初级保健中疼痛筛查和功能评估结果与新诊断的疼痛及疼痛治疗有关联吗？一项观察性研究。

Are Pain Screening and Functional Assessment Results Associated with New Diagnoses and Treatment for Pain in Primary Care? An Observational Study.

作者信息

Hudson Scholle Sarah, Nguyen-Louie Tam T, Bifulco Lauren, Blaz Jacquelyn W, Blankson Mary L, Channamsetty Veena, Anderson Daren R

机构信息

National Committee for Quality Assurance, Washington, DC, USA.

Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA.

出版信息

J Pain Res. 2022 Aug 5;15:2249-2261. doi: 10.2147/JPR.S367480. eCollection 2022.

DOI:10.2147/JPR.S367480

PMID:35957962

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9362509/

Abstract

PURPOSE

To determine if pain screening and functional assessment results are associated with new diagnoses and treatment for pain in primary care.

PATIENTS AND METHODS

Observational study at 13 primary care sites of a statewide federally qualified health center that implemented routine screening and functional assessment for all adults in primary care. The study group included 10,091 adults aged 18+ who had an in-person visit between July 2, 2018, and June 1, 2019, where they screened positive for chronic pain and completed a 3-question functional assessment with the PEG (Pain, Enjoyment of Life, General Activity). Multivariate logistic regressions quantified associations between pain frequency, diagnosis and treatment, sociodemographics, comorbidities, and self-reported severe pain impairment with pain diagnoses and treatment documented after screening.

RESULTS

Patients were mostly women (60.3%), Latinx (41.1%), English-speaking (80.1%), and Medicaid-insured (62.0%); they averaged 49.1 years old (SD = 13.7 years). Patients with severe pain impairment or who were Latinx were more likely to get a newly documented pain diagnosis (absolute risk difference [ARD]: 13.2% and 8.6%, ps < 0.0001), while patients with mental health/substance use or medical comorbidities were less likely (ARDs: -20.0% to -6.2%, ps < 0.001). Factors most consistently associated with treatment were prior treatment of the same modality (4 of 7 treatments, ARDs = 27.3% to 44.1%, ps <0.0001), new pain diagnosis (5 of 7, ARDs = 3.2% to 27.4%, ps <0.001), and severe impairment (4 of 7, ARDs = 2.6% to 6.5%, ps < 0.0001). A new diagnosis had the strongest association with non-opioid pain analgesics and physical medicine (ARD = 27.0% and 27.4%, p < 0.0001). Latinx patients were less likely to receive opioid analgesics and mental health/substance use medications and counseling (ARDs = -3.3% to 7.5%, ps <0.0001).

CONCLUSION

Screening and assessment with patient-reported tools may influence pain care. Care for Latinx patients differed from non-Latinx white patients.

摘要

目的

确定疼痛筛查和功能评估结果是否与初级保健中疼痛的新诊断及治疗相关。

患者与方法

在全州范围内一家符合联邦资格的健康中心的13个初级保健站点进行观察性研究，该中心对初级保健中的所有成年人实施常规筛查和功能评估。研究组包括10091名18岁及以上的成年人，他们在2018年7月2日至2019年6月1日期间进行了面对面就诊，慢性疼痛筛查呈阳性，并使用PEG（疼痛、生活乐趣、一般活动）完成了一个包含3个问题的功能评估。多因素逻辑回归分析量化了疼痛频率、诊断与治疗、社会人口统计学、合并症以及自我报告的严重疼痛损害与筛查后记录的疼痛诊断及治疗之间的关联。

结果

患者大多为女性（60.3%）、拉丁裔（41.1%）、说英语（80.1%）且参加医疗补助保险（62.0%）；平均年龄49.1岁（标准差=13.7岁）。有严重疼痛损害的患者或拉丁裔患者更有可能获得新记录的疼痛诊断（绝对风险差异[ARD]：13.2%和8.6%，p值<0.0001），而有心理健康/物质使用问题或医疗合并症的患者可能性较小（ARD：-20.0%至-6.2%，p值<0.001）。与治疗最一致相关的因素是相同方式的既往治疗（7种治疗中的4种，ARD=27.3%至44.1%，p值<0.0001）、新的疼痛诊断（7种中的5种，ARD=3.2%至27.4%，p值<0.001）以及严重损害（7种中的4种，ARD=2.6%至6.5%，p值<0.0001）。新诊断与非阿片类镇痛药物和物理治疗的关联最强（ARD=27.0%和27.4%，p<0.0001）。拉丁裔患者接受阿片类镇痛药物、心理健康/物质使用药物及咨询的可能性较小（ARD=-3.3%至7.5%，p值<0.0001）。