■确定疼痛筛查和功能评估结果是否与初级保健中疼痛的新诊断和治疗相关。
■在全州联邦合格健康中心的13个初级保健站点进行的观察性研究,该研究对初级保健中的所有成年人进行了常规筛查和功能评估。研究组包括10,091名18岁以上的成年人,他们在2018年7月2日至2019年6月1日之间进行了面对面的访问,他们在那里筛查出慢性疼痛呈阳性,并使用PEG完成了3个问题的功能评估(疼痛,享受生活,一般活动)。多变量逻辑回归量化疼痛频率之间的关联,诊断和治疗,社会人口统计学,合并症,和自我报告的严重疼痛障碍,以及筛查后记录的疼痛诊断和治疗。
■患者大多是女性(60.3%),拉丁裔(41.1%),说英语(80.1%),和医疗补助保险(62.0%);他们平均年龄为49.1岁(SD=13.7岁)。患有严重疼痛障碍或Latinx的患者更有可能获得新记录的疼痛诊断(绝对风险差异[ARD]:13.2%和8.6%,ps<0.0001),而患有精神健康/物质使用或医疗合并症的患者则不太可能(ARDs:-20.0%至-6.2%,ps<0.001)。与治疗最一致的因素是相同模式的先前治疗(7种治疗中的4种,ARDs=27.3%到44.1%,ps<0.0001),新的疼痛诊断(7个中的5个,ARDs=3.2%至27.4%,ps<0.001),和严重损害(7个中的4个,ARD=2.6%至6.5%,ps<0.0001)。新诊断与非阿片类止痛药和物理药物的相关性最强(ARD=27.0%和27.4%,p<0.0001)。Latinx患者不太可能接受阿片类镇痛药和精神健康/物质使用药物和咨询(ARDs=-3.3%至7.5%,ps<0.0001)。
■使用患者报告工具进行筛查和评估可能会影响疼痛护理。对拉丁裔患者的护理与非拉丁裔白人患者不同。
UNASSIGNED: To determine if pain screening and functional assessment results are associated with new diagnoses and treatment for pain in primary care.
UNASSIGNED: Observational
study at 13 primary care sites of a statewide federally qualified health center that implemented routine screening and functional assessment for all adults in primary care. The
study group included 10,091 adults aged 18+ who had an in-person visit between July 2, 2018, and June 1, 2019, where they screened positive for chronic pain and completed a 3-question functional assessment with the PEG (Pain, Enjoyment of Life, General Activity). Multivariate logistic regressions quantified associations between pain frequency, diagnosis and treatment, sociodemographics, comorbidities, and self-reported severe pain impairment with pain diagnoses and treatment documented after screening.
UNASSIGNED: Patients were mostly women (60.3%), Latinx (41.1%), English-speaking (80.1%), and Medicaid-insured (62.0%); they averaged 49.1 years old (SD = 13.7 years). Patients with severe pain impairment or who were Latinx were more likely to get a newly documented pain diagnosis (absolute risk difference [ARD]: 13.2% and 8.6%, ps < 0.0001), while patients with mental health/substance use or medical comorbidities were less likely (ARDs: -20.0% to -6.2%, ps < 0.001). Factors most consistently associated with treatment were prior treatment of the same modality (4 of 7 treatments, ARDs = 27.3% to 44.1%, ps <0.0001), new pain diagnosis (5 of 7, ARDs = 3.2% to 27.4%, ps <0.001), and severe impairment (4 of 7, ARDs = 2.6% to 6.5%, ps < 0.0001). A new diagnosis had the strongest association with non-opioid pain analgesics and physical medicine (ARD = 27.0% and 27.4%, p < 0.0001). Latinx patients were less likely to receive opioid analgesics and mental health/substance use medications and counseling (ARDs = -3.3% to 7.5%, ps <0.0001).
UNASSIGNED: Screening and assessment with patient-reported tools may influence pain care. Care for Latinx patients differed from non-Latinx white patients.