Gender differences in reports of chronic pain, in coping responses to the consequences of painful conditions, and in the use of health care services have recently received considerable attention. This report examines the gender effects of referral practices to a chronic pain specialty clinic and the nature of the relationship between health care needs and use of health care services. This historical cohort analytic survey of 571 patients referred to the pain clinic assessed them by gender for selected referral variables through a chart review, and randomly sampled (n = 222) these patients' current adjustment and health service use through mailed questionnaires or telephone interview. The questionnaire consisted of psychosocial scales (PAIS-SR; Social Support); cognitions, including the Meaning of Illness Questionnaire (MIQ); and a health service utilization inventory designed to assess direct, out-of-pocket, indirect, and cash transfer expenditures. Selected referral demographic characteristics were similar between the gender groups at referral with the exception of three factors: distance from clinic, referring physician, and having a disability pension. At follow-up, the adjustment groups were similar to their gender counterparts on all sociodemographic and clinical variables including a high prevalence of poor psychosocial adjustment. Women's adjustment was accounted for by cognitive variables, whereas men's adjustment was by social variables. There were differential expenditures for health service use by gender with similar health care needs. Women used specific health care services more than men, which was explained in part by psychological need and meaning. Men's use of services, on the other hand, was explained in part by meaning alone. The importance of gender differences in the role that social support and meaning variables play in predicting psychosocial adjustment to chronic pain is elaborated in this study. The interaction effects between health care need and gender to explain variations in use of health care services indicates that users of services varied in ways that suggest a bias or barrier of their own or of service providers to access services.
*School of Nursing, ‡Department of Clinical Epidemiology and Biostatistics, ¶Centre for Health Economics and Policy Analysis, ∥Department of Psychiatry, §Health and Social Service Utilization Research Unit, McMaster University, Faculty of Health Sciences; and †Chronic Pain and Clinic Services, The Chedoke Division of the Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
Manuscript submitted October 26, 1995; 1st revision received March 7, 1996; 2nd revision received June 12, 1996; accepted for publication July 31, 1996.
Address correspondence and reprint requests to Dr. R. Weir at School of Nursing, Faculty of Health Sciences, McMaster University, HSC 3N28, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.