Influence of Prescription Benefits on Reported Pain in Cancer Patients
Influence of Prescription Benefits on Reported Pain in Cancer Patients
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DOI：
10.1111/j.1526-4637.2008.00427.x
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发表时间：
2008-11-01
期刊：
影响因子：
3.1
通讯作者：
Wieder, Robert
中科院分区：
文献类型：
--
作者：
Bryan, Margarette;De La Rosa, Nila;Wieder, Robert
为了确定处方覆盖范围与贫困患者的癌症疼痛及其后遗症之间的关系，在UMDNJ大学医院进行了一项回顾性图表审查，分析了20名医疗补助患者和20名自费/慈善护理患者的图表，以了解保险覆盖范围对出院时和随后三次门诊访视时报告的疼痛的影响。确定患者和疾病特征、疼痛治疗方案、剂量、报告的疼痛及其影响。除年龄和种族外，组间无统计学差异。医疗补助组更年轻，大多数是非裔美国人，而自费/慈善护理患者大多数是西班牙裔。自费/慈善护理患者处方了较低剂量的透皮芬太尼。自费/慈善护理患者倾向于报告更高的疼痛水平，但这仅在第二次门诊访视时具有统计学显著性。疼痛强度差异的临床意义反映在计划外访视和入院的差异上。医疗补助组对疼痛治疗方案的依从性有所改善，自费/慈善护理组则有所减少，但差异未达到统计学显著性。缺乏资金作为不遵守的原因，只有自费/慈善护理patients. The贫困的患者没有处方覆盖的倾向于报告更多的癌症疼痛，接受较低剂量的芬太尼透皮贴剂，并倾向于较低的遵守疼痛治疗方案，由于经济原因。在这项试点研究中观察到的趋势将指导假设驱动的回归分析的设计。
To identify associations between prescription coverage and cancer pain and its sequelae in indigent patients.A retrospective chart review at UMDNJ-University Hospital.Charts from 20 patients with Medicaid and 20 patients categorized as Self-pay/Charity Care were analyzed for the influence of insurance coverage on reported pain at the time of a hospital discharge and at three subsequent clinic visits. Patient and disease characteristics, pain regimens, doses, reported pain and its impact were determined.The groups were statistically indistinguishable except for age and ethnicity. The Medicaid group was younger and had a majority of African Americans while the Self-pay/Charity Care patients had a majority of Hispanics. Lower doses of transdermal fentanyl were prescribed to Self-pay/Charity Care patients. Self-pay/Charity Care patients tended to report higher pain levels, but this was statistically significant only at the second clinic visit. The clinical significance of differences in pain intensity was reflected in differences in unscheduled visits and admissions. Adherence to pain regimens improved in the Medicaid group and diminished in the Self-pay/Charity Care group, but the differences did not achieve statistical significance. Lack of funds as the reason for non-adherence was only given by Self-pay/Charity Care patients.Indigent patients without prescription coverage trended toward reporting more cancer pain, received lower doses of transdermal fentanyl, and trended to lower adherence to pain regimens due to financial reasons. The trends observed in this pilot study will guide the design of a hypothesis-driven regression analysis.