Prevalence, causes, severity, impact, and management of chronic pain in Australian general practice patients.

OBJECTIVE: To determine the prevalence of chronic pain, its causes, severity, management, impact on sleep, mood and activity levels, and general practitioner (GP) and patient satisfaction with pain management. DESIGN: A subset of 197 GPs and 5,793 patients from the BEACH program, a continuous, national cross-sectional survey of Australian general practice. RESULTS: The prevalence of chronic pain was 19.2% (95% confidence interval: 17.4-21.0) (N = 1,113). The most commonly reported causal conditions were osteoarthritis (48.1%) and back problems (29.4%). For pain severity (using Von Korff's pain grades), 25.2% were at Grade I (lowest); 37.1% were at Grade II; 28.3% at Grade III; and 9.4% at Grade IV (highest). Medication was used for pain management by 86.1% of patients, and one third also used nonpharmacological managements. One third of patients were taking opioids, most commonly those at the highest pain severity grades. On "Live Better with Pain Log" scale, the impact of pain was similar across activity (mean = 4.0), sleep (mean = 4.8), and mood (mean = 4.8). On a scale of 1 (highest) to 5 (lowest), GPs' satisfaction (mean = 2.5) was highly correlated (r = 0.7) with patients' satisfaction (mean = 2.6) with pain management. CONCLUSIONS: Chronic pain impairs patient quality of life, and is a public health burden. This study provides a national overview of the prevalence, causes, severity, management and impact of chronic pain in Australian general practice patients, and the parity between GP and patient satisfaction with pain management.

Estimating prevalence of common chronic morbidities in Australia.

OBJECTIVES: To estimate prevalence of selected diagnosed chronic diseases among patients attending general practice, in the general practice patient population, and in the Australian population, and to compare population estimates with those of the National Health Survey (NHS). DESIGN, SETTING AND PARTICIPANTS: In late 2005, 305 general practitioners each provided data for about 30 consecutive patients (total, 9156) as part of the BEACH (Bettering the Evaluation And Care of Health) program, a continuous national study of general practice activity. GPs used their knowledge of the patient, patient self-report, and medical records as sources. MAIN OUTCOME MEASURES: Crude prevalence of each listed condition currently under management among surveyed patients, and adjusted prevalence for the general practice patient population, and the national population. RESULTS: 39.6% of respondents had none of the listed conditions diagnosed; 30.0% had a cardiovascular problem (uncomplicated hypertension, 17.6%; ischaemic heart disease, 9.5%); 24.8% had a psychological problem (depression, 14.2%; anxiety, 10.7%); 22.8% had arthritis, mostly osteoarthritis (20.0%); 10.7% had asthma; and 8.3% had diabetes, mostly type 2 (7.2%). Adjustment to the population attending general practice resulted in lower estimates for cardiovascular disease, arthritis and diabetes but had little effect on prevalence of asthma and psychological problems. After adjusting for non-attenders, about one in five people in the population had a cardiovascular problem, a similar proportion had a psychological problem, 14.8% had arthritis, and about 10% had asthma, hyperlipidaemia and gastro-oesophageal reflux disease. Estimates were similar to NHS results for any arthritis, asthma, and malignant neoplasms; higher for any cardiovascular problem; far higher for specific cardiovascular diseases, cerebrovascular disease and hyperlipidaemia; and almost twice the NHS estimate for psychological problems (particularly depression and anxiety). Estimates for type 1 diabetes aligned with NHS results, but were far higher for "all diabetes" and type 2 diabetes. CONCLUSIONS: This study offers an alternative, perhaps more accurate, approach to measurement of disease prevalence than the NHS approach, which relies on respondent self-report alone. It provides valid prevalence estimates with the help of GPs at a fraction of the cost of the NHS. This study could be repeated annually to augment other data sources and better define existing health needs in the population.