Prevalence and Predictors of Patient Nonadherence to Pharmacological Acute Pain Therapy at Home After Day Surgery: A Prospective Cohort Study

Stessel, Björn; Theunissen, Maurice; Marcus, Marco A. E.; Joosten, Elbert A.J.; Kuijk, Sander M. J. van; Fiddelers, Audrey A. A.; Peters, Madelon L.; Hoofwijk, D.; Buhre, W.; Gramke, Hans-Fritz

doi:10.1111/papr.12589

Cited by 11 publications

(19 citation statements)

References 44 publications

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“…Furthermore, patients in the full adherence group were overall more satisfied with their medication than the non-adherence/partial adherence group, which was in line with our previously published results (14). Recently, we published the results of a prospective cohort study (n = 1248) assessing the prevalence of adherence to a treatment schedule for pain after ambulant surgery (14). We demonstrated a prevalence of respectively 21.60% and 20.00% of non-adherence and partial adherence to the treatment schedule after ambulant surgery (14).…”

Section: Discussionsupporting

confidence: 92%

“…We also found that women and patients with high baseline levels for pain and pain interference with social activities were underrepresented in the full-adherence group. Furthermore, patients in the full adherence group were overall more satisfied with their medication than the non-adherence/partial adherence group, which was in line with our previously published results (14). Recently, we published the results of a prospective cohort study (n = 1248) assessing the prevalence of adherence to a treatment schedule for pain after ambulant surgery (14).…”

Section: Discussionsupporting

confidence: 87%

“…Proper adherence to prescribed postoperative pain medication is a prerequisite to prevent the pain after ambulant surgery (14). Adherence is "the extent of similarity between the patient's actual dosage and the predefined schedule" (15).…”

Section: Introductionmentioning

confidence: 99%

“…The reasons for medication non-adherence are categorized into two groups: intentional and unintentional (16). Unintentional non-adherence can occur when a patient wants to follow the schedule but is prohibited due to a poor recall or financial issues (14,16). Intentional non-adherence can occur when the patient is deliberately not adhering to the treatment schedule because of fear of adverse effects (14,16).…”

Section: Introductionmentioning

confidence: 99%

“…Unintentional non-adherence can occur when a patient wants to follow the schedule but is prohibited due to a poor recall or financial issues (14,16). Intentional non-adherence can occur when the patient is deliberately not adhering to the treatment schedule because of fear of adverse effects (14,16). It has already been demonstrated that analgesic non-adherence and partial adherence after day surgery is rather common (14).…”

Section: Introductionmentioning

confidence: 99%

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Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery

et al. 2020

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Background: Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. Objectives: The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. Methods: The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. Results: Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. Conclusions: Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%