Comfortably numb? Exploring satisfaction with chronic back pain visits
Received 28 October 2008; received in revised form 1 March 2009; accepted 20 April 2009. published online 17 June 2009.
Abstract
Background context
Chronic back pain is a condition characterized by high rates of disability, health-care service use, and costs.
Purpose
The purpose of this study was to identify factors associated with patients' satisfaction with their last health-care provider visit for chronic low back pain (LBP).
Study design/setting
A cross-sectional, state-level, telephone survey was administered to patients with chronic LBP.
Patient sample
The sample consisted of 624 individuals with chronic LBP who reported seeing a health-care provider in the previous year.
Outcome measures
Dependent variables included satisfaction with last visit for LBP and intent to seek care from additional providers. Independent variables included the Roland-Morris Disability Questionnaire, 3-month pain ratings using a 0 to 10 Likert scale, the Medical Outcomes Survey Short Form 12, and self-reported health service utilization (provider type, number of visits to health-care providers, medication use during the previous month, and treatments and diagnostic tests during the previous year).
Methods
Bivariate and multivariate analyses were used to explore how demographic, insurance-related, and health-related characteristics were associated with patient satisfaction.
Results
Participants who were not satisfied with one or more aspects of their last clinic visit were younger (51.0 vs. 54.21 years), reported higher 3-month pain ratings (7.23 vs. 6.53), and were more commonly Hispanic (53.2% vs. 46.8% for other ethnicities) and uninsured (43.1% vs. 29.3% for other insurance groups). Those who intended to seek care from additional providers were younger (50.05 vs. 55.49 years), had higher 3-month pain ratings (7.20 vs. 6.46), had lower Short Form 12 mental health component scores (44.75 vs. 49.55) and physical component scores (30.07 vs. 31.55), and were more commonly black (54.6% vs. 45.4% for other racial groups) and uninsured (56.9% vs. 43.1% for other insurance groups). Narcotic use was associated with satisfaction (odds ratio=2.12, p=.01), whereas lack of insurance was associated with respondents' intent to seek care from additional providers (odds ratio=2.97, p<.01).
Conclusions
Factors other than disability were associated with satisfaction with chronic LBP visits. Understanding the role of medication in satisfaction and its implications for the health behaviors of this highly disabled population may be particularly important.
aUniversity of New Mexico, College of Nursing, MSC 09 5350, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
bUniversity of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, 725 Airport Rd, CB# 7590 Chapel Hill, NC 27599-7590, USA
Corresponding author. University of New Mexico, College of Nursing, MSC 09 5350, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA. Tel.: (505) 272-4142; fax: (505) 272-8901.
FDA drugs/status: not applicable.
Author disclosures: ASW (research support for investigator salary, NIH NINRT32 NR08856); JKF (research support for investigator salary and trips/travel, NIAMS R01 AR051970); TSC (research support for investigator salary, NIH).
This study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) R01 AR051970. Funding for ASW's time was provided by NIH NINRT32 NR08856. Conduct of this study was approved by the Biomedical Institutional Review Board of the University of North Carolina at Chapel Hill.
ABSTRACT