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Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e3182851584
Original Articles

The Primary Practice Physician Program for Chronic Pain (© 4PCP): Outcomes of a Primary Physician—Pain Specialist Collaboration for Community-based Training and Support

Chelimsky, Thomas C. MD*; Fischer, Robert L. PhD; Levin, Jennifer B. PhD; Cheren, Mark I. EdD§; Marsh, Sybil K. MD; Janata, Jeffrey W. PhD

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Objectives: One in 3 patients sees a primary care physician (PCP) for chronic pain yet most PCPs receive no training in this field. We evaluated the impact of 4PCP (© Primary Practice Physician Program for Chronic Pain) comprising of a specialist-PCP training collaboration integrated with clinical support.

Methods: This prospective, controlled pilot study randomly assigned 31 physicians to receive a training program either immediately or after a 1-year control period. 4PCP includes: (1) an active learning arm, providing patient-focused, practice-based learning collaboration emphasizing the biopsychosocial pain model; (2) a PCP-led clinical support arm facilitating rehabilitative matrix style care by teams of pain-informed health providers. Main outcome measures included a 19-item chronic pain physician perspectives questionnaire, physician engagement through continuing medical education hours earned, and an array of established measures of patient pain and function.

Results: PCPs receiving the intervention reported improvements in diagnosing and managing chronic pain (P=0.023), especially its functional consequences (P=0.008), in treatment satisfaction, and in involving other disciplines. Mean visit time dropped from 20 to 11 minutes (P<0.03) with improved patient outcomes, which correlated with 4PCP physician engagement. Significant benefit began at 10 continuing medical education hours and proved durable 1 year after trial.

Discussion: This pilot study demonstrates successful interdisciplinary chronic pain management by PCPs with durability of training effect, improved patient outcomes, visit efficiency, and job satisfaction. 4PCP provides a promising framework to propel the national concept of PCP-specialist collaboration for chronic pain management.

© 2013 by Lippincott Williams & Wilkins

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