Predictors for chronic pain‐related health care utilization: a cross‐sectional nationwide study in <scp>I</scp>celand

Jónsdóttir, Þorbjörg; Jónsdóttir, Helga; Líndal, Eiríkur; Óskarsson, Guðmundur Kristján; Gunnarsdóttir, Sigrún

doi:10.1111/hex.12245

Cited by 23 publications

(32 citation statements)

References 37 publications

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“…Table 1 presents the instruments and their psychometric properties. Questions about access and use of health care were adjusted from Jonsdottir et al 31 Instruments not available in Icelandic were translated from their original languages to Icelandic and then back translated. Moreover, in cooperation with the authors, discrepancies were clarified and the text was changed accordingly.…”

Section: Methodsmentioning

confidence: 99%

Self‐reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross‐sectional study

2018

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AimsThere are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio‐economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio‐economic factors were associated with patient‐reported outcome measures (PROMs).Methods and resultsIn this cross‐sectional survey, PROMs were measured with seven validated instruments, as follows: self‐care (the 12‐item European Heart Failure Self‐Care Behaviour scale), HF‐related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care—‘Patients' evaluation’), health status (EQ‐5D visual analogue scale), health‐related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status.The patients' (n = 124, mean age 73 ± 14.9, 69% male) self‐care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF‐specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients' sense of security was high (>70% had a mean score of 5 or 6, scale 1–6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ‐5D) on average at 65.5 (scale 0–100), and 33% had poor or very bad HRQoL. The monthly income per household was <€3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care‐related items, and >90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out‐of‐pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out‐of‐pocket expenses after the crisis, income, or whether patients lived alone or with others.ConclusionsThis Icelandic patient population reported similar health‐related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.

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Section: Methodsmentioning

confidence: 99%

Self‐reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross‐sectional study

2018

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“…50,51 In addition, men tend to postpone health care consultations for pain and mental disorders longer than women. 52,53 A low socioeconomic position was associated with prolonged concomitant BZDR and opioid use in persons with and without AD. Individuals with a higher education have a lower risk for developing AD 54 and on the other hand, low education has been associated with musculoskeletal conditions and pain which may explain the difference in drug use.…”

Section: Associated Factorsmentioning

confidence: 99%

Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

Karttunen

Taipale

Hamina

et al. 2018

Int J Geriat Psychiatry

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Objective The study aims to determine the prevalence of concomitant use of benzodiazepines and opioids among community‐dwelling older people with or without Alzheimer's disease (AD). An additional aim was to describe the factors associated with prolonged concomitant use, and the most commonly used combinations of these drugs. Methods This study utilized data from the register‐based Medication Use and Alzheimer's disease (MEDALZ) study, including all community‐dwelling residents of Finland who received a clinically verified AD diagnosis between 2005 and 2011 (n = 70 718) and their matched comparison persons without AD. After exclusion of individuals who were hospitalized throughout the follow‐up, 69 353 persons with and 69 353 without AD were included in this study. Results Benzodiazepines and related drugs (BZDRs) were used by 28 475 (41.1%) of those with and 24 506 (35.3%) of those without AD. Prolonged (greater than or equal to 90 days) concomitant use of BZDRs and opioids was more common among BZDR users without AD (N = 3936; 16.1%) than among those with AD (N = 2963; 10.4%). A shorter duration of concomitant use (1‐89 days) revealed similar results, N = 3821; 15.6% and N = 3008; 10.6%, respectively. Prolonged concomitant use of BZDRs and opioids was associated with female sex, low socioeconomic position, most of the common comorbidities and history of substance abuse or long‐term benzodiazepine use. The most commonly used combinations were Z‐drug (31.7%) or benzodiazepine (29.9%) with a weak opioid. Conclusions Despite the recommendations and risks, the prevalence of concomitant BZDR and opioid use was common in older persons with or without AD. It is important to develop strategies to reduce unnecessary concomitant use of these drugs.

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“…6 The increase in visits and costs related to the care of chronic pain are at least partially related to the characteristics of the pain, including pain intensity and resulting disability and interference. [9][10][11] Nevertheless, other characteristics of individuals with chronic pain have been identified as potential contributors to increased visits and resulting medical costs. These characteristics include sociodemographic status, 9 insurance, 12 and comorbid conditions, 13 including depression 7,9 and other mental illnesses, 7,13 chronic obstructive pulmonary disorder, 8 diabetes mellitus, hypertension, and cardiovascular disease.…”

Section: Résumémentioning

confidence: 99%

“…Sociodemographic information was collected on sex, age, marital status, education, and annual household income (Appendix A, items [8][9][10][11]16). Health information, in addition to chronic pain status, included smoking status and the number of chronic conditions (not including chronic pain) and was captured using items from the 2010 Canadian Community Health Survey (an annual cross-sectional survey administered by Statistics Canada that captures multiple health characteristics, including health status) 20 (Appendix, items 18 and 7).…”

Section: Data Collection Itemsmentioning

confidence: 99%

Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study

Mann

Johnson

VanDenKerkhof

2016

Can J Anesth/J Can Anesth

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Purpose This study was designed to investigate the role of chronic pain in healthcare visits. The specific objectives were to document the frequency of healthcare visits and to identify characteristics associated with frequent visits. Methods This is a secondary analysis of data from a Canadian cross-sectional study on chronic pain. One thousand two hundred and ninety-four participants were screened for chronic pain, and 741 reported having ''pain or discomfort that had been experienced either all the time or intermittently for at least three months''. Data regarding sociodemographics, general health, and healthcare visits were also collected. The frequency of healthcare visits was defined as at or above the 90th percentile for the group. Frequency was calculated for each setting, i.e., physicians' offices (C 9), emergency departments (C 1), and other (C 15). Binary logistic regression analyses were conducted to identify factors associated with frequent visits.Results Chronic pain increased the frequency of visits to physicians (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.8 to 7.9), emergency departments (OR, 1.4; 95% CI, 1.0 to 2.0), and ''other'' healthcare professionals (OR, 8.3; 95% CI, 4.5 to 15.5). Having C3 chronic conditions significantly increased the odds of frequent healthcare visits. Conclusion Interventions aimed at reducing healthcare costs for chronic pain should target individuals living with multiple chronic conditions. Research is needed to develop and test interventions that focus on the needs of these groups. Identifying the risk factors for high healthcare use and improving self-management may reduce healthcare visits. RésuméObjectif Cette étude a été conçue afin d'examiner le rô le de la douleur chronique dans les visites aux services de soins de santé. Les objectifs spécifiques de l'étude étaient de documenter la fréquence des visites et de déterminer les caractéristiques associées à des visites fréquentes. Méthode Cette étude est une analyse secondaire de données tirées d'une étude canadienne transversale sur la douleur chronique. Au total, 1094 patients ont été dépistés pour la douleur chronique, et 741 ont rapporté ressentir « des douleurs ou un inconfort perçus de façon continue ou intermittente pendant au moins trois mois ». Les données sociodémographiques ainsi que celles concernant la santé générale et les visites aux services de soins de santé ont également été colligées. La fréquence des visites aux services de soins de santé a été définie comme étant égale ou au-dessus du 90 e percentile pour le groupe et calculée pour chaque type de service, soit les docteurs et spécialistes (C 9), les départements d'urgence (C 1), et

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Predictors for chronic pain‐related health care utilization: a cross‐sectional nationwide study in Iceland

Abstract: Background Individuals with chronic pain are among the most frequent users of health care. Still, a significant percentage does not utilize health care for pain. A range of factors predict chronic pain-related health care utilization.

Cited by 23 publications

References 37 publications

Self‐reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross‐sectional study

Self‐reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross‐sectional study

Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study

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