Determinants of medication underuse and medication overuse in patients with chronic non-malignant pain: A multicenter study

作者：Broekmans Susan^*; Dobbels Fabienne; Milisen Koen; Morlion Bart; Vanderschueren Steven

来源：International Journal of Nursing Studies, 2010, 47(11): 1408-1417.

DOI：10.1016/j.ijnurstu.2010.03.014

• Patient adherence
• Non-malignant
• Chronic pain
• Medication

Background: 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.
Objective: 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.
Design: A multicenter cross-sectional study.
Settings: Three multidisciplinary outpatient pain centers in Flanders, Belgium.
Participants: A total of 265 patients with chronic non-malignant pain participated in the study.
Methods: 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.
Results: 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).
Conclusion: 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.

• 出版日期2010-11