ABSTRACT
BACKGROUND
A difficult to manage comorbid condition, like chronic pain, could adversely affect the delivery of recommended care for other serious health problems, such as hypertension.
OBJECTIVE
We examined whether addressing pain at a primary care visit acts as a competing demand in decisions to intensify blood pressure (BP) medications for diabetic patients with an elevated BP.
DESIGN
Prospective cohort study. Participants: 1,169 diabetic patients with a BP ≥140/90 prior to a primary care provider (PCP) visit were enrolled.
MEASUREMENTS
After the visit, PCPs provided information about the top three issues discussed and whether hypertension medications were intensified or reasons for not intensifying. We used multi-level logistic regression to assess whether discussing pain during the visit decreased the likelihood of BP medication intensification. We calculated predicted probabilities of medication intensification by whether pain was discussed.
RESULTS
PCPs discussed pain during 222 (20%) of the visits. Visit BP did not differ between patients with whom pain was and was not discussed. BP medications were intensified during 44% of the visits. The predicted probability of BP medication intensification when pain was discussed was significantly lower than when pain was not discussed (35% vs. 46%, p = 0.02).
CONCLUSIONS
Discussing pain at a primary care visit competed with the intensification of BP medication. This finding is concerning given that controlling blood pressure may be the most important factor in decreasing long-term complications for patients with diabetes. Better care management models for complex patients are needed to ensure that both pain and other chronic conditions are adequately addressed.
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Acknowledgement
This study was supported through grants IIR 02–225 and DIB 98–001 from the Department of Veterans Affairs (VA), Health Services Research and Development Service. John Piette is a VA Career Scientist. This work was also supported in part by the Michigan Diabetes Research and Training Center grant P60DK-20572 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the University of Michigan or the NIH. The authors are indebted to our recruitment coordinator and research assistants who worked tirelessly to recruit patients for this study; to our data manager; to our site principal investigators, without whom this study could not have taken place; and to the many providers and patients who participated in the study. The authors would also like to thank Dr. Connie Standiford for her comments on earlier drafts of this manuscript.
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Krein, S.L., Hofer, T.P., Holleman, R. et al. More Than a Pain in the Neck: How Discussing Chronic Pain Affects Hypertension Medication Intensification. J GEN INTERN MED 24, 911–916 (2009). https://doi.org/10.1007/s11606-009-1020-y
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DOI: https://doi.org/10.1007/s11606-009-1020-y