*Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine †Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto ‡Centro Nacional de Observação em Dor (OBSERVDOR - Portuguese National Pain Observatory) §Department of Experimental Biology, Faculty of Medicine ∥Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal.
Med Care. 2013 Oct;51(10):859-69. doi: 10.1097/MLR.0b013e3182a53e4e.
Few studies have described patterns and determinants of health services utilization (HSU) in chronic pain (CP) subjects. We aimed to describe these, in particular, regarding medical consultations (MCs), diagnostic tests (DTs), pain medicines (PMs) and nonpharmacologic treatment methods (NTM) utilization.
A cross-sectional nationwide study was conducted in a representative sample of the Portuguese population. The 5094 participants were selected using random digit dialling and were contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population.
Prevalence of CP and CP with moderate to severe disability was 36.7% and 10.8%, respectively. Most CP subjects were being managed/treated by health professionals (81%) and had high levels of HSU. More than half of them had used imaging DT in the previous 6 months. Main factors associated with HSU were as follows: pain-related disability, intensity, duration, and depressive symptoms for MC utilization; sex, pain-related disability, and duration for PM utilization; and education level and depression diagnosis for NTM utilization.
The main drivers behind HSU are pain severity, psychological distress, and socio-economic determinants. An important set of benchmarks are presented regarding HSU in CP subjects, comprising useful tools for public health policy and decision-making. Results presented may suggest possible inequalities in the access to NTM, and interventions to improve access are encouraged. Moreover, possible indirect evidence of imaging DT overuse is presented, and it is recommended that their use in CP subjects should more closely follow existing guidelines.
很少有研究描述慢性疼痛（CP）患者的卫生服务利用（HSU）模式和决定因素。我们旨在描述这些模式和决定因素，特别是关于医疗咨询（MC）、诊断测试（DT）、止痛药物（PM）和非药物治疗方法（NTM）的利用。
本研究在葡萄牙代表性人群中进行了一项横断面全国性研究。使用随机数字拨号法选择了 5094 名参与者，并通过计算机辅助电话访谈与他们联系。问卷包括简短疼痛量表和疼痛残疾指数。对人口进行了适当加权的估计。
CP 和中重度残疾 CP 的患病率分别为 36.7%和 10.8%。大多数 CP 患者由卫生专业人员进行管理/治疗（81%），且 HSU 水平较高。超过一半的患者在过去 6 个月内使用了影像学 DT。HSU 的主要相关因素如下：MC 利用与疼痛相关的残疾、强度、持续时间和抑郁症状有关；PM 利用与性别、疼痛相关残疾和持续时间有关；NTM 利用与教育程度和抑郁诊断有关。
HSU 的主要驱动因素是疼痛严重程度、心理困扰和社会经济决定因素。本研究提供了一组关于 CP 患者 HSU 的重要基准，为公共卫生政策和决策提供了有用的工具。结果表明，在获得 NTM 方面可能存在不平等现象，鼓励采取干预措施以改善获取途径。此外，还提出了影像学 DT 过度使用的可能间接证据，建议 CP 患者应更严格地遵循现有指南使用这些 DT。
