title: Pain and the use of outpatient services among persons with HIV: results from a nationally representative survey.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Services Administration College of Health Professions, University of Florida, Gainesville, Florida 32610-0195, USA.
authors.forename: Aram
authors.initials: A
authors.lastname: Dobalian
authors.forename: Jennie C I
authors.initials: JC
authors.lastname: Tsao
authors.forename: R Paul
authors.initials: RP
authors.lastname: Duncan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement / Q000706:statistics & numerical data; D016012:Poisson Distribution; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States; D014600:Utilization Review