VA Center for Integrated Healthcare, New York 14215, USA.
Pain Med. 2013 Jul;14(7):1021-31. doi: 10.1111/pme.12126. Epub 2013 Apr 24.
Patients with chronic pain have been shown to be more frequent utilizers of primary care, a contributor to increased health care costs. This study aimed to clarify which patient factors predict primary care utilization among veterans with chronic pain.
Data were gathered from the electronic medical records of veterans who used Veterans Affairs primary care services from 2003 to 2009 in upstate New York. Chronic pain cases (N = 792) were those veterans diagnosed with a musculoskeletal condition of the hip, knee, or lower back during two or more primary care encounters over a period ≥ 3 months. Cases were frequency matched by age to controls, or those veterans who did not have a chronic musculoskeletal condition of the hip, knee, or lower back. Demographic information, medical and psychiatric diagnoses, medication use, and other health-related factors were used in regression models to predict primary care utilization.
Cases consistently accrued more primary care encounters than controls during each year of the observation period. Cases also accrued more encounters from specialty medicine clinics, chronic pain clinics, and behavioral health clinics co-located in primary care. The contribution of mental health factors to care utilization differed by case-control status. Diagnosis of depression and substance use disorders were predictors of care utilization only among controls, whereas anxiety disorders, use of anxiolytics, and adjustment disorders were predictors only among cases. Cases with a co-occurring anxiety disorder had a greater than twofold increased risk (odds ratio = 2.36, 95% confidence interval = 1.32-4.22) of being in the top 10% of the distribution of total primary care utilization.
Mental health conditions that commonly co-occur with chronic musculoskeletal pain contribute to greater health care utilization. Improved screening and early intervention for these disorders in primary care may improve patient outcomes and stem high rates of care utilization of veterans.
患有慢性疼痛的患者被发现更频繁地使用初级保健，这是导致医疗保健费用增加的一个因素。本研究旨在明确哪些患者因素可预测慢性疼痛退伍军人对初级保健的利用。
数据来自 2003 年至 2009 年期间在纽约州北部使用退伍军人事务部初级保健服务的退伍军人的电子病历。慢性疼痛病例（N=792）是指在≥3 个月的时间内，在两次或两次以上的初级保健就诊中被诊断出患有髋关节、膝关节或下背部肌肉骨骼疾病的退伍军人。通过年龄对病例进行频数匹配，以找到对照组，即那些没有髋关节、膝关节或下背部慢性肌肉骨骼疾病的退伍军人。回归模型中使用了人口统计学信息、医疗和精神科诊断、药物使用和其他与健康相关的因素，以预测初级保健的利用。
在观察期的每一年中，病例累积的初级保健就诊次数始终多于对照组。病例还从位于初级保健的专科医学诊所、慢性疼痛诊所和行为健康诊所累积了更多的就诊次数。心理健康因素对护理利用的贡献因病例对照状态而异。抑郁和物质使用障碍的诊断仅在对照组中是护理利用的预测因素，而焦虑障碍、使用抗焦虑药物和适应障碍仅在病例中是预测因素。同时患有焦虑障碍的病例，其在总初级保健利用分布的前 10%中所占的比例增加了两倍多（优势比=2.36，95%置信区间=1.32-4.22）。
与慢性肌肉骨骼疼痛常同时发生的精神健康状况会导致更高的医疗保健利用率。在初级保健中改进这些疾病的筛查和早期干预，可能会改善患者的预后并遏制退伍军人高利用率的医疗服务。
