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 > or = 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.
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 diabeticpatients with an elevated BP. DESIGN: Prospective cohort study. PARTICIPANTS: 1,169 diabeticpatients with a BP > or = 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.
Authors: Sarah L Krein; C Raymond Bingham; John F McCarthy; Allison Mitchinson; Jonathan Payes; Marcia Valenstein Journal: Psychiatr Serv Date: 2006-07 Impact factor: 3.084
Authors: Susan M Frayne; Jewell H Halanych; Donald R Miller; Fei Wang; Hai Lin; Leonard Pogach; Erica J Sharkansky; Terence M Keane; Katherine M Skinner; Craig S Rosen; Dan R Berlowitz Journal: Arch Intern Med Date: 2005 Dec 12-26
Authors: Paula Tanabe; Stephen D Persell; James G Adams; Jennifer C McCormick; Zoran Martinovich; David W Baker Journal: Ann Emerg Med Date: 2008-01-22 Impact factor: 5.721
Authors: Barbara J Turner; Christopher S Hollenbeak; Mark Weiner; Thomas Ten Have; Simon S K Tang Journal: Ann Intern Med Date: 2008-04-15 Impact factor: 25.391
Authors: Eve A Kerr; Michele Heisler; Sarah L Krein; Mohammed Kabeto; Kenneth M Langa; David Weir; John D Piette Journal: J Gen Intern Med Date: 2007-07-24 Impact factor: 5.128
Authors: Stacie L Daugherty; J David Powers; David J Magid; Frederick A Masoudi; Karen L Margolis; Patrick J O'Connor; Julie A Schmittdiel; P Michael Ho Journal: Hypertension Date: 2012-06-25 Impact factor: 10.190
Authors: Elizabeth A Bayliss; Patrick J Blatchford; Sophia R Newcomer; John F Steiner; Diane L Fairclough Journal: J Gen Intern Med Date: 2011-01-04 Impact factor: 5.128
Authors: Brandon K Bellows; Natalia Ruiz-Negrón; Kirsten Bibbins-Domingo; Jordan B King; Mark J Pletcher; Andrew E Moran; Valy Fontil Journal: Circ Cardiovasc Qual Outcomes Date: 2019-06-05
Authors: Elizabeth M Magnan; Mari Palta; Heather M Johnson; Christie M Bartels; Jessica R Schumacher; Maureen A Smith Journal: J Diabetes Complications Date: 2014-10-13 Impact factor: 2.852
Authors: Heather M Johnson; Andrea G Olson; Jamie N LaMantia; Amy J H Kind; Nancy Pandhi; Eneida A Mendonça; Mark Craven; Maureen A Smith Journal: J Gen Intern Med Date: 2014-11-06 Impact factor: 5.128
Authors: Donna M Zulman; Susana B Martins; Yan Liu; Samson W Tu; Brian B Hoffman; Steven M Asch; Mary K Goldstein Journal: AMIA Annu Symp Proc Date: 2015-11-05