Physician‐to‐Physician Telephone Consultations for Chronic Pain Patients: A Pragmatic Randomized Trial

Abstract

Primary care physicians have reported a lack of confidence in managing pain, yet it is the topic of one-third of primary care visits. Telephone consultations between pain specialists and primary care physicians may have a significant impact on the care of patients experiencing chronic pain. The authors of this study evaluated this impact using a pragmatic, experimental design to evaluate whether this technique led to benefits for patients compared with wait-list controls.

A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain

“…Eighteen articles focused exclusively on physicians’ perceptions, 15 , 24 , 42–46 , 48 , 50 , 51 , 53 , 54 , 56 , 59 , 61 , 64–66 and one article focused exclusively on nurse practitioners’ perspectives. 47 The remaining articles discussed perspectives of family physicians, while also including nurse practitioners 20 , 41 , 60 , 62 , 63 and allied health care workers including physician assistants, 20 , 41 , 60 nurses, 16 , 20 , 22 , 41 , 54 , 60 pharmacists, 16 , 20 , 41 , 49 , 58 , 60 dentists, 58 social workers, 20 , 41 , 60 physiotherapists, 16 , 20 , 41 , 60 occupational therapists, 20 , 41 , 60 psychologists, 16 , 41 chiropractors, 41 kinesiologists, 41 and dietitians. 41 The PCPs in the studies ranged from recently graduated physicians and NPs to those with up to 49 years of experience.…”

“… 41 Most geographical regions of Canada were represented, with nine studies surveying physicians all across Canada 17 , 24 , 42 , 44 , 51 , 59 ; other studies included participants from specific provinces: Newfoundland and Labrador, 64 Nova Scotia, 16 , 46 British Columbia, 53 Alberta, 65 Saskatchewan, 62 Quebec, 16 , 49 , 56 , 61 and Ontario. 15 , 20 , 41 , 43 , 45 , 47 , 48 , 50 , 52 , 54 , 57 , 60 , 63 , 66 …”

“…Models cited as successful in addressing some gaps of care included Project ECHO interactive tele-mentoring, 49 , 53 , 56 interprofessional education workshops, 49 , 53 , 56 online learning modules, 59 teleconsultations/electronic consultations, 63 , 65 , 66 and streamlining referral pathways with clear tiered approaches to accessing tertiary pain care, such as Quebec’s Pain Centers of Expertise.…”

“…Alternative means of knowledge transfer was noted in three studies examining telephone consultations or electronic consultations (e-consults) for specific patients whom PCPs had referred to tertiary pain centers. 63 , 65 , 66 The study that incorporated a randomized control design comparing telephone consultations and usual care found no significant differences in patient outcomes, but PCPs reported satisfaction with the timely feedback on cases and found value in this means of knowledge transfer. 65 In another study, e-consults were found to be beneficial in suggesting a new or additional course of action in 74% of cases, with a median response time of 1.9 days, demonstrating a means with which pain clinics may have improved waitlists and PCPs receive timely feedback.…”

“… 65 In another study, e-consults were found to be beneficial in suggesting a new or additional course of action in 74% of cases, with a median response time of 1.9 days, demonstrating a means with which pain clinics may have improved waitlists and PCPs receive timely feedback. 63 In a subsequent quality initiative examining e-consults, patients selected from the tertiary pain center waitlists that were appropriate for e-consults (i.e., did not request interventions, did not involve cancer cases or complex regional pain syndrome, or did not require physical examination) were offered e-consults. 66 Twenty-six percent of PCPs indicated that they were interested in this service, and 39% of PCP referrals were found by pain specialists to have questions that could at least be partially be managed by e-consults, demonstrating a practical means with a potential to reduce waitlists.…”