Pain severity and healthcare resource utilization in patients with osteoarthritis in the United States

Abstract

Objective: To evaluate healthcare resource utilization (HCRU) by osteoarthritis (OA) pain severity. Methods: Cross-sectional surveys of US physicians and their patients were conducted between February and May 2017. Using the Numeric Rating Scale, patients were classified by self-reported pain intensity in the last week into mild (0-3), moderate (4-6), and severe (7-10) cohorts. Parameters assessed included clinical characteristics, HCRU, and current caregiver support. Descriptive statistics were obtained, and analysis of variance and chi-square tests were performed. Results: Patients (n = 841) were mostly female (60.9%) and white (77.8%), with mean age of 64.6 years. Patients reported mild (45.4%), moderate (35.9%), and severe (18.7%) OA pain. Mean number of affected joints varied by pain severity (range mild: 2.7 to severe: 3.6; p < 0.0001). Pain severity was associated with an increased number of physician-reported and patient-reported overall healthcare provider visits (HCPs; both p < 0.001). As pain increased, patients reported an increased need for mobility aids, accessibility modifications to homes, and help with daily activities due to functional disability. The number of imaging tests used to diagnose OA was similar across pain severity but varied when used for monitoring (X-rays: p < 0.0001; computerized tomography scans: p < 0.0447). Hospitalization rates for OA were low but were significantly associated with pain severity (mild: 4.9%; severe: 11.5%). Emergency department visits were infrequent but increasing pain severity was associated with more prior and planned surgeries. Conclusion: Greater current pain was associated with more prior HCRU including imaging for monitoring progression, HCP visits including more specialty care, hospitalizations, surgery/planned surgery, and loss of independence due to functional disability. Yet rates of hospitalizations and X-ray use were still sizable even among patients with mild pain. These cross-sectional findings warrant longitudinal assessment to further elucidate the impact of pain on HCRU.

Moderate to Severe Osteoarthritis Pain and Its Impact on Patients in the United States: A National Survey

“…While moderate-to-severe OA pain respondents were significantly more likely to be female and of working age (<65 years), they were also less likely to be employed and have an income ≥$75,000. These trends in employment and income were reported in both Zhao et al 19 and Nalamachu et al 25 Similarly, the significantly greater prevalence of clinical comorbidities in moderate-to-severe respondents is consistent with those two studies; however, depression and insomnia were 2- to 4-fold greater, respectively, in the mild OA pain cohort in our study. Although these differences likely reflect the mild cohort definition, they may also be due to use of self-report in the current study relative to diagnostic coding in administrative claims or a physician-reported diagnosis in the medical chart at the time of the visit for OA.…”

“…Significantly greater HCRU across all categories in the prior 6 months was observed in moderate-to-severe OA respondents compared with mild OA. While similar trends in resource utilization were generally observed in the other studies, 19 , 22 , 25 heterogeneity in measurement and definitions precludes meaningful comparisons.…”

“…Similarly, obesity (BMI≥30) appeared to be more prevalent in the moderate-to-severe pain respondents, consistent with 3 of the other pain severity studies. 19 , 21 , 24 , 25 …”

Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain – A Population-Based Cohort Study

“…Several factors are associated with high levels of healthcare utilization due to pain. 7,15 These include older age, 7,15,16 low socioeconomic status, 7,16 marital status (people never married seek healthcare less often than those married) 17 and being female, 7,15,18 high pain intensity, [18][19][20] high level of disability, 18,19,21 number of pain sites, 21 comorbidity, 16 body mass index (BMI), poor general health, 15,16,22 negative health beliefs (health anxiety, catastrophizing, fear avoidance), 15,22,23 being retired or unemployed, 8 and previous healthcare use. 22,24 Personality has also been suggested as an important factor in the development of pain and coping strategies -including healthcare-seeking.…”

Real-world assessment of “OFF” episode–related healthcare resource utilization among patients with Parkinson’s disease in the United States

“…Throughout the literature, the DSP methodology has been used to assess the relationships between diseases and/or symptoms of disease with HCRU [33][34][35] ; nonetheless, there are some limitations to this specific study that should be highlighted. As PRFs were completed by neurologists for the next 10 to 12 consecutively consulting patients with PD, the sample collected was pseudo-random, rather than a truly random sample.…”