Gupta Shaloo, Patel Haridarshan, Scopel Justin, Mody Reema R
Health Outcomes Practice, Kantar Health, Princeton, New Jersey.
Consultant, Immensity Consulting, Inc., Chicago, Illinois.
J Opioid Manag. 2015 Jul-Aug;11(4):325-38. doi: 10.5055/jom.2015.0282.
The authors sought to characterize health-related quality of life (HRQoL), medication adherence, productivity losses, and treatment satisfaction associated with modifications to opioid therapy due to opioid-induced constipation (OIC).
A cross-sectional, between-subjects design was used to examine health outcomes among US noncancer participants currently taking opioids.
PATIENTS, PARTICIPANTS: Participants were adults in the 2012 US National Health and Wellness Survey, who reported currently using opioids (> 30 days) and experiencing constipation. Respondents were categorized as making modifications to opioid therapy due to OIC (modifiers, n = 244) or making no modifications (nonmodifiers, n = 247).
Patient Assessment of Constipation Quality of Life (PAC-QoL) and Symptoms (PAC-Sym), Morisky Medication Adherence Scale (MMAS-4), Work Productivity and Activity Impairment, and the Treatment Satisfaction Questionnaire for Medication (TSQM II) for OIC treatment were administered. Generalized linear models were adjusted to control for baseline characteristics (age, gender, comorbidities, opioid strength, etc).
Modifiers reported poorer HRQoL (PAC-QoL total: 1.74 vs 1.44, p < 0.001), worse constipation (PAC-Sym total: 1.56 vs 1.35, p = 0.003), more pain-related resource use (surgery: odds ratio (OR) = 3.72, p = 0.002; emergency room visits: OR = 1.88, p = 0.049; hospitalizations: OR = 2.47, p = 0.033), and lower adherence (MMAS-4 pain: OR = 0.12, p < 0.001; MMAS-4 OIC: OR = 0.39, p < 0.001) than nonmodifiers. Modifiers reported greater presenteeism (49.75 percent vs 38.28 percent, p = 0.038), but no significant differences were found for activity impairment or OIC treatment satisfaction.
Treating OIC effectively may help prevent inadequate pain management secondary to opioid therapy modification, help increase HRQoL, lessen OIC symptoms, decrease productivity loss, and improve adherence to opioid and OIC treatments.
作者试图描述与因阿片类药物引起的便秘（OIC）而调整阿片类药物治疗相关的健康相关生活质量（HRQoL）、药物依从性、生产力损失和治疗满意度。
采用横断面、受试者间设计来检查美国目前正在服用阿片类药物的非癌症参与者的健康结果。
患者、参与者：参与者为2012年美国国家健康与健康调查中的成年人，他们报告目前正在使用阿片类药物（超过30天）且患有便秘。受访者被分为因OIC而调整阿片类药物治疗的人群（调整者，n = 244）或未进行调整的人群（未调整者，n = 247）。
采用便秘生活质量患者评估（PAC-QoL）和症状评估（PAC-Sym）、Morisky药物依从性量表（MMAS-4）、工作生产力和活动障碍量表，以及OIC治疗的药物治疗满意度问卷（TSQM II）。采用广义线性模型对基线特征（年龄、性别、合并症、阿片类药物强度等）进行校正。
与未调整者相比，调整者报告的HRQoL较差（PAC-QoL总分：1.74对1.44，p < 0.001），便秘情况更严重（PAC-Sym总分：1.56对1.35，p = 0.003），与疼痛相关的资源使用更多（手术：比值比（OR）= 3.72，p = 0.002；急诊就诊：OR = 1.88，p = 0.049；住院：OR = 2.47，p = 0.033），依从性更低（MMAS-4疼痛：OR = 0.12，p < 0.001；MMAS-4 OIC：OR = 0.39，p < 0.001）。调整者报告的出勤主义更高（49.75%对38.28%，p = 0.038），但在活动障碍或OIC治疗满意度方面未发现显著差异。
有效治疗OIC可能有助于预防因调整阿片类药物治疗导致的疼痛管理不足，有助于提高HRQoL，减轻OIC症状，减少生产力损失，并提高对阿片类药物和OIC治疗的依从性。
