How Much Time Do Low-Income Patients and Primary Care Physicians Actually Spend Discussing Pain? A Direct Observation Study
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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
The authors wish to thank Rodney A. Hayward, MD, and Hwa-Jung Choi, PhD, for assistance with data analysis and imputation. They also thank colleagues at the University of Michigan and Wayne State University/Karmanos Cancer Institute for helpful comments on earlier versions of this manuscript.
Dr Henry is supported by the US Department of Veterans Affairs and the Robert Wood Johnson Foundation Clinical Scholars program, which also funded this project. The primary study was funded by NICHD grant R21 HD050450 (L. Penner) and NCI Center grant P30CA22453 (Karmanos Cancer Institute/Wayne State University).
Preliminary findings were presented at the Robert Wood Johnson Foundation Clinical Scholars program annual meeting; Atlanta, GA; 2-5 November 2010; and the Society for General Internal Medicine annual meeting; Phoenix, AZ, 4-7 May 2011.
Conflicts of Interest
The authors declare that they do not have a conflict of interest.
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