Abstract
BackgroundHemodialysis patients (HD) need to adhere to a complex medication regimen. Because their daily pill burden is one of the highest reported, poor compliance is a major cause of therapeutic failure. The primary aim of this study was to define patterns of medication prescription, intake and documentation among HD patients.MethodsHD patients treated between 2007 and 2009 and assigned to the largest health service provider in Israel were randomly selected. Drug practices were abstracted from their records and compared to electronic pharmacy data. The discrepancy between drug intake reports and the actual purchase was measured to estimate adherence. Drug purchase, intake report and physician order were plotted in complementing diagrams to appreciate consistency and discrepancy patterns.ResultsThe study included full analysis of 75 patients. The mean overall drug adherence was 56.7% (95% CI 53.6-59.9%), varying among drug families and over time. Often, there was a systematic disengagement between the nurses’ documentation and the actual patient purchase. Specifically, we observed either different quantities of medication use, improper documentation of a non-purchased drug, drug purchase without nurse documentation and futile physician attempts to modify prescriptions of unpurchased medication. We found a high rate of physician order turbulence for active vitamin D and calcium.ConclusionsDrug prescription, documentation and adherence are incongruent and their mismatches are diverse. Summary estimates do not divulge the extent of these disparities. These system-wide communication failures compromise patient care. Strategies to promote system reconciliation and reasonable medication prescription are in need.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-170) contains supplementary material, which is available to authorized users.
Highlights
Hemodialysis patients (HD) need to adhere to a complex medication regimen
We found a high rate of physician order turbulence for active vitamin D and calcium
Strategies to promote system reconciliation and reasonable medication prescription are in need
Summary
Hemodialysis patients (HD) need to adhere to a complex medication regimen. Because their daily pill burden is one of the highest reported, poor compliance is a major cause of therapeutic failure. Hemodialysis (HD) patients are prescribed numerous oral medications [1], averaging 17 to 25 doses per day [2,3]. This high medication burden results from the complexity of end stage renal disease and its comorbidities [4]. While non-adherence to HD sessions, in the form of missing or shortening sessions, is associated with higher mortality [6,9], it is assumed, but not proven, that non-adherence to medications in general, and to specific drug groups in particular, may be associated with unfavorable outcomes in HD patients
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