Primary Care Utilization among Veterans with Chronic Musculoskeletal Pain: A Retrospective Chart Review

Beehler, Gregory P.; Rodrigues, Amy E.; Mercurio-Riley, Denise A.; Dunn, Andrew

doi:10.1111/pme.12126

Cited by 31 publications

(33 citation statements)

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“…The majority of studies were from USA ( n = 28) , followed by UK ( n = 4 studies) , Spain ( n = 3 studies) and Canada ( n = 3 studies) , with single studies from Norway , Denmark , Australia and India . There were no studies that compared data from multiple countries.…”

Section: Resultsmentioning

confidence: 99%

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

et al. 2020

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Mathieson S, ). What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies (Review). J Intern Med 2020; 287: 458-474.Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.

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Section: Resultsmentioning

confidence: 99%

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

et al. 2020

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“…Other solutions might include (l) streamlining referral to VATCs; (2) using telehealth or allowing local elirüeian teams to perform initial waitlisting evaluations; (3) aetive monitoring of liver disease burden at all VA hospitals with assessment of hospitals with low transplant referral rates; and (4) lowering finaneial disincentives for access to local transplant ser- Outcomes reported as subhazard ratios because of the competing risk model. The distance » waitlisting at a VA interaction term was not included in the final multivariable model because it was not significant (P = , 22), although waitlisting at a VATC was included in the model even though it was not significant (P = ,60), Primary insurance type was also not signiticant (P = ,72), Residential-level poverty was neither independently associated with mortality nor was it a confounder.…”

Section: Discussionmentioning

confidence: 97%

Association of Distance From a Transplant Center With Access to Waitlist Placement, Receipt of Liver Transplantation, and Survival Among US Veterans

Goldberg

French

Forde

et al. 2014

JAMA

134

144

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“…(18,19) In order to study care patterns in consistent users of VA care, we defined regular users of VA care as patients who had at least two outpatient primary care appointments within the VA for 2 years following the index HBsAg 1 result. (20) As length of follow-up was variable, when evaluating process outcomes, we excluded patients with less than 2 years of follow-up data and excluded patients with index HBsAg 1 from 1999 to 2002 due to missing data for laboratory values and prescriptions. The institutional review board at the Philadelphia VA Medical Center approved the study protocol.…”

Section: Setting/data Sourcementioning

confidence: 99%

“…In order to study care patterns in consistent users of VA care, we excluded 4876 patients who did not have at least two outpatient primary care appointments within the VA for 2 years following the HBsAg1 result. (20) We also excluded 112 patients who died within 7 days of having an HBsAg 1 result, leaving 21,419 in the final cohort. A total of 12,450 patients had 2 years of process outcomes data (Fig.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Care delivery and outcomes among US veterans with hepatitis B: A national cohort study

et al. 2016

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Previous studies have identified gaps in hepatitis B care. The objectives of this study were to evaluate the delivery of care among a national cohort of US veterans with chronic hepatitis B infection and examine risk factors for adverse clinical outcomes. We conducted a retrospective cohort study using the Veterans Health Administration Corporate Data Warehouse from 1999 to 2013 to evaluate (1) care delivery and (2) clinical outcomes such as hepatocellular carcinoma, hepatic decompensation, and mortality among US veterans with hepatitis B. Incidence rates with 95% confidence intervals were calculated and Cox regression models were used to evaluate clinical outcomes. We identified 21,419 veterans with a positive hepatitis B surface antigen, and 97% of patients had alanine aminotransferase and 44% had hepatitis B virus DNA testing; hepatitis B e antigen and hepatitis B e antibody were tested <50% of the time. Patients receiving specialty care had a higher prevalence of recommended laboratory testing. Patients with elevated alanine aminotransferase in specialty care were more likely to receive antiviral therapy (50% versus 24% for specialty care versus no specialty care, P < 0.001). Among patients with cirrhosis, 69% received one-time liver imaging. The proportion of follow-up time adherent to annual imaging was 0.39 (standard deviation 5 0.42), and the proportion was 0.28 (standard deviation 5 0.33) for biannual imaging; both proportions were higher in the specialty care group (all P < 0.05). Antiviral therapy (hazard ratio 5 0.85, 95% confidence interval 0.76-0.95, P 5 0.005) and liver imaging (hazard ratio 5 0.84, 95% confidence interval 0.76-0.91, P < 0.001) were independently associated with decreased mortality in adjusted analyses. Conclusion: We observed a low prevalence of recommended laboratory testing, antiviral therapy initiation, and liver imaging among a national cohort of veterans with hepatitis B infection; antiviral therapy and liver imaging were independently associated with decreased mortality. (HEPATOLOGY 2016;63:1774-1782 SEE EDITORIAL ON PAGE 1755A pproximately 350 million people worldwide are chronically infected with hepatitis B virus (HBV). In the United States, the prevalence of chronic hepatitis B remains incompletely quantified, with estimates ranging from approximately 800,000 individuals to as high as 2.2 million when including foreign-born Americans. (1,2) Chronic HBV infection is a significant cause of morbidity and mortality, leading to liver failure, cirrhosis, and hepatocellular carcinoma (HCC) in 25%-40% of infected persons. (3) Specifically, in the United States, hepatitis B is the underlying cause of an estimated 1800-4000 deaths each year. (2,4) Despite the significant burden of disease and existence of management guidelines for the evaluation and treatment of chronic HBV, (5) studies have shown variable adherence to recommended HBV care, including low rates of alanine aminotransferase (ALT) and HBV DNA level monitoring and infrequent HCC surveillance. (6,7) Significant gaps i...

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Primary Care Utilization among Veterans with Chronic Musculoskeletal Pain: A Retrospective Chart Review

Abstract: 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.

Cited by 31 publications

References 55 publications

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

Association of Distance From a Transplant Center With Access to Waitlist Placement, Receipt of Liver Transplantation, and Survival Among US Veterans

Care delivery and outcomes among US veterans with hepatitis B: A national cohort study

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