Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria

Abstract

The aim of this analysis was to assess the impact of chronic back pain and psychological distress on the utilization of primary and secondary levels of care in the ambulatory health care sector in Austria - a country without a gatekeeping system. Additionally, we aimed to determine if the joint effect of chronic back pain and psychological distress was higher than the impact of the sum of the two single conditions. The database used for this analysis was the Austrian Health Interview Survey, with data from 15,474 individuals. Statistical methods used were descriptive tests, regression models and the calculation of synergistic effects. Both chronic back pain and psychological distress had a positive association with the utilization of the primary (OR for chronic back pain 1.53 and psychological distress 1.33) and secondary (OR for chronic back pain 1.32 and psychological distress 1.24) levels of the health care sector. In the fully adjusted model, the synergistic effect of chronic back pain and psychological distress was significant for the secondary level of care (S 1.99, PAF 0.20), but not for the primary level of care (S 1.16, PAF 0.07). Synergistic effects and associations for chronic back pain and psychological distress on the utilization of both the primary and secondary levels of the ambulatory health care sector were observed, particularly for the secondary level of care. Our results demonstrate the utilization of health care services settings by individuals with these conditions, and offer opportunities to consider reorganization and structuring of the Austrian health care system.

The influence of general practitioners on access points to health care in a system without gatekeeping: a cross-sectional study in the context of the QUALICOPC project in Austria

“…Therefore, the sheer presence of a usual GP, which is politically and informally promoted as the first point of contact and coordinator of care, is insufficient to regulate pathways of patients within the health care system. This is particularly evident for patients with chronic conditions, who otherwise would benefit most from appropriate pathways of care (7,15,32,39).…”

How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey

“…In accordance with our study, an association of multiple pain, pain severity, and depressive disorders was found in the elderly population in a recent study in Germany [ 55 ]. Moreover, studies suggest that the interaction between pain and mental disorders act synergistically with regard to higher health care utilisation [ 33 ], or exit from the labour market [ 16 , 32 ]. However, whether depression and anxiety are a cause or consequence of pain, or whether they are the results of different paths of the same pathogenesis, still remains unresolved and under discussion [ 30 , 31 ].…”

“…Most studies focussing on social factors related to pain either do not differentiate between pain in different body sites [ 1 , 3 , 6 , 14 , 16 , 20 , 21 , 25 – 27 , 31 ], or focus narrowly on pain in one specific area like back pain [ 11 , 15 , 30 , 32 , 33 ], low back pain [ 7 , 10 ], headache [ 9 , 19 , 22 ], on pain due to a specific underlying pathogenesis [ 4 , 8 ], a specific disease like migraine [ 28 , 29 ], or osteoarthritis [ 5 ].…”

Preventive aspectsregarding back pain

“…That means that the effect of pain and ADL deficits on healthcare utilisation was much higher than merely the addition of the effects of the single conditions [27]. Similarly, a synergistic effect on healthcare utilisation (primary care and specialised outpatient care) was found in the general adult population in Austrians regarding chronic back pain and anxiety/depression [28]. Loss of productivity is one of the main factors causing costs due to back pain.…”