Utility of catastrophizing, body symptom diagram score and history of opioid use to predict future health care utilization after a primary care visit for musculoskeletal pain.
Utility of catastrophizing, body symptom diagram score and history of opioid use to predict future health care utilization after a primary care visit for musculoskeletal pain.
复制标题
利用灾难化、身体症状图评分和阿片类药物使用史来预测肌肉骨骼疼痛初级保健就诊后未来医疗保健的利用。
DOI：
10.1093/fampra/cmz046
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发表时间：
2020
期刊：
影响因子：
2.2
通讯作者：
George,StevenZ
中科院分区：
文献类型：
--
作者：
Rhon,DanielI;Lentz,TrevorA;George,StevenZ
背景自我报告的信息，疼痛和疼痛的信念往往收集在初始咨询肌肉骨骼疼痛。这些数据可能提供效用超出了最初的遭遇，有助于提供进一步的洞察预后和长期的相互作用的病人与卫生系统。ESTA本研究的目的是确定是否疼痛灾难性和疼痛相关的身体症状可以预测未来的医疗保健utilization.MethodsThis是一个纵向队列研究。基线数据是在一家大型军事医院的多学科诊所接受肌肉骨骼疾病的初步治疗后收集的。受试者完成了疼痛灾难化量表，一个特定区域的残疾措施，数字疼痛评级量表和身体症状图。从军事卫生系统数据存储库中提取访视前和访视后1年的医疗保健利用数据。开发了适用于偏斜和计数数据的多变量回归模型，以预测（i）肌肉系统特定的医疗访视，（ii）12个月阿片类药物使用，（iii）肌肉系统特定的医疗费用和（iv）总医疗费用。我们调查了是否疼痛灾难化×身体症状图的相互作用提高预测，并开发了单独的模型阿片类药物的天真的个人和那些有阿片类药物使用史的探索性analysis.ResultsPain灾难化，但不是身体症状图是一个显着的预测肌肉骨骼的访问，肌肉骨骼的成本和总医疗费用。探索性分析表明，这些关系是最强大的阿片类药物use.ConclusionsPain catastrophizing的历史的患者可以确定高的医疗保健利用率和成本的风险，即使在控制常见的临床变量。在初级保健环境中解决疼痛灾难化可能有助于减轻未来的医疗保健利用和成本，同时改善临床结果。这些结果为未来在更大和更传统的初级保健环境中进行验证研究提供了方向。
BackgroundSelf-report information about pain and pain beliefs are often collected during initial consultation for musculoskeletal pain. These data may provide utility beyond the initial encounter, helping provide further insight into prognosis and long-term interactions of the patient with the health system.ObjectiveThe aim of this study was to determine if pain catastrophizing and pain-related body symptoms can predict future health care utilization.MethodsThis was a longitudinal cohort study. Baseline data were collected after receiving initial care for a musculoskeletal disorder in a multidisciplinary clinic within a large military hospital. Subjects completed the Pain Catastrophizing Scale, a region-specific disability measure, numeric pain rating scale and a body symptom diagram. Health care utilization data for 1 year prior and after the visit were extracted from the Military Health System Data Repository. Multivariable regression models appropriate for skewed and count data were developed to predict (i) musculoskeletal-specific medical visits, (ii) 12-month opioid use, (iii) musculoskeletal-specific medical costs and (iv) total medical costs. We investigated whether a pain catastrophizing × body symptom diagram interaction improved prediction, and developed separate models for opioid-naïve individuals and those with a history of opioid use in an exploratory analysis.ResultsPain catastrophizing but not body symptom diagram was a significant predictor of musculoskeletal visits, musculoskeletal costs and total medical costs. Exploratory analyses suggest these relationships are most robust for patients with a history of opioid use.ConclusionsPain catastrophizing can identify risk of high health care utilization and costs, even after controlling for common clinical variables. Addressing pain catastrophizing in the primary care setting may help to mitigate future health care utilization and costs, while improving clinical outcomes. These results provide direction for future validation studies in larger and more traditional primary care settings.