The effect of concurrent pain on the management of patients with depression: an analysis of NHS healthcare resource utilisation using the GPRD database
The effect of concurrent pain on the management of patients with depression: an analysis of NHS healthcare resource utilisation using the GPRD database
Introduction:
Patients with depression frequently report painful physical symptoms. However, there are scant data from the UK concerning differences in primary and secondary care resource use between depressed patients with and without pain treated in general practice.
Methods:
Patients with depression codes were identified from the General Practice Research Database (GPRD) excluding those with psychoses. The observation period was 1st January 2000–31st December 2006. Patients were further categorised into three groups: (i) no painful physical symptom codes ever in the observation period (NO PAIN); (ii) patients with no other diagnostic or test codes 30 days either side of a pain code (PAIN MINUS DIAGNOSIS) and (iii) patients with pain codes and other diagnostic codes (PAIN PLUS DIAGNOSIS). Rates of general practitioner (GP) visits, antidepressant and concomitant prescribing and switching, secondary care referrals and diagnostic tests were reported per group with 95% confidence limits (CI).
Results:
A total of 145,784 patients with depression aged 18–50 years were selected. Of these, 48,615 (33.3%) were classed as NO PAIN, the remaining 66.6% having pain. PAIN MINUS DIAGNOSIS patients constituted 5654 (5.8%) of those with pain. PAIN MINUS DIAGNOSIS and PAIN PLUS DIAGNOSIS had a significantly higher rate of GP visits than NO PAIN patients, 10.37 (95% CI 10.23, 10.52); 11.15 (11.11,11.20) and 7.04 (7.00, 7.08) respectively. Inter and intraclass drug switching was high with 13% of PAIN MINUS DIAGNOSIS and 14% of PAIN PLUS DIAGNOSIS patients having three or more switches compared with 7% of NO PAIN patients. Referral rates to secondary care were significantly higher in both pain groups compared with patients with no pain. Diagnostic testing was significantly greater in PAIN MINUS DIAGNOSIS and PAIN PLUS DIAGNOSIS groups than NO PAIN patients for all test types, with X-rays being the most common test; 3.85 (3.69,4.00); 2.77 (2.74,2.80); 0.91 (0.89, 0.94) respectively.
Conclusion:
Patients in general practice diagnosed with depression and concurrent painful physical symptoms have higher resource use in primary and secondary care.
698-706
Watson, L.
b19c88c5-88f3-44fe-935e-1cece1d079a2
Baird, J.
f4bf2039-6118-436f-ab69-df8b4d17f824
Hosel, J.
9e704ec3-71be-4bab-966a-58e0b7d80305
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
May 2009
Watson, L.
b19c88c5-88f3-44fe-935e-1cece1d079a2
Baird, J.
f4bf2039-6118-436f-ab69-df8b4d17f824
Hosel, J.
9e704ec3-71be-4bab-966a-58e0b7d80305
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
Watson, L., Baird, J., Hosel, J. and Peveler, Robert
(2009)
The effect of concurrent pain on the management of patients with depression: an analysis of NHS healthcare resource utilisation using the GPRD database.
Internation Journal of Clinical Practice, 63 (5), .
(doi:10.1111/j.1742-1241.2009.02017.x).
Abstract
Introduction:
Patients with depression frequently report painful physical symptoms. However, there are scant data from the UK concerning differences in primary and secondary care resource use between depressed patients with and without pain treated in general practice.
Methods:
Patients with depression codes were identified from the General Practice Research Database (GPRD) excluding those with psychoses. The observation period was 1st January 2000–31st December 2006. Patients were further categorised into three groups: (i) no painful physical symptom codes ever in the observation period (NO PAIN); (ii) patients with no other diagnostic or test codes 30 days either side of a pain code (PAIN MINUS DIAGNOSIS) and (iii) patients with pain codes and other diagnostic codes (PAIN PLUS DIAGNOSIS). Rates of general practitioner (GP) visits, antidepressant and concomitant prescribing and switching, secondary care referrals and diagnostic tests were reported per group with 95% confidence limits (CI).
Results:
A total of 145,784 patients with depression aged 18–50 years were selected. Of these, 48,615 (33.3%) were classed as NO PAIN, the remaining 66.6% having pain. PAIN MINUS DIAGNOSIS patients constituted 5654 (5.8%) of those with pain. PAIN MINUS DIAGNOSIS and PAIN PLUS DIAGNOSIS had a significantly higher rate of GP visits than NO PAIN patients, 10.37 (95% CI 10.23, 10.52); 11.15 (11.11,11.20) and 7.04 (7.00, 7.08) respectively. Inter and intraclass drug switching was high with 13% of PAIN MINUS DIAGNOSIS and 14% of PAIN PLUS DIAGNOSIS patients having three or more switches compared with 7% of NO PAIN patients. Referral rates to secondary care were significantly higher in both pain groups compared with patients with no pain. Diagnostic testing was significantly greater in PAIN MINUS DIAGNOSIS and PAIN PLUS DIAGNOSIS groups than NO PAIN patients for all test types, with X-rays being the most common test; 3.85 (3.69,4.00); 2.77 (2.74,2.80); 0.91 (0.89, 0.94) respectively.
Conclusion:
Patients in general practice diagnosed with depression and concurrent painful physical symptoms have higher resource use in primary and secondary care.
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Published date: May 2009
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Local EPrints ID: 148367
URI: http://eprints.soton.ac.uk/id/eprint/148367
PURE UUID: f5deb2c7-ed8b-4f69-a92f-859ef80d4317
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Date deposited: 28 Apr 2010 09:02
Last modified: 14 Mar 2024 02:47
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Author:
L. Watson
Author:
J. Hosel
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