Mental health diagnoses are not associated with indicators of lower quality pain care in electronic health records of a national sample of Veterans treated in Veterans Health Administration primary care settings.

Prior research has demonstrated disparities in general medical care for patients with mental health conditions, but little is known about disparities in pain care. The objective of this retrospective cohort study was to determine whether mental health conditions are associated with indicators of pain care quality (PCQ) as documented by primary care clinicians in the Veterans Health Administration (VHA). We used natural language processing to analyze electronic health record data from a national sample of Veterans with moderate to severe musculoskeletal pain with primary care visits in Fiscal Year 2017. Twelve PCQ indicators were annotated from clinician progress notes as present or absent; PCQ score was defined as the sum of these indicators. Generalized estimating equation Poisson models examined associations among mental health diagnosis categories and PCQ scores. The overall mean PCQ score across 135,408 person-visits was 8.4 (SD=2.3). In the final adjusted model, post-traumatic stress disorder was associated with higher PCQ scores (RR=1.006, 95%CI 1.002 to 1.010, P=.007). Depression, alcohol use disorder, other substance use disorder, schizophrenia and bipolar disorder diagnoses were not associated with PCQ scores. Overall, results suggest that in this patient population, presence of a mental health condition is not associated with lower quality pain care.