Abstract
Patients often fail to attend appointments in chronic pain clinics for unknown reasons.
We hypothesized that certain patient characteristics predict failure to attend scheduled
appointments, pointing to systematic barriers to accessing chronic pain services for
certain underserved populations. We collected retrospective data from a longitudinal
observational cohort of patients at an academic pain clinic in Newark, New Jersey.
To examine the effect of demographic factors on appointment status, we fit a marginal
logistic regression using generalized estimating equations with exchangeable correlation.
A total of 1,394 patients with 3,488 total encounters between January 1, 2006, and
December 31, 2009, were included. Spanish spoken as a primary language (alternatively
Hispanic or other race) and living between 5 and 10 miles from the clinic were associated
with reduced odds of arriving for an appointment; making an appointment for a particular
complaint such as cancer pain or back pain, an interventional pain procedure scheduled
in connection with the appointment, unemployed status, and continuity of care (as
measured by office visit number) were associated with increased odds of arriving.
Spanish spoken as a primary language and distance to the pain clinic predicted failure
to attend a scheduled appointment in our cohort. If these constitute systematic barriers
to access, they may be amenable to targeted interventions.
Perspective
We identified certain patient characteristics, specifically Spanish spoken as a primary
language and geographic distance from the clinic, that predict failure to attend an
inner-city chronic pain clinic. These identified barriers to accessing chronic pain
services may be modifiable by simple cost-effective interventions.
Key words
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Article info
Publication history
Published online: April 21, 2014
Accepted:
March 20,
2014
Received in revised form:
March 6,
2014
Received:
January 29,
2014
Footnotes
R.W. is supported by grants UL1TR000086, TL1RR000087, and KL2TR000088. C.H. is supported by CDC grants 1U01-OH10412-01 (Project Primary Investigator), 1U01OH010411-01, 1U01OH010513-01, NIH grants P01 AG03949, R01 AG034119, 2R01AG022092-06A1, 1UL1TR001073-01, and 5P30-CA013330-40, along with CDC contracts 200-2011-39378 and 200-2011-39489. A.K. and N.S. report no grant support. N.S. serves on the Speaker's Bureau for Cadence Pharmaceutical and Salix Pharmaceuticals. A.K. serves on the Speaker's Bureau for Perdue Pharma, Insys Pharmaceuticals, and Jazz Pharmaceuticals. C.H.'s wife received a $300 fee for record review from Services for the Underserved, New York, NY. R.W. and M.A. report no conflicts of interest.
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Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
