Impact of Pharmacist Counseling on Treatment Adherence Outcomes of patients undergoing Maintenance Hemodialysis

Abstract

Objectives: The study objective was to assess the impact of pharmacists’ counseling on treatment adherence of patients undergoing maintenance hemodialysis. Methods: This was a quasi-experimental interventional study with four months of follow-up. An indirect method was used to assess adherence and self-report from patients. A modified and validated version of the Greek simplified Medication Adherence questionnaire for hemodialysis patients was used. Patient counseling by the pharmacist was described as a semi-structured approach. A comparison of the scores in each month was performed using Repeated-measures ANOVA. Friedman's test, Wilcoxon signed-rank test, Cochran's Q test, McNemar test. Results: A significant improvement in % of medication adherence over the months (p<0.001, by Cochran’s Q test). There was a significant improvement in fluid adherence in every pair of months, except for months 1 to 2 (by Repeated-measures ANOVA tests). The mean rank shows diet adherence was improved from months 1, months 2, 3, and 4 (Friedman’s test, p<=0.001). The pairwise comparison shows that diet adherence was found to be statistically significant between months 1 and 2, 3, and 4 (P<0.05). All the other pairwise comparison shows no difference. Repeated measure ANOVA shows mean of the weight gain is reduced from months 1 to 2, 3, and 4(p <0.001). Conclusion: The patients improved in treatment adherence in four months. Pharmacists' counseling, along with the services of other healthcare professionals, positively affected patient adherence. Therefore, we recommend that pharmacy counseling services be added to the services available to hemodialysis patients.