Abstract
BackgroundEnd-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.MethodsA 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.ResultsParticipants 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).ConclusionsPatients 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.
Highlights
End-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence
We aimed to qualitatively explore factors associated with medication adherence, and examine the differential perspectives on medication-taking behaviour shown by haemodialysis patients
Due to the complexity of disease treatment and associated symptom burden, patients often required additional over-the-counter medicines including multi-vitamin preparations, vitamin D, iron and mineral supplements, pain medicines etc., which are not covered by the benefit schemes and patients needed them. This qualitative study explored factors associated with medication adherence in haemodialysis patients, and examined their perceptions on medication-taking behaviour
Summary
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. An estimated 2.6 million people worldwide received dialysis treatment for End-stage kidney disease (ESKD) in 2010, and a two-fold increase is expected by 2030 [1]. Medication nonadherence is highly prevalent in ESKD patients undergoing haemodialysis with an average prevalence rate of 52.5% [4]. Little is known about haemodialysis patients’ perceptions regarding their prescribed regimen and the factors influencing their medication-taking behaviour. We aimed to qualitatively explore factors associated with medication adherence, and examine the differential perspectives on medication-taking behaviour shown by haemodialysis patients
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