Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.
Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.
复制标题
DOI：
10.1097/j.pain.0000000000000583
复制
发表时间：
2016-08
期刊：
影响因子：
7.4
通讯作者：
Rosenblum A
中科院分区：
文献类型：
--
作者：
Nikulina V;Guarino H;Acosta MC;Marsch LA;Syckes C;Moore SK;Portenoy RK;Cruciani RA;Turk DC;Rosenblum A
在慢性非癌症疼痛的长期阿片类药物治疗期间，监测具有异常阿片类药物服用行为（AMTB）史的患者的药物依从性是一项必不可少的实践。然而，对自我报告、医生报告和生物流体筛查的现有监测工具之间的一致性的研究有限。目前的研究检查了患者和提供者对AMTB和尿液药物筛查的评估之间的关联，使用的数据来自一项认知行为干预的随机试验，该试验旨在改善110名接受阿片类药物治疗的慢性疼痛患者的药物依从性和疼痛相关结局，这些患者筛查出AMTB阳性并参加了疼痛计划。提供者完成了异常行为检查表（ABC），患者完成了当前阿片类药物滥用测量（COMM）和化学应对量表（CCI）。在多变量分析中，将ABC评分与COMM和CCI评分进行比较，同时控制人口统计学和AMTB的既定风险因素，如疼痛严重程度。根据临床截止值，84%的患者报告了具有临床意义的AMTB水平，提供者将36%的患者评为升高水平。提供者报告的AMTB与COMM或CCI评分无关。然而，有经验的提供者（执业护士/主治医生）的ABC评分高于经验不足的提供者（研究员），并与CCI评分和AMTB的风险因素相关。患者和提供者报告的AMTB和尿液药物筛查结果之间的相关性很低，而且很大程度上不显著。总之，患者和供应商之间的一致性报告AMTB慢性疼痛患者处方阿片类药物的供应商培训水平不同。
During long-term opioid therapy for chronic, non-cancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report and bio-fluid screening. The current study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated, chronic pain patients who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared to COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely non-significant. In conclusion, concordance between patient and provider reports of AMTB among chronic pain patients prescribed opioid medication varied by provider level of training.