Mental Health Diagnoses are Not Associated With Indicators of Lower Quality Pain Care in Electronic Health Records of a National Sample of Veterans Treated in Veterans Health Administration Primary Care Settings

• Published in: The journal of pain Vol. 24; no. 2; pp. 273 - 281
• Main Authors: Dobscha, Steven K., Luther, Stephen L., Kerns, Robert D., Finch, Dezon K., Goulet, Joseph L., Brandt, Cynthia A., Skanderson, Melissa, Bathulapalli, Harini, Fodeh, Samah J., Hahm, Bridget, Bouayad, Lina, Lee, Allison, Han, Ling
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023
• Subjects: Chronic Pain - epidemiology; Electronic Health Records; Humans; Mental Health; Musculoskeletal pain; Pain care; Primary Health Care; Quality of Health Care; Retrospective Studies; United States - epidemiology; United States Department of Veterans Affairs; Veterans - psychology; Veterans Health; Veterans Health Administration (VHA); United States; Musculoskeletal pain; Pain care; Veterans Health Administration (VHA); Mental health
• ISSN: 1526-5900; 1528-8447; 1528-8447
• DOI: 10.1016/j.jpain.2022.08.009

•Diagnoses of post-traumatic stress disorder were associated with higher pain quality (PCQ) scores.•Other common mental health diagnosis categories were not associated with PCQ scores.•Married Veterans and Veterans with higher baseline pain levels had higher PCQ scores.•Hispanic ethnicity and cancer diagnoses were associated with slightly lower PCQ scores.•Sensitivity analysis using an alternative PCQ scoring algorithm showed similar results. Prior research has demonstrated disparities in general medical care for patients with mental health conditions, but little is known about disparities in pain care. The objective of this retrospective cohort study was to determine whether mental health conditions are associated with indicators of pain care quality (PCQ) as documented by primary care clinicians in the Veterans Health Administration (VHA). We used natural language processing to analyze electronic health record data from a national sample of Veterans with moderate to severe musculoskeletal pain during primary care visits in the Fiscal Year 2017. Twelve PCQ indicators were annotated from clinician progress notes as present or absent; PCQ score was defined as the sum of these indicators. Generalized estimating equation Poisson models examined associations among mental health diagnosis categories and PCQ scores. The overall mean PCQ score across 135,408 person-visits was 8.4 (SD = 2.3). In the final adjusted model, post-traumatic stress disorder was associated with higher PCQ scores (RR = 1.006, 95%CI 1.002–1.010, P = .007). Depression, alcohol use disorder, other substance use disorder, schizophrenia, and bipolar disorder diagnoses were not associated with PCQ scores. Overall, results suggest that in this patient population, presence of a mental health condition is not associated with lower quality pain care. This study used a natural language processing approach to analyze medical records to determine whether mental health conditions are associated with indicators of pain care quality as documented by primary care clinicians. Findings suggest that presence of a diagnosed mental health condition is not associated with lower quality pain care.