Medication Adherence Perspectives in Haemodialysis Patients: a Qualitative Study

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2017 May 24

PMID 28532480

Citations 20

Authors

Saurav Ghimire

Ronald L Castelino

Matthew D Jose

Syed Tabish R Zaidi

Affiliations

Soon will be listed here.

Abstract

Background: End-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence. The aims of this study were to explore factors associated with medication adherence, and, to examine the differential perspectives on medication-taking behaviour shown by adherent and nonadherent haemodialysis patients.

Methods: A qualitative exploratory design was used. One-on-one semi-structured interviews were conducted with 30 haemodialysis patients at the outpatient dialysis facility in Hobart, Australia. Patient self-reported adherence was measured using 4-item Morisky Green Levine scale. Interview transcripts were thematically analysed and mapped against the World Health Organization (WHO) determinants of medication adherence.

Results: Participants were 44-84 years old, and were prescribed with 4-19 medications daily. More than half of the participants were nonadherent to their medications based on self-reported measure (56.7%, n = 17). Themes mapped against WHO adherence model comprised of patient-related (knowledge, awareness, attitude, self-efficacy, action control, and facilitation); health system/ healthcare team related (quality of interaction, and mistrust and collateral arrangements); therapy-related (physical characteristics of medicines, packaging, and side effects); condition-related (symptom severity); and social/ economic factors (access to medicines, and relative affordability).

Conclusions: Patients expressed a number of concerns that led to nonadherence behaviour. Many of the issues identified were patient-related and potentially modifiable by using psycho-educational or cognitive-behavioural interventions. Healthcare professionals should be more vigilant towards identifying these concerns to address adherence issues. Future research should be aimed at understanding healthcare professionals' perceptions and practices of assessing medication adherence in dialysis patients that may guide intervention to resolve this significant issue of medication nonadherence.

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References

Ghimire S, Peterson G, Castelino R, Jose M, Zaidi S . Medication Regimen Complexity and Adherence in Haemodialysis Patients: An Exploratory Study. Am J Nephrol. 2016; 43(5):318-24. DOI: 10.1159/000446450. View

Williams A, Manias E, Walker R . Adherence to multiple, prescribed medications in diabetic kidney disease: A qualitative study of consumers' and health professionals' perspectives. Int J Nurs Stud. 2008; 45(12):1742-56. DOI: 10.1016/j.ijnurstu.2008.07.002. View

Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. DOI: 10.1093/intqhc/mzm042. View

Karamanidou C, Clatworthy J, Weinman J, Horne R . A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease. BMC Nephrol. 2008; 9:2. PMC: 2270809. DOI: 10.1186/1471-2369-9-2. View

Johnson M . The Medication Adherence Model: a guide for assessing medication taking. Res Theory Nurs Pract. 2002; 16(3):179-92. DOI: 10.1891/rtnp.16.3.179.53008. View

Browne T, Merighi J . Barriers to adult hemodialysis patients' self-management of oral medications. Am J Kidney Dis. 2010; 56(3):547-57. DOI: 10.1053/j.ajkd.2010.03.002. View

de Bruin M, Viechtbauer W, Schaalma H, Kok G, Abraham C, Hospers H . Standard care impact on effects of highly active antiretroviral therapy adherence interventions: A meta-analysis of randomized controlled trials. Arch Intern Med. 2010; 170(3):240-50. DOI: 10.1001/archinternmed.2009.536. View

Krespi R, Bone M, Ahmad R, Worthington B, Salmon P . Haemodialysis patients' beliefs about renal failure and its treatment. Patient Educ Couns. 2004; 53(2):189-96. DOI: 10.1016/S0738-3991(03)00147-2. View

Parham R, Riley S, Hutchinson A, Horne R . Patients' satisfaction with information about phosphate-binding medication. J Ren Care. 2009; 35 Suppl 1:86-93. DOI: 10.1111/j.1755-6686.2009.00063.x. View

10.

Hsu K, Fink J, Ginsberg J, Yoffe M, Zhan M, Fink W . Self-reported Medication Adherence and Adverse Patient Safety Events in CKD. Am J Kidney Dis. 2015; 66(4):621-9. PMC: 4586079. DOI: 10.1053/j.ajkd.2015.03.026. View

11.

Ghimire S, Castelino R, Lioufas N, Peterson G, Zaidi S . Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PLoS One. 2015; 10(12):e0144119. PMC: 4670103. DOI: 10.1371/journal.pone.0144119. View

12.

Lindberg M, Lindberg P . Overcoming obstacles for adherence to phosphate binding medication in dialysis patients: a qualitative study. Pharm World Sci. 2008; 30(5):571-6. DOI: 10.1007/s11096-008-9212-9. View

13.

Osterberg L, Blaschke T . Adherence to medication. N Engl J Med. 2005; 353(5):487-97. DOI: 10.1056/NEJMra050100. View

14.

Griva K, Ng H, Loei J, Mooppil N, McBain H, Newman S . Managing treatment for end-stage renal disease--a qualitative study exploring cultural perspectives on facilitators and barriers to treatment adherence. Psychol Health. 2012; 28(1):13-29. DOI: 10.1080/08870446.2012.703670. View

15.

S Ingersoll K, Cohen J . The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008; 31(3):213-24. PMC: 2868342. DOI: 10.1007/s10865-007-9147-y. View

16.

Rifkin D, Laws M, Rao M, Balakrishnan V, Sarnak M, Wilson I . Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis. 2010; 56(3):439-46. PMC: 2935303. DOI: 10.1053/j.ajkd.2010.04.021. View

17.

Weingart S, Gandhi T, Seger A, Seger D, Borus J, Burdick E . Patient-reported medication symptoms in primary care. Arch Intern Med. 2005; 165(2):234-40. DOI: 10.1001/archinte.165.2.234. View

18.

Searles A, Doran E, Faunce T, Henry D . The affordability of prescription medicines in Australia: are copayments and safety net thresholds too high?. Aust Health Rev. 2012; 37(1):32-40. DOI: 10.1071/AH11153. View

19.

Cleemput I, Kesteloot K, Vanrenterghem Y, de Geest S . The economic implications of non-adherence after renal transplantation. Pharmacoeconomics. 2004; 22(18):1217-34. DOI: 10.2165/00019053-200422180-00006. View

20.

Liyanage T, Ninomiya T, Jha V, Neal B, Patrice H, Okpechi I . Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015; 385(9981):1975-82. DOI: 10.1016/S0140-6736(14)61601-9. View