Outpatient Pain Predicts Subsequent One-Year Acute Health Care Utilization Among Adults With Sickle Cell Disease
Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 65-74, July 2014
Abstract
Context
Patient
demographic and clinical factors have known associations with acute
health care utilization (AHCU) among patients with sickle cell disease
(SCD), but it is unknown if pain measured predominantly in an outpatient
setting is a predictor of future AHCU in patients with SCD.
Objectives
To
determine whether multidimensional pain scores obtained predominantly
in an outpatient setting predicted subsequent 1-year AHCU by 137 adults
with SCD and whether the pain measured at a second visit also predicted
AHCU.
Methods
Pain data included the Composite Pain Index
(CPI), a single score representative of a multidimensional pain
experience (number of pain sites, intensity, quality, and pattern).
Based on the distribution of AHCU events, we divided patients into three
groups: 1) zero events (zero), 2) 1 to 3 events (low), or 3) 4 to 23
events (high).
Results
The initial CPI scores differed significantly by the three groups (
F(2,134) = 7.38,
P = 0.001). Post hoc comparisons showed that the zero group had lower CPI scores than both the low (
P < 0.01) and high (
P < 0.001)
groups. In multivariate overdispersed Poisson regression analyses, age
and CPI scores (at both measurement times) were statistically
significant predictors of utilization events. Pain intensity scores at
both measurement times were significant predictors of utilization, but
other pain scores (number of pain sites, quality, and pattern) were not.
Conclusion
Findings
support use of outpatient CPI scores or pain intensity and age to
identify at-risk young adults with SCD who are likely to benefit from
improved outpatient pain management plans.
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