Impact of a Novel Community-Based Biobehavioral Chronic Pain Team Training Program (4PCP) on Practitioner and Patient Outcomes

基于社区的新型生物行为慢性疼痛团队培训计划 (4PCP) 对从业者和患者结果的影响

• 批准号: 10709558
• 负责人: Thomas C. Chelimsky
• 金额: $ 40万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709558
• 关键词: Impact; Novel; Community; Based; Biobehavioral

Impact of a Novel Community-Based Biobehavioral Chronic Pain Team Training Program (4PCP) on Practitioner and Patient Outcomes ABSTRACT Although primary care medical practitioners (PCPs) provide the first and sometimes only line of treatment for patients with chronic pain, surveys show they are generally not comfortable with its management. This may reflect a dual shortcoming in their educational preparation. First the average medical school spends 0 to 6 hours on chronic pain, when pain organizations like the International Association for the Study of Pain (IASP) suggest 74 hours. Second, medical training is primarily oriented towards a biopharmacologic framework. While drugs may help the nociceptive component of pain, and anxiety or depression, they offer little to address the core emotional, cognitive and behavioral roots of chronic pain. This biopharmacologic mindset, that a drug might “do it all”, may have set a stage for today's opioid crisis. Managing these deeper chronic pain issues requires a biopsychosocial framework, that views a chronic pain syndrome as a brain disorder, reinforced by years of negative cognitive, emotional and behavioral habits, requiring retraining through physical & behavioral activation, and cognitive restructuring. However, since this framework and skillset are foreign to most PCPs, they remain ill-prepared to manage the totality of a chronic pain syndrome. In the 4PCP (Primary Practice Physician Program for Chronic Pain) pilot, we demonstrated that PCPs eagerly learned and implemented this new framework into their practice, increasing confidence with chronic pain management, reducing visit times, and improving patient pain. That study did not formally address opioids, though physicians tapered opioids spontaneously. We now ask 2 new questions: (1) Will a dissemination-ready, fully codified, intensive version of 4PCP produce better outcomes, sustained for 2 years? (2) Will practitioners find new confidence and skills in managing pain as a team and taper opioids? In 27 practices (4 practitioners each, 108 total) in 4 cities (Bozeman, Cleveland, Madison, Milwaukee) we will teach the new curriculum, 3 practices at a time every 2 months over 18 months, using a stepped cluster design. Practices will co-train with a paired psychologist and PT to build a clinical team. For each practitioner, we will identify 10 patients with chronic pain, ideally on opioids (1080 total) for patient outcomes. We will measure 3 types of outcomes before and for 2 years after the training intervention: (1) patient improvement; (2) the change in practitioner satisfaction with care rendered and practitioner burnout; (3) the change in opioid prescribing in the enrolled patients based on state records.

一种新的基于社区的生物行为慢性疼痛的影响 关于从业者和患者结局的团队培训计划（4PCP） 摘要 虽然初级保健医生（PCP）提供第一线，有时也是唯一的一线， 对于慢性疼痛患者的治疗，调查显示，他们通常不舒服， 管理这可能反映了他们在教育准备方面的双重缺陷。首先，平均医疗 学校花0到6个小时在慢性疼痛上，当疼痛组织，如国际疼痛协会， 疼痛研究（IASP）建议74小时。第二，医疗培训主要面向 生物药理学框架。虽然药物可能有助于疼痛的伤害性成分，焦虑或 抑郁症，他们提供了一点解决慢性疼痛的核心情感，认知和行为根源。这 生物药理学的思维模式，即药物可能“做到这一切”，可能为今天的阿片类药物危机奠定了基础。 管理这些更深层次的慢性疼痛问题需要一个生物心理社会框架， 疼痛综合征是一种大脑疾病，由于多年的负面认知、情绪和行为习惯而强化， 需要通过身体和行为激活以及认知重建进行再训练。不过既然这 框架和技能对大多数PCP来说是陌生的，他们仍然没有准备好管理整个慢性疾病。 疼痛综合征在4PCP（慢性疼痛初级实践医生计划）试点中，我们证明了 PCP急切地学习并将这一新框架应用于实践， 慢性疼痛管理，减少就诊时间，改善患者疼痛。这项研究没有正式 解决阿片类药物问题，尽管医生会自发地逐渐减少阿片类药物。 我们现在提出两个新问题：（1）一个准备好传播的、完全编纂的、密集的4PCP版本 能持续两年产生更好的结果吗(2)从业者是否会找到新的信心和技能， 团队治疗疼痛逐渐减少阿片类药物在4个城市的27个诊所（每个诊所4名从业人员，共计108名） （波兹曼，克利夫兰，麦迪逊，密尔沃基）我们将教授新课程，每2次练习3次 18个月，使用阶梯式群集设计。实践将与配对的心理学家共同训练， 建立临床团队。对于每个医生，我们将确定10名慢性疼痛患者，理想情况下， 阿片类药物（共1080例）用于患者结局。我们将衡量之前和之后2年的3种结果 培训干预：（1）患者改善;（2）医生对所提供护理满意度的变化 和从业者倦怠;（3）根据州记录，入选患者中阿片类药物处方的变化。