Health care utilization among veterans with pain and posttraumatic stress symptoms

Samantha D. Outcalt, Zhangsheng Yu, Helena Maria Hoen, Tenesha Marie Pennington, Erin E. Krebs

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms. Methods: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Results: Participants were 94.7% men and had a mean age of 58.9 years. Nearly all used primary care (99.2%), 37.1% used pain-related specialty care, and 33.8% used mental health services. Nonopioid and opioid analgesics were the most commonly used medications (63.7% and 53.8%, respectively). Except for mental health visits, which did not differ between PTSD-only and pain+PTSD groups, the pain+PTSD group used significantly more of all categories of health care services than the pain-only and PTSD-only groups. For example, the pain+PTSD group had 7% more primary care visits (rate ratio [RR]=1.07; 95% confidence interval [CI]: 1.05, 1.09) than the pain-only group and 46% more primary care visits than the PTSD-only group (RR=1.46; 95% CI: 1.40, 1.52). Adjusted rates of opioid, benzodiazepine, nonopioid analgesic, and antidepressant prescriptions were higher for the pain+PTSD group than either of the comparison groups. Conclusions: Our findings support our expectation that veterans with both pain and PTSD symptoms use more health care services than those with pain or PTSD symptoms alone. Research is needed to assess the health care costs associated with increases in health care utilization among these veterans.

Original languageEnglish
Pages (from-to)1872-1879
Number of pages8
JournalPain Medicine
Volume15
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Patient Acceptance of Health Care
Veterans
Post-Traumatic Stress Disorders
Pain
Non-Narcotic Analgesics
Primary Health Care
Opioid Analgesics
Prescriptions
Benzodiazepines
Antidepressive Agents
Health Services
Mental Health
Confidence Intervals
Delivery of Health Care
Mental Health Services
Statistical Models
Ambulatory Care

Keywords

  • Chronic Pain
  • Health Care
  • Posttraumatic Stress Syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Outcalt, S. D., Yu, Z., Hoen, H. M., Pennington, T. M., & Krebs, E. E. (2014). Health care utilization among veterans with pain and posttraumatic stress symptoms. Pain Medicine, 15(11), 1872-1879. https://doi.org/10.1111/pme.12045

Health care utilization among veterans with pain and posttraumatic stress symptoms. / Outcalt, Samantha D.; Yu, Zhangsheng; Hoen, Helena Maria; Pennington, Tenesha Marie; Krebs, Erin E.

In: Pain Medicine, Vol. 15, No. 11, 01.11.2014, p. 1872-1879.

Research output: Contribution to journalArticle

Outcalt, SD, Yu, Z, Hoen, HM, Pennington, TM & Krebs, EE 2014, 'Health care utilization among veterans with pain and posttraumatic stress symptoms', Pain Medicine, vol. 15, no. 11, pp. 1872-1879. https://doi.org/10.1111/pme.12045
Outcalt, Samantha D. ; Yu, Zhangsheng ; Hoen, Helena Maria ; Pennington, Tenesha Marie ; Krebs, Erin E. / Health care utilization among veterans with pain and posttraumatic stress symptoms. In: Pain Medicine. 2014 ; Vol. 15, No. 11. pp. 1872-1879.
@article{9eaa9c5a22e94ad8ae21216b0624fb0c,
title = "Health care utilization among veterans with pain and posttraumatic stress symptoms",
abstract = "Objective: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms. Methods: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Results: Participants were 94.7{\%} men and had a mean age of 58.9 years. Nearly all used primary care (99.2{\%}), 37.1{\%} used pain-related specialty care, and 33.8{\%} used mental health services. Nonopioid and opioid analgesics were the most commonly used medications (63.7{\%} and 53.8{\%}, respectively). Except for mental health visits, which did not differ between PTSD-only and pain+PTSD groups, the pain+PTSD group used significantly more of all categories of health care services than the pain-only and PTSD-only groups. For example, the pain+PTSD group had 7{\%} more primary care visits (rate ratio [RR]=1.07; 95{\%} confidence interval [CI]: 1.05, 1.09) than the pain-only group and 46{\%} more primary care visits than the PTSD-only group (RR=1.46; 95{\%} CI: 1.40, 1.52). Adjusted rates of opioid, benzodiazepine, nonopioid analgesic, and antidepressant prescriptions were higher for the pain+PTSD group than either of the comparison groups. Conclusions: Our findings support our expectation that veterans with both pain and PTSD symptoms use more health care services than those with pain or PTSD symptoms alone. Research is needed to assess the health care costs associated with increases in health care utilization among these veterans.",
keywords = "Chronic Pain, Health Care, Posttraumatic Stress Syndrome",
author = "Outcalt, {Samantha D.} and Zhangsheng Yu and Hoen, {Helena Maria} and Pennington, {Tenesha Marie} and Krebs, {Erin E.}",
year = "2014",
month = "11",
day = "1",
doi = "10.1111/pme.12045",
language = "English",
volume = "15",
pages = "1872--1879",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Health care utilization among veterans with pain and posttraumatic stress symptoms

AU - Outcalt, Samantha D.

AU - Yu, Zhangsheng

AU - Hoen, Helena Maria

AU - Pennington, Tenesha Marie

AU - Krebs, Erin E.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Objective: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms. Methods: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Results: Participants were 94.7% men and had a mean age of 58.9 years. Nearly all used primary care (99.2%), 37.1% used pain-related specialty care, and 33.8% used mental health services. Nonopioid and opioid analgesics were the most commonly used medications (63.7% and 53.8%, respectively). Except for mental health visits, which did not differ between PTSD-only and pain+PTSD groups, the pain+PTSD group used significantly more of all categories of health care services than the pain-only and PTSD-only groups. For example, the pain+PTSD group had 7% more primary care visits (rate ratio [RR]=1.07; 95% confidence interval [CI]: 1.05, 1.09) than the pain-only group and 46% more primary care visits than the PTSD-only group (RR=1.46; 95% CI: 1.40, 1.52). Adjusted rates of opioid, benzodiazepine, nonopioid analgesic, and antidepressant prescriptions were higher for the pain+PTSD group than either of the comparison groups. Conclusions: Our findings support our expectation that veterans with both pain and PTSD symptoms use more health care services than those with pain or PTSD symptoms alone. Research is needed to assess the health care costs associated with increases in health care utilization among these veterans.

AB - Objective: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms. Methods: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Results: Participants were 94.7% men and had a mean age of 58.9 years. Nearly all used primary care (99.2%), 37.1% used pain-related specialty care, and 33.8% used mental health services. Nonopioid and opioid analgesics were the most commonly used medications (63.7% and 53.8%, respectively). Except for mental health visits, which did not differ between PTSD-only and pain+PTSD groups, the pain+PTSD group used significantly more of all categories of health care services than the pain-only and PTSD-only groups. For example, the pain+PTSD group had 7% more primary care visits (rate ratio [RR]=1.07; 95% confidence interval [CI]: 1.05, 1.09) than the pain-only group and 46% more primary care visits than the PTSD-only group (RR=1.46; 95% CI: 1.40, 1.52). Adjusted rates of opioid, benzodiazepine, nonopioid analgesic, and antidepressant prescriptions were higher for the pain+PTSD group than either of the comparison groups. Conclusions: Our findings support our expectation that veterans with both pain and PTSD symptoms use more health care services than those with pain or PTSD symptoms alone. Research is needed to assess the health care costs associated with increases in health care utilization among these veterans.

KW - Chronic Pain

KW - Health Care

KW - Posttraumatic Stress Syndrome

UR - http://www.scopus.com/inward/record.url?scp=84911991328&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911991328&partnerID=8YFLogxK

U2 - 10.1111/pme.12045

DO - 10.1111/pme.12045

M3 - Article

VL - 15

SP - 1872

EP - 1879

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 11

ER -