The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness: Primary Care Experience, Chronic Pain, and Substance use

Background Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. Objective To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2024, Vol.39 (16), p.3172-3181
Main Authors: Varley, Allyson L., DeRussy, Aerin J., Jones, Audrey L., Hoge, April, Gordon, Adam J., Richman, Joshua, Riggs, Kevin R., Gelberg, Lillian, Gabrielian, Sonya, Blosnich, John R., Montgomery, Ann Elizabeth, Carey, Evan, Kertesz, Stefan G.
Format: Article
Language:English
Subjects:
Internal Medicine
Medicine
Medicine & Public Health
Original Research
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Summary:Background Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. Objective To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences among VHE and to explore the association of pain treatment utilization and unfavorable care experiences in VHE with chronic pain. Methods We surveyed VHE ( n  = 3039) engaged in homeless-tailored primary care at 29 Veterans Affairs Medical Centers (VAMCs). We assessed unfavorable primary care experiences with four validated Primary Care Quality-Homeless (PCQ-H) scales: multivariable logistic regressions explored associations between unfavorable care experiences for VHE with chronic pain and problematic substance use, chronic pain alone, problematic substance use alone, or neither. We then examined the association between receipt of pain treatments and unfavorable experiences among VHE with chronic pain. Last, we identified PCQ-H items that had the greatest difference in unfavorable response rates between VHE with and without chronic pain. Results The prevalence of unfavorable primary care experience was higher on all four scales for patients reporting chronic pain (with or without problematic substance use) (all p  
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-024-09078-x