Zin Che Suraya, Taufek Nor Hidayah, Ahmad Mazlila Meor
Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia.
Department of Anesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia.
Front Pharmacol. 2019 Oct 29;10:1286. doi: 10.3389/fphar.2019.01286. eCollection 2019.
Limited data are available on the adherence to opioid therapy and the influence of different patient groups on adherence. This study examined the patterns of adherence in opioid naïve and opioid existing patients with varying age and gender. This retrospective cohort study was conducted using the prescription databases in tertiary hospital settings in Malaysia from 2010 to 2016. Adult patients aged ≥18 years, receiving at least two opioid prescriptions, were included and stratified into the opioid naïve and existing patient groups. Adherence to opioid therapy was measured using the proportion of days covered (PDC), which was derived by dividing the total number of days covered with any opioids by the number of days in the follow-up period. Generalized linear modeling was used to assess factors associated with PDC. A total of 10,569 patients with 36,650 prescription episodes were included in the study. Of these, 91.7% ( = 9,696) were opioid naïve patients and 8.3% ( = 873) were opioid existing patients. The median PDC was 35.5% (interquartile range (IQR) 10.3-78.7%) and 26.8% (IQR 8.8-69.5%) for opioid naïve and opioid existing patients, respectively. A higher opioid daily dose (coefficient 0.010, confidence interval (CI) 0.009, 0.012 < 0.0001) and increasing age (coefficient 0.002, CI 0.001, 0.003 < 0.0001) were associated with higher levels of PDC, while lower PDC values were associated with male subjects (coefficient -0.0041, CI -0.072, -0.010 = 0.009) and existing opioid patients (coefficient -0.134, CI -0.191, -0.077 < 0.0001). The suboptimal adherence to opioid medications was commonly observed among patients with non-cancer pain, and the opioid existing patients were less adherent compared to opioid naïve patients. Increasing age and a higher daily opioid dose were factors associated with higher levels of adherence, while male and opioid existing patients were potential determinants for lower levels of adherence to opioid medications.
关于阿片类药物治疗的依从性以及不同患者群体对依从性的影响，现有数据有限。本研究调查了不同年龄和性别的初用阿片类药物患者和已使用阿片类药物患者的依从模式。这项回顾性队列研究利用了马来西亚三级医院2010年至2016年的处方数据库。纳入年龄≥18岁、至少接受过两份阿片类药物处方的成年患者，并将其分为初用阿片类药物患者组和已使用阿片类药物患者组。使用覆盖天数比例（PDC）来衡量阿片类药物治疗的依从性，该比例通过将使用任何阿片类药物的总覆盖天数除以随访期天数得出。采用广义线性模型评估与PDC相关的因素。该研究共纳入10569例患者，有36650次处方记录。其中，91.7%（n = 9696）为初用阿片类药物患者，8.3%（n = 873）为已使用阿片类药物患者。初用阿片类药物患者和已使用阿片类药物患者的PDC中位数分别为35.5%（四分位间距（IQR）10.3 - 78.7%）和26.8%（IQR 8.8 - 69.5%）。每日阿片类药物剂量较高（系数0.010，置信区间（CI）0.009，0.012，P < 0.0001）和年龄增加（系数0.002，CI 0.001，0.003，P < 0.0001）与较高的PDC水平相关，而较低的PDC值与男性受试者（系数 -0.0041，CI -0.072，-0.010，P = 0.009）和已使用阿片类药物患者（系数 -0.134，CI -0.191，-0.077，P < 0.0001）相关。在非癌痛患者中，阿片类药物的依从性普遍欠佳，与初用阿片类药物患者相比，已使用阿片类药物患者的依从性更低。年龄增加和每日阿片类药物剂量较高是依从性较高的相关因素，而男性和已使用阿片类药物患者是阿片类药物依从性较低的潜在决定因素。
