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Improved pain management could reduce use of outpatient care and associated costs for patients with HIV disease

Despite treatment advances, pain remains a considerable problem for an estimated 25 to 80 percent of people infected with HIV. Improved pain management in these patients and identification of those at risk for developing pain could reduce their use of outpatient care, lead to substantial cost savings, and improve quality of life for affected individuals, according to a study led by Aram Dobalian, Ph.D., J.D., of the University of Florida at Gainesville. This research was supported by the Agency for Healthcare Research and Quality (HS08578) through the HIV Cost and Services Utilization Study (HCSUS).

Dr. Dobalian and his colleagues assessed outpatient use over 6 months among 2,267 participants in HCSUS, a nationally representative probability sample of HIV-positive adults receiving care in the United States. Overall, 67 percent of patients with HIV disease reported suffering from pain during the previous 4 weeks. Self-reported pain was higher among those with AIDS, intravenous drug-using females, the unemployed, and those without a college degree. Blacks reported less pain than other patients. Patients reporting or developing more pain and those in poorer health (CD4 count less than 50 and less energy) used more outpatient services.

Individuals who did not report pain at first or second followup were predicted to have 5.20 outpatient visits; those who had no pain at first followup but developed maximum pain (10 score) by the second followup were predicted to have 6.94 visits; and those with maximum pain at first and second followups were predicted to have 7.24 visits. Individuals with Medicare, Medicaid, or private insurance were more likely to have used outpatient services than uninsured patients. However, those with private HMO coverage were no more likely to use outpatient services than those without insurance.

See "Pain and the use of outpatient services among persons with HIV," by Dr. Dobalian, Jennie C.I. Tsao, Ph.D., and R. Paul Duncan, Ph.D., in the February 2004 Medical Care 42(2), pp. 129-138.

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