Utilization of Health Care Services and Ambulatory Resources Associated with Chronic Noncancer Pain.
OBJECTIVE
Examine traditional and uncompensated health care utilization associated with chronic noncancer pain.


METHODS
Retrospective chart review.


METHODS
Tertiary academic medical center.


METHODS
Internal medicine patients on long-term opioids for chronic noncancer pain with or without a pain agreement between April 1, 2014, and April 1, 2015 (N = 834). Patients without pain served as controls (N = 782).


METHODS
Univariate statistics were used to compare health care utilization by the presence of chronic pain, pain agreement status, opioid dose, and schedule. Logistic regression was used to assess predictors of health care utilization, with emergency room visits, hospitalizations, and after-hour calls as binary outcomes and office visits and phone/e-mail contacts as ordinal outcomes.


RESULTS
Patients with chronic pain used significantly more health care resources compared with patients without pain (all P  < 0.001). Patients on a pain agreement had more telephone and secure messages than patients without an agreement ( P  = 0.002). Controlling for demographics and other factors, patients with chronic pain had 2.6 (95% confidence interval [CI] = 2.1-3.4) times the odds of an emergency room visit, 5.0 (95% CI = 3.6-7.0) times the odds of a hospitalization, and 2.3 (95% CI = 1.7-3.0) times the odds of an after hour call, compared with nonpain controls. Ordinal logistic regression yield adjusted common odds ratios of 3.4 (95% CI = 2.7-4.2) and 2.9 (95% CI = 2.3-3.6) for total clinic visits and telephone or secure messages, respectively, indicating higher utilization for chronic pain patients.


CONCLUSIONS
Patients with chronic noncancer pain utilized more traditional and uncompensated health care resources compared with patients without chronic pain.
Department of Medicine, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.|Center for Patient Care and Outcomes Research, Medical College of Wisconsin.|Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Cynthia
C
Kay
Center for Patient Care and Outcomes Research, Medical College of Wisconsin.
Erica
E
Wozniak
Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Joanne
J
Bernstein
D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000175:diagnosis* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies
D000701:Analgesics, Opioid
Health Care; Primary Care;  Chronic Pain