Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
Int J Nurs Stud. 2010 Nov;47(11):1408-17. doi: 10.1016/j.ijnurstu.2010.03.014. Epub 2010 May 15.
In chronic non-malignant pain, medication is often used as an important cornerstone of the treatment. Medication non-adherence is a frequent problem in chronic conditions. In patients with chronic non-malignant pain, medication non-adherence ranges between 8% and 53%. Two types of non-adherence can be identified: underuse and overuse of pain medication.
To examine determinants of both medication underuse and overuse non-adherence in patients with chronic non-malignant pain, with a focus on factors related to all five categories of determinants of medication non-adherence simultaneously, as proposed by the WHO.
A multicenter cross-sectional study.
Three multidisciplinary outpatient pain centers in Flanders, Belgium.
A total of 265 patients with chronic non-malignant pain participated in the study.
Medication non-adherence was assessed by a self-report interview. Associations of socio-economic, treatment related, condition related, patient related and health care system related factors with medication underuse or overuse were determined by building two separate multivariable binary logistic regression models.
Thirty eight percent of the patients were fully adherent. Based on multivariable analyses, underuse was significantly associated with more prescribed analgesics (OR=2.303), self-medication (OR=4.679), lower pain intensity (OR=0.821), active coping strategies (OR=1.132) and lack of information (OR=0.268). Overuse of medication was associated with more prescribed analgesics (OR=1.645) and current smoking (OR=2.744).
Patients underusing or overusing their medication do have a different risk profile. The set of determinants of non-adherence, proposed by WHO, is suitable to study determinants of underuse, but the framework is less suitable to study determinants of medication overuse.
在慢性非恶性疼痛中，药物治疗通常是治疗的重要基石。药物不依从是慢性疾病中的一个常见问题。在慢性非恶性疼痛患者中，药物不依从的比例在 8%至 53%之间。可以识别两种类型的不依从：药物过度使用和药物使用不足。
研究慢性非恶性疼痛患者药物使用不足和过度使用不依从的决定因素，重点关注与世界卫生组织提出的药物不依从五个类别的决定因素相关的因素，同时关注所有五个类别的决定因素。
多中心横断面研究。
比利时佛兰德斯的三个多学科门诊疼痛中心。
共有 265 名慢性非恶性疼痛患者参加了这项研究。
通过自我报告访谈评估药物不依从性。通过建立两个单独的多变量二项逻辑回归模型，确定社会经济、治疗相关、病情相关、患者相关和医疗保健系统相关因素与药物使用不足或过度使用的关联。
38%的患者完全依从。基于多变量分析，药物使用不足与更多的处方止痛药（OR=2.303）、自我用药（OR=4.679）、较低的疼痛强度（OR=0.821）、积极的应对策略（OR=1.132）和缺乏信息（OR=0.268）显著相关。药物过度使用与更多的处方止痛药（OR=1.645）和当前吸烟（OR=2.744）有关。
药物使用不足或过度使用的患者确实有不同的风险特征。世界卫生组织提出的不依从决定因素集适用于研究药物使用不足的决定因素，但该框架不太适用于研究药物过度使用的决定因素。
