Dobalian Aram, Tsao Jennie C I, Duncan R Paul
Department of Health Services Administration College of Health Professions, University of Florida, Gainesville, Florida 32610-0195, USA.
Med Care. 2004 Feb;42(2):129-38. doi: 10.1097/01.mlr.0000108744.45327.d4.
The negative impact of pain on health-related quality of life has been documented for persons with human immunodeficiency virus (HIV). Furthermore, pain could be an important factor in seeking medical care. However, the relationship between pain and health service utilization is poorly understood.
The objective of this study was to investigate the effect of pain on use of outpatient services among a nationally representative sample of adults receiving medical care for HIV using Andersen's Behavioral Model of Health Services Use.
We used Poisson regression to assess outpatient use over 6 months among 2267 respondents in the HIV Cost and Services Utilization Study. Key predisposing variables include gender and race/ethnicity. Enabling factors include income and insurance. Need factors include pain, CD4 count, and diagnosis of acquired immunodeficiency syndrome (AIDS).
Sixty-seven percent of respondents reported experiencing pain during the previous 4 weeks. Self-reported pain was higher among those with AIDS, intravenous drug-using females, the unemployed, and those without a baccalaureate degree, but lower among blacks. Patients reporting more pain and those developing more pain used more outpatient services. Poorer health (CD4 count <50 cells/mm3, less energy) was also associated with higher use. Persons with Medicare, Medicaid, or private insurance were more likely to have used outpatient services than the uninsured. Persons with a private HMO were no more likely to use services than those without insurance.
Improved pain management could reduce outpatient use for persons experiencing pain and lead to substantial cost savings. Inequalities in outpatient use related to insurance are evident.
已有文献记载疼痛对人类免疫缺陷病毒（HIV）感染者的健康相关生活质量有负面影响。此外，疼痛可能是寻求医疗护理的一个重要因素。然而，疼痛与医疗服务利用之间的关系却鲜为人知。
本研究的目的是使用安德森医疗服务利用行为模型，调查疼痛对全国具有代表性的接受HIV医疗护理的成年样本中门诊服务利用情况的影响。
我们使用泊松回归来评估HIV成本与服务利用研究中2267名受访者在6个月内的门诊服务利用情况。主要的易患因素包括性别和种族/民族。促成因素包括收入和保险。需求因素包括疼痛、CD4细胞计数和获得性免疫缺陷综合征（AIDS）诊断。
67%的受访者报告在过去4周内经历过疼痛。艾滋病患者、静脉吸毒女性、失业者以及没有学士学位的人自我报告的疼痛程度较高，但黑人的疼痛程度较低。报告疼痛较多和疼痛加剧的患者使用的门诊服务更多。健康状况较差（CD4细胞计数<50个/mm3，精力不足）也与较高的门诊服务利用率相关。拥有医疗保险、医疗补助或私人保险的人比未参保者更有可能使用门诊服务。拥有私人健康维护组织（HMO）保险的人与未参保者相比，使用门诊服务的可能性并无增加。
改善疼痛管理可以减少疼痛患者的门诊服务利用，并大幅节省成本。与保险相关的门诊服务利用不平等现象明显。
