Identification des grands utilisateurs de soins de santé chez les patients souffrant de la douleur chronique non cancéreuse et suivis en soins de première ligne
Background: Chronic non-cancer pain (CNCP) has major social and economic impacts. Identifying patients at risk of being heavy health care users could be very useful; therefore, by improving their care direct health care costs could eventually be reduced. Purpose: To identify bio-psycho-social factors predicting the risk of being a heavy health care user among primary care CNCP patients. Methods: Patients reporting moderate to severe CNCP for at least 6 months with an active analgesic prescription from a primary care physician were recruited in community pharmacies on the territory of the Réseau universitaire integré de santé (RUIS), of the Université de Montréal between May 2009 and January 2010. The latter comprises six areas: Mauricie and centre du Quebec, Laval, Montreal, the Laurentians, Lanaudière and Montérégie. Upon recruitment, their bio-psycho-social characteristics were documented through self-administered and telephone questionnaires. The direct health costs were estimated for the health care services provided to patients in the year preceding and following recruitment using the database of the Régie d’Assurance maladie du Québec, RAMQ (Quebec province public health care insurance). These costs took into account the pain-related hospitalizations, emergency room visits, ambulatory care, and medication prescribed for pain treatment  and drug side effects Heavy health care users were defined as those in the highest annual direct health care costs quartile in the year following recruitment. Logistic multivariate regression models using the Akaike information criterion were developed in order to identify the predictors of heavy health care use. Results: The median annual direct health care cost incurred by heavy health care users (n = 63) was CAD 7,627, compared to CAD 1,554 for the standard health care users (n = 188). The final predictive model of the risks of being a heavy health care user included pain located in the lower body (Odds ratio (OR) = 3.03; 95% CI: 1.20 - 7.65), pain-related disability (OR = 1.24; 95% CI: 1.03 - 1.48), and health care costs in the previous year (OR = 17.67; 95% CI: 7.90 - 39.48). Other retained variables were sex, comorbidity, depression level, and patients’ attitudes towards medical pain cure. Conclusion: Patients suffering from CNCP in the lower body and having a greater impact of pain on their daily functioning were more likely to be heavy health care and services users. Previous year annual direct cost was also a significant predictor. Improving pain management in this clientele of patients may improve their health and eventually reduce their health care cost to the health care system.
Chronic non-cancer pain Primary care Direct health care costs Cost predictors Cohort study Akaike information criterion