Patient Preference and Adherence (Feb 2020)
Non-Adherence to Pharmacotherapy: A Prospective Multicentre Study About Its Incidence and Its Causes Perceived by Chronic Pain Patients
Abstract
Rute Sampaio, 1, 2 Luís Filipe Azevedo, 3– 5 Cláudia Camila Dias, 4, 5 José M Castro Lopes 1–3 1Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; 2Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal; 3Centro Nacional de Observação em Dor - OBSERVDOR, Porto, Portugal; 4Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto (MEDCIDS), Porto, Portugal; 5Centro de Investigação Em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, PortugalCorrespondence: Rute SampaioFaculty of Medicine of Porto University, Department of Biomedicine – 5 th Floor, Alameda Hernani Monteiro, Porto 4200-319, PortugalEmail [email protected]: Pharmacological interventions remain the cornerstone of chronic pain treatment; however, nearly 40% of the prescription medicines are not taken as prescribed. The present study aims at understanding and describing non-adherence from the perspective of chronic pain patients during a 1-year follow-up study.Methods: A cohort of 950 consecutive patients referred to a first consultation in Multidisciplinary Chronic Pain Clinics was followed with a standardized protocol for 1 year. This included assessment of pain characteristics; prescribed medication; therapeutic adherence; effectiveness of treatment, non-adherence and its perceived reasons; clinical outcomes and quality of life. We used a mixed methods approach, including qualitative and quantitative analyses.Results: Forty-nine percent of the 562 patients who responded to all assessments during follow-up were adherent after 1 year of chronic pain treatment. The core associations between each “non-adherence reason” and Anatomical Therapeutic Chemical Code (ATC) group were perceived side effects (p=0.019) and delayed start (p=0.022) for narcotic analgesics (opioids); perceived non-efficacy (p=0.017) and delayed start (p=0.004) for antiepileptics and anticonvulsants; perceived low necessity (p=0.041) and delayed start (p=0.036) for analgesics antipyretics; change in prescriptions because of a new clinical condition for antidepressants (p=0.024); high concerns (p=0.045) and change in prescriptions because of a new clinical condition (p< 0.001) for non-steroidal anti-inflammatory drugs; delayed start (p=0.016) and financial constraints (p=0.018) for other medications.Discussion: This study emphasizes the patient’s perspective regarding non-adherence to pharmacological treatment of chronic pain, providing valuable and novel information to be used in future interventions to help patients make an informed choice about their adherence behavior.Keywords: chronic pain, pharmacological treatment, non-adherence, patient’s perspective
