses, RNs, and registered practical nurses, RPNs)

INTERVENTION: ECHO Ontario Liver

OUTCOME MEASURES: Focus group discussions explored PCPs’ experience in ECHO, their role in liver care management (interprofessional collaboration), and impact of ECHO on practice.

RESULTS: Three focus groups were conducted between November 2021 and January 2022. Six participants were NPs, four were RNs, and one was a RPN. Six (55%) providers practiced in rural communities. All were female. Nursing PCPs involved in different levels of liver management were interviewed. They played active management roles from coordinating appointments to providing wraparound patient services. ECHO allowed participants to access specialty knowledge and education they did not receive in their training. Though PCPs practiced on a team, these individuals become the point person on their team to attend ECHO, gaining advanced training in this disease area. Participants also used the ECHO patient case presentation and recommendations as a means of advocating for care on their clinical teams.

CONCLUSIONS: Nursing PCPs play a variety of roles within the management of liver disease on their clinical teams. ECHO Ontario Liver increased participants’ access to specialty liver knowledge and case presentations and recommendations were often used as a means of advocacy.