Secondary healthcare utilization among users of a self-management application for musculoskeletal pain: A prospective cohort study based on 12,842 individuals in Denmark.

OBJECTIVE

To identify which users of a self-management app for musculoskeletal pain are more likely to utilize secondary healthcare (i.e., specialist services within the musculoskeletal domain following primary care referrals).

STUDY

DESIGN

Cohort study with one-year follow-up.

METHODS

Data on secondary healthcare utilization was collected from the Danish National Patient Register. Potential risk factors were collected from the Danish Population Statistics Register and the TrainAwayPain application (TAP app) which is designed to support musculoskeletal pain self-management. Univariate negative binomial regression models were applied to identify differences in the frequency of secondary healthcare contacts due to musculoskeletal pain in the 12 months following app download. Results were reported as incidence rate ratios (IRRs).

RESULTS

We observed higher utilization of secondary healthcare among females (IRR 1.32 (95 %CI 1.19-1.46)), older (IRR 1.03 (95 %CI 1.02-1.03)), those with short-cycle higher education (IRR 1.91 (95 %CI 1.61-2.26)), residents of the Region of Southern Denmark (IRR 1.82 (95 %CI 1.48-2.24)), those experiencing hip pain (IRR 1.63 (95 %CI 1.33-2.00)), and those with long-term pain (IRR 2.31 (95 %CI 2.06-2.62)). By contrast, lower rates of secondary healthcare utilization were noted among app users with higher musculoskeletal health status (IRR 0.95, (95 %CI 0.95-0.96)). These comparisons are relative to app users who are male, younger, live in the North Denmark Region, have neck pain, and experience pain <1 month.

CONCLUSION

Those who most likely seek secondary healthcare may be female, older, not from the Northern part of Denmark, experiencing peripheral joint pain rather than spinal pain, have longer symptom duration, and more severe symptoms.