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

一种新的社区生物行为慢性疼痛的影响 关于从业者和患者结果的团队培训计划(4PCP) 摘要 尽管初级保健从业者(PCP)提供了第一条，有时也是唯一一条路线 对于慢性疼痛患者的治疗，调查显示他们通常对其 管理层。这可能反映了他们在教育准备方面的双重缺陷。首先，普通医疗人员 学校在慢性疼痛上花费了0到6个小时，而像国际疼痛协会这样的疼痛组织 疼痛研究(IASP)建议使用74小时。第二，医学培训主要面向 生物药理学框架。虽然药物可能有助于疼痛的伤害性成分，但焦虑或 对于抑郁症，它们几乎没有提供什么来解决慢性疼痛的核心情感、认知和行为根源。这 生物药理学思维，即一种药物可能“无所不能”，可能为今天的阿片类药物危机奠定了基础。 处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，它认为慢性疼痛 疼痛综合症是一种大脑疾病，多年来的负面认知、情感和行为习惯强化了这一现象。 需要通过身体和行为激活以及认知重建来进行再训练。然而，由于这一点 框架和技能对大多数PCP来说都是陌生的，他们仍然没有做好准备来管理整个慢性疾病 疼痛综合症。在4PCP(慢性疼痛初级医师计划)试点中，我们演示了 初级保健医生热切地学习这一新框架并将其应用到他们的实践中，增加了对 慢性疼痛管理，减少就诊次数，改善患者疼痛。这项研究并没有正式 解决阿片类药物，尽管医生自发地减少了阿片类药物。 我们现在提出两个新问题：(1)4PCP的传播准备就绪、完全编纂、密集版本 产生更好的结果，持续2年？(2)从业者会在以下方面找到新的信心和技能 作为一个团队管理疼痛和减少阿片类药物？在4个城市的27个诊所(每个诊所4名从业人员，共108名) (博兹曼，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。练习将与一名配对的心理学家和 PT打造一支临床团队。对于每个医生，我们将识别10名慢性疼痛患者，理想情况下是 阿片类药物(共1080个)对患者预后的影响。我们将在两年前和两年后衡量三种结果 培训干预：(1)患者的改善；(2)从业者对所提供护理的满意度的变化 与从业者的职业倦怠有关；(3)根据国家记录，纳入患者的阿片类药物处方的变化。

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.