Factors Affecting Patient Satisfaction with Health Care for Chronic Low Back Pain

Katharine Hepburn once said, I don't know what happiness is. When I get a box of chocolate turtles, I'm happy. When my box of chocolate turtles is gone, I'm unhappy. Happiness or satisfaction isn't always so easy when you suffer from chronic low back pain. In this study, researchers conducted a telephone survey of 624 people with chronic low back pain to find out what makes them unhappy with their health care. The two main areas of study included satisfaction with the last visit about their back pain and whether they intended to seek services elsewhere.

Patient satisfaction may not seem like a valid way to assess the success of any treatment. But, in fact, patient satisfaction is very important -- especially to the cost of health care. A satisfied customer (patient) is a happy health care consumer with lower overall health care costs. The patient who is not satisfied with the care received and who intends to seek other services contributes to the rising cost of health care.

Back pain is a good place to start because it affects so many people. Studies show that eight out of every 10 adults will experience back pain some time in their lives. When 80 per cent of the population is involved, that gets a lot of attention. And even though less than 10 per cent of acute back pain episodes go on to become chronic cases of low back pain, this figure is rising. More and more people are seeking the services of health care specialists for low back pain that lasts more than three months.

Lots of treatment approaches for chronic low back pain have been studied. In the end, it turns out that staying active and getting at least 30 minutes of exercise daily is the best medicine around for this problem. Unfortunately, that means a change in lifestyle for many people who are more likely to seek passive treatment with one health care provider after another. If researchers can find out what factors contribute to satisfaction with health care services, it may be possible to use those variables early on in treatment for a faster, more successful result.

The patients in this study completed several surveys answering questions about their pain intensity, whether or not they had back and leg pain, their general health status, functional level, and use of health-care providers and treatments over the past 12 months. A separate, six-question survey assessed patient satisfaction. These questions were direct and to the point (e.g., Were you satisfied with your doctor? Would you see the same doctor again for this problem?).

Many patient characteristics were collected and compared. For example, age, race, sex, education level, annual household income, and type of insurance were all considered. Type of care last received (e.g., primary care physician, surgeon, physical therapist, chiropractor, other specialist) was noted. Pain rating and number of health visits for back pain in the last three- and 12 months were recorded. Data on the amount and type of pain medication used in the last month and over the last year were also collected.

Here's what they found. The patients most likely to be unhappy with their health care for chronic low back pain were younger, Hispanic, had higher ratings of pain intensity, and were without health insurance. The patient most likely to seek additional services was young, Black, uninsured, and with an overall lower level of mental and physical health. Medicare patients and individuals who had some type of insurance were the least likely to seek additional care.

One other important finding was that patients who used narcotic medications to control their pain were more likely to be satisfied with their care. Reasons for this weren't explored in this study but the authors offered some suggestions. Perhaps the fact that their doctor prescribed medications validates the patient (proves there's something wrong). It's also possible that these medications alter mood and improve a sense of well-being. But as this study showed, the functional status of patients on narcotics didn't improve.

In general, the majority of patients were satisfied with their care. The number of visits didn't seem to affect satisfaction. Those who weren't happy didn't attribute their dissatisfaction with their health care provider. They might not have felt they got an adequate explanation of their problem, so decided to seek other opinions. That's a problem when it comes to chronic back pain because most of the time, the reason for their pain is unknown. Seeking more diagnostic help and spending more money to do so doesn't solve the problem.

That brings us back to what we already know works: regular exercise and change in behavior. Until patients are convinced that this is the best medicine for them, they will continue to seek more and more health care services looking for an answer to their problem. The results of this study show that there are some factors linked with dissatisfaction (age, race, insurance status, mental health). But exactly how and why these particular factors affect the way patients think is still unknown. The authors suggest that more study is needed to understand how to bring care to a level that meets patients' needs and satisfies them. The role of narcotic medications in patient satisfaction deserves a second look as well.

Andrea S. Wallace, PhD, RN, et al. Comfortably Numb? Exploring Satisfaction with Chronic Back Pain Visits. In The Spine Journal. September 2009. Vol. 9. No. 9. Pp. 721-728.

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