Abstract
Background: We know little about how much time low-income patients and physicians spend discussing pain during primary care visits. Objective: 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. Design: 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. Participants: A total of 133 patients presenting to a primary care clinic for any reason; 17 family medicine residents. Main Measures: 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. KEY RESULTS: 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. Conclusions: 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 787-793 |
| Number of pages | 7 |
| Journal | Journal of General Internal Medicine |
| Volume | 27 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2012 |
| Externally published | Yes |
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Keywords
- black patients
- direct observation
- pain
- patient-physician communication
- patient-physician relationship
- primary care
- time
ASJC Scopus subject areas
- Internal Medicine
Cite this
How much time do low-income patients and primary care physicians actually spend discussing pain? a direct observation study. / Henry, Stephen G; Eggly, Susan.
In: Journal of General Internal Medicine, Vol. 27, No. 7, 07.2012, p. 787-793.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - How much time do low-income patients and primary care physicians actually spend discussing pain? a direct observation study
AU - Henry, Stephen G
AU - Eggly, Susan
PY - 2012/7
Y1 - 2012/7
N2 - Background: We know little about how much time low-income patients and physicians spend discussing pain during primary care visits. Objective: 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. Design: 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. Participants: A total of 133 patients presenting to a primary care clinic for any reason; 17 family medicine residents. Main Measures: 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. KEY RESULTS: 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. Conclusions: 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.
AB - Background: We know little about how much time low-income patients and physicians spend discussing pain during primary care visits. Objective: 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. Design: 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. Participants: A total of 133 patients presenting to a primary care clinic for any reason; 17 family medicine residents. Main Measures: 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. KEY RESULTS: 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. Conclusions: 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.
KW - black patients
KW - direct observation
KW - pain
KW - patient-physician communication
KW - patient-physician relationship
KW - primary care
KW - time
UR - http://www.scopus.com/inward/record.url?scp=84862643051&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862643051&partnerID=8YFLogxK
U2 - 10.1007/s11606-011-1960-x
DO - 10.1007/s11606-011-1960-x
M3 - Article
C2 - 22231657
AN - SCOPUS:84862643051
VL - 27
SP - 787
EP - 793
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 7
ER -