How Much Time Do Low-Income Patients and Primary Care Physicians Actually Spend Discussing Pain? A Direct Observation Study
We know little about how much time low-income patients and physicians spend discussing pain during primary care visits.
To measure the frequency and duration of pain-related discussions at a primary care clinic serving mostly low-income black patients; to investigate variables associated with these discussions.
We measured the frequency and duration of pain-related discussions using video-recorded primary care visits; we used multiple regression to evaluate associations between discussions and patient self-report variables.
A total of 133 patients presenting to a primary care clinic for any reason; 17 family medicine residents.
Independent variables were pain severity, health status, physical function, chief complaint, and whether the patient and physician had met previously. Dependent variables were presence of pain-related discussions and percent of total visit time spent discussing pain.
Sixty-nine percent of visits included pain-related discussions with a mean duration of 5.9 min (34% of total visit time). Increasing pain severity [OR 1.69, 95% CI (1.18, 2.41)] and pain-related chief complaints [OR 4.10, 95% CI (1.39, 12.12)] were positively associated with the probability of discussing pain. When patients discussed pain, they spent 4.5% more [95% CI (0.60, 8.37)] total visit time discussing pain for every one-point increase in pain severity. Better physical function was negatively associated with the probability of discussing pain [OR 0.65, 95% CI (0.48, 0.86)], but positively associated with the percent of total visit time spent discussing pain [3% increase; 95% CI (0.32, 5.75)] for every one-point increase in physical function). Patients and physicians who had met previously spent 11% less [95% CI (-21.65, -0.55)] total visit time discussing pain. Pain severity was positively associated with time spent discussing pain only when patients and physicians had not met previously.
Pain-related discussions comprise a substantial proportion of time during primary care visits. Future research should evaluate the relationship between time spent discussing pain and the quality of primary care pain management.
KEY WORDSpain patient-physician communication direct observation time primary care patient-physician relationship black patients
- 4.Institute of Medicine. Relieving Pain in America: a Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011.Google Scholar
- 30.Harris J, Pryor J, Adams S. The challenge of intercoder agreement in qualitative inquiry. Electronic Emissary; 1997; Available from: http://emissary.wm.edu/templates/content/publications/intercoder-agreement.pdf. Accessed 1 December 2011.
- 31.Hsaio C, Cherry DK, Beatty PC, Rechtsteiner EA. National ambulatory medical care survey: 2007 summary. Hyattsville, Maryland: National Center for Health Statistics. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr027.pdf. Accessed 1 December 2011.
- 35.Diggle P, Heagerty P, Liang K-L, Zeger SL. Analysis of Longitudinal Data. 2nd ed. Oxford, New York: Oxford University Press; 2002.Google Scholar
- 36.Royston P. Multiple imputation of missing values: update. Stata J. 2005;5:188–201.Google Scholar
- 37.Royston P. Multiple imputation of missing values: further update of ice, with an emphasis on categorical variables. Stata J. 2009;9:466–77.Google Scholar
- 38.Tai-Seale M, Bolin J, Bao X, Street R. Management of chronic pain among older patients: inside primary care in the US. Eur J Pain. 2011;[in press].Google Scholar