title: Primary care utilization among veterans with chronic musculoskeletal pain: a retrospective chart review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: VA Center for Integrated Healthcare, New York 14215, USA. gregory.beehler@va.gov.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Beehler
authors.forename: Amy E
authors.initials: AE
authors.lastname: Rodrigues
authors.forename: Denise
authors.initials: D
authors.lastname: Mercurio-Riley
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Dunn
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015984:Causality; D059350:Chronic Pain / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D057286:Electronic Health Records; D005260:Female; D005544:Forecasting; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Chronic Pain; Comorbidity; Health Care Utilization; Mental Health; Musculoskeletal Diseases; Primary Health Care