Abstract
PURPOSE: In the context of increased access to multidisciplinary pain team care in the veterans health administration (VHA) in recent years, the current study sought to determine whether continuity of pain clinic care varied for rural compared to urban veterans, following an initial pain clinic visit. Specifically, the frequency of general pain clinic visits and pain clinic psychology visits were contrasted between rural and urban veterans in 2015 and 2022. METHODS: National VHA administrative data were used to build two cohorts of veterans with an initial pain clinic visit in 2015 or 2022. Number of pain clinic visits and number of pain clinic psychology visits in the following year were calculated. Multivariable regression models examined rural/urban differences in receipt of follow-up pain clinic visits and receipt of follow-up pain psychology visits in both 2015 and 2022, after adjusting for demographic characteristics and psychiatric comorbidity. FINDINGS: Veterans with an initial pain clinic visit increased by 22.5% from 2015 (n = 95,549) to 2022 (n = 117,044) and included about one-third rural veterans in both years. Rural veterans had lower rates of follow-up pain clinic visits in 2015 (adjusted odds ratio [aOR]: 0.85; 95% confidence interval [CI]: 0.82-0.87) and this gap remained, but narrowed, by 2022 (aOR: 0.92; 95% CI: 0.90-0.95). The gap in pain psychology follow-up visits, however, disappeared between 2015 (adjusted incidence rate ratio [aIRR]: 0.88; 95% CI: 0.81-0.95) and 2022 (aIRR: 1.00; 95% CI: 0.93-1.08). CONCLUSIONS: The rural gap in continuity of specialty pain clinic services for veterans has improved across time, particularly in relation to pain clinic psychology visits.