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Inanaga R, Toida T, Aita T, Kanakubo Y, Ukai M, Toishi T, Kawaji A, Matsunami M, Okada T, Munakata Y, Suzuki T, Kurita N. Trust, Multidimensional Health Literacy, and Medication Adherence among Patients Undergoing Long-Term Hemodialysis. Clin J Am Soc Nephrol 2024; 19:463-471. [PMID: 38127331 PMCID: PMC11020446 DOI: 10.2215/cjn.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Basic health literacy and trust in physicians can influence medication adherence in patients receiving dialysis. However, how high-order health literacy is associated with medication adherence and how trust in physicians mediates this association remain unclear. We assessed the inter-relationships between health literacy, trust in physicians, and medication adherence. We investigated the mediating role of trust in physicians in the relationship between health literacy and medication adherence. METHODS This multicenter cross-sectional study included Japanese adults receiving outpatient hemodialysis at six dialysis centers. Multidimensional health literacy was measured using the 14-item Functional, Communicative, and Critical Health Literacy scale. Trust in physicians was measured using the five-item Wake Forest Physician Trust scale. Medication adherence was measured using the 12-item Adherence Starts with Knowledge scale. A series of general linear models were created to analyze the associations between health literacy and Adherence Starts Knowledge scores with and without trust in physicians. Mediation analysis was performed to determine whether trust in physicians mediated this association. RESULTS In total, 455 patients were analyzed. Higher functional and communicative health literacies were associated with less adherence difficulties (per 1-point higher: -1.79 [95% confidence interval (CI): -2.59 to -0.99] and -2.21 [95% CI: -3.45 to -0.96], respectively), whereas higher critical health literacy was associated with greater adherence difficulties (per 1-point higher: 1.69 [95% CI: 0.44 to 2.94]). After controlling for trust in physicians, the magnitude of the association between health literacies and medication adherence decreased. Trust in physicians partially mediated the association between functional or communicative health literacy and medication adherence (especially beliefs) and completely mediated the association between critical health literacy and medication adherence (especially behaviors). CONCLUSIONS Functional and communicative health literacies were positively associated with medication adherence, whereas critical health literacy was negatively associated with it. Each association was mediated by trust in physicians.
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Affiliation(s)
- Ryohei Inanaga
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Tatsunori Toida
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Miyazaki, Japan
| | - Tetsuro Aita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of General Internal Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yusuke Kanakubo
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Mamiko Ukai
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
| | - Takumi Toishi
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Atsuro Kawaji
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Masatoshi Matsunami
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Tadao Okada
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
| | - Yu Munakata
- Chikuseikai Munakata Clinic, Tokyo, Japan
- Munakata Clinic, Chiba, Japan
| | - Tomo Suzuki
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
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Zhu L, Liu Y, Yang F, Yu S, Fu P, Yuan H. Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: a cross-sectional study. BMC Nephrol 2023; 24:307. [PMID: 37875849 PMCID: PMC10594921 DOI: 10.1186/s12882-023-03346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Maintenance hemodialysis (MHD) patients have complex medication regimens that require a high level of skill to interpret medication information. However, there is currently a lack of research evaluating the ability to read and understand medication labels in Chinese MHD patients. In addition, the relationship between frailty and medication literacy among MHD patients remains unclear. Therefore, this study aims to assess the potential factors affecting medication literacy in MHD patients and to explore the relationship between frailty and medication literacy. METHODS This cross-sectional study was conducted using convenience sampling in West China Hospital of Sichuan University, China. Using a general questionnaire, we collected demographic, clinical and laboratory data. Medication literacy was assessed by the Chinese Medication Literacy Scale, and frailty was assessed by the FRAIL Scale. Univariate analyses examined potential factors associated with medication literacy. An ordered logistic regression was used to analyze the relationships between medication literacy and these factors. Spearman's correlation was used to assess the association between medication literacy and frailty. RESULTS A total of 290 MHD patients were included in the analysis. Inadequate, marginal, and adequate medication literacy was found in 56 (19.3%), 153 (52.8%), and 81 (27.9%) patients, respectively. Ordered logistic regression revealed factors associated with inadequate medication literacy: age (OR = 0.281, 95% CI = 0.139-0.565, p < 0.001 for < 65 years); education (OR = 8.612, 95% CI = 3.524-21.046, p < 0.001 for ≤ primary school education; OR = 3.405, 95% CI = 1.683-6.887, p = 0.001 for junior high school education); presence of caregiver medication assistance (OR = 2.302, 95% CI = 1.173-4.516, p = 0.015); frailty (OR = 0.440, 95% CI = 0.216-0.893, p = 0.023 for frail patients); and high β2-microglobulin (β2-MG) (OR = 1.010, 95% CI = 1.002-1.019, p = 0.012). Spearman's analysis showed that medication literacy was negatively correlated with frailty in MHD patients (R=-0.189, p = 0.001). CONCLUSIONS Medication literacy levels in MHD patients needed improvement and were associated with certain patient characteristics, including age, education level, presence of caregiver support, β2-microglobulin levels, and risk of frailty. This study identified subgroups of MHD patients, such as those who were older, had lower education, had caregiver assistance, had high β2-microglobulin levels, or were frail, to have inadequate medication literacy. These findings underscore the need for routine screening and targeted interventions to improve medication literacy in this population.
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Affiliation(s)
- Linfang Zhu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yang Liu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Fengxue Yang
- Sichuan Nursing Vocational College, Chengdu, 610041, China
| | - Shaobin Yu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huaihong Yuan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China.
- West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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Naga YS, Hamdy NA, Bassiouny AE, Selim M, ElHafeez SSA. Effect of medication therapy management services on medication-burden quality of life in hemodialysis patients. BMC Nephrol 2023; 24:277. [PMID: 37730586 PMCID: PMC10512485 DOI: 10.1186/s12882-023-03332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Hemodialysis (HD) patients commonly receive polypharmacy leading to increased likelihood of drug related problems (DRPs) and poor quality of life. Medication Therapy Management (MTM) services discover and resolve DRPs and may specifically improve Medication-burden Quality of life (MBQoL) in HD patients. We aimed to assess the effect of MTM services on DRPs and MBQoL among HD patients. METHODS A prospective pre-post study was conducted on 104 patients in an HD unit in Alexandria, Egypt. MBQoL was assessed at baseline and after three months of MTM sessions, using the Arabic, validated version of the Patient Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) questionnaire. Cohen's d test and multiple linear regression were used to assess the effect size of MTM and the factors affecting MBQoL, respectively. DRPs, adverse events and adherence were also monitored. RESULTS MBQoL improved significantly after the implementation of MTM (Cohen's d=0.88, p < 0.01) with the largest effect size in the "medicine information and relation with healthcare providers" domain. DRPs decreased significantly after MTM implementation (11.97 ± 4.65 versus 7.63 ± 3.85 per patient, p<0.001). The mean adverse events per patient were also reduced (9.69 ± 4.12 versus 6.56 ± 3.77, p < 0.001). CONCLUSION Applying MTM services presents an opportunity to improve care for HD patients by improving MBQoL, decreasing DRPs and adverse events.
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Affiliation(s)
- Yasmine Salah Naga
- Internal Medicine department, Nephrology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Noha Alaa Hamdy
- Clinical Pharmacy and Pharmacy Practice department, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Amany El Bassiouny
- Clinical pharmacist, Al Moassat University Hospital, Alexandria University, Alexandria, Egypt
| | - Mohamed Selim
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samar Samy Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Xie C, Li L, Zhou L, Sun C, Zhang Y, Li Y. Mediating role of learned helplessness' components in the association between health literacy/social support and self-management among maintenance haemodialysis patients in Changsha, China: a cross-sectional study. BMJ Open 2023; 13:e068601. [PMID: 37640465 PMCID: PMC10462950 DOI: 10.1136/bmjopen-2022-068601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To explore the multiple mediating roles of the learned helplessness's core system in the relationship between health literacy/social support and self-management. DESIGN Cross-sectional survey design. SETTING Changsha, China. PARTICIPANTS 239 Chinese maintenance haemodialysis (MHD) patients. METHODS Two multiple mediator models were constructed based on the COM-B (Capacity, Opportunity, Motivation - Behaviour) model. A total of 239 Chinese MHD patients participated in a cross-sectional study, which included surveys on the Learned Helplessness Scale for MHD patients, Dialysis Knowledge Questionnaire, Social Support Scale and Self-Management Scale for Haemodialysis. The PROCESS macro in SPSS was used for mediated effects analysis. RESULTS Helplessness and internality partially mediated the relationship between health literacy/social support and self-management ((β=-0.212, p<0.01; β=0.240, p<0.01)/(β=-0.331, p<0.001; β=0.376, p<0.001)). The mediation effect size was 0.780 (95% CI (0.373 to 1.218)) in the health literacy model, accounting for 45.29% of the total effect, and 0.286 (95% CI (0.207 to 0.377)) in the social support model, accounting for 57.88% of the total effect. The differences in effect sizes for helplessness and internality in the two models were -0.080 (95% CI (-0.374 to 0.216)) and -0.041 (95% CI (-0.127 to 0.043)), respectively. CONCLUSION Health literacy/social support directly affects MHD patients' self-management and indirectly affects it by changing learned helplessness, such as increasing internality while reducing helplessness.
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Affiliation(s)
- Chunyan Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Li Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Urology, Xinjiang Medical University Affiliated First Hospital, Urumqi, China
| | - Lin Zhou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Cuifang Sun
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yini Zhang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
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Alzahrani AMA. Prevalence of Non-adherence to Prescribed Medications among Hemodialysis Patients in Makkah City. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:526-534. [PMID: 37929545 DOI: 10.4103/1319-2442.388187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Patients with end-stage kidney disease (ESKD) are required to take multiple medications. Adherence to a complex regimen of medications is challenging and might lead to non-adherence. This study aimed to assess nonadherence to prescribed medications among patients with ESKD in Makkah City and determine the factors associated with a such behavior. A cross-sectional study was conducted at three governmental hospitals in Makkah City, Saudi Arabia. Descriptive statistics were performed to characterize participants, and a multivariable logistic regression analysis was used to determine factors associated with nonadherence to prescribed medications among patients with ESKD. In total, 358 patients have submitted completed surveys and were included in this study. A considerable number (45.25%) of participating patients were found to be nonadherent to prescribed medications. The factors: age, belief that taking medications as scheduled is important, adherence to dialysis sessions, and the number of comorbid diseases had significant and negative associations with nonadherence to prescribed medications. On the other hand, the factors: forgetfulness and having depression were significantly and positively associated with non-adherence to prescribed medications. Non-adherence to medications among patients on hemodialysis is a significant issue that leads to life-threatening complications. The factors identified as being significantly associated with nonadherence should be considered in designing future interventions to improve adherence to medications.
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Affiliation(s)
- Ali Mohammed A Alzahrani
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
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Alzahrani AMA, Al-Khattabi GH. Factors Affecting Adherence to Phosphate-binding Medications among Patients with End-stage Kidney Disease in Makkah City. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:516-525. [PMID: 37929544 DOI: 10.4103/1319-2442.388186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Despite the evidence that the management of hyperphosphatemia depends heavily on adherence to phosphate-binding (PB) medications, many dialysis patients are non-adherent. Therefore, factors associated with non-adherence to PB medications should be identified and eliminated. This study aimed to identify and highlight factors influencing adherence to PB medications among patients with end-stage kidney disease (ESKD). A cross-sectional survey was conducted in the hemodialysis centers of three major governmental hospitals in Makkah City, Saudi Arabia. The World Health Organization's five dimensions of adherence to medication (patient, socioeconomic, condition, therapy, and health system) were used to guide the analysis. A multivariable logistic regression analysis was used to determine factors influencing adherence to PB medications among patients with ESKD. Three hundred and fifty-eight patients submitted completed questionnaires and were included in this study; of them, 87.99% were adherent to PB medications. The factors sex, adherence to dietary restrictions, and duration on dialysis were found to be significantly and positively associated with adherence to PB medications, whereas the factors difficulty to take medications and difficulty to adhere to a large number of tablets had significant and negative associations with adherence to PB medications. Hyperphosphatemia is a cause for concern as it leads to several life-threatening complications. The results of the present study encourage to recruit representative samples and consider more factors, such as patients' attitudes toward medications and provider-level factors, to inform policy and/or programmatic interventions that increase adherence to PB medications among patients with ESKD.
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Affiliation(s)
- Ali Mohammed A Alzahrani
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghanim H Al-Khattabi
- Department of Preventive Medicine and Public Health Executive, Ministry of Health, Makkah, Saudi Arabia
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Latif AA, Lee KW, Phang K, Rashid AA, Chan NN, Peh SC, Thilaganathan T, Ooi PB. Patient-related factors associated with medication adherence behavior in patients with end-stage renal disease: A systematic review. Tzu Chi Med J 2022; 34:473-484. [PMID: 36578649 PMCID: PMC9791854 DOI: 10.4103/tcmj.tcmj_212_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives This systematic review aims to identify influencing factors of medication adherence behavior in patients with end-stage renal disease (ESRD), with a special interest in patient-related factors based on the World Health Organization adherence model. Materials and Methods Primary electronic databases comprising PubMed, Scopus, Web of Science, Embase and Cochrane Library, as well as ProQuest (Health and Medical), ProQuest (Psychology), and EBSCOHost (APA PsychARTICLES) were used to search for literature on patient-related factors in medication adherence, from inception till August 31, 2021. Results 479 articles were identified and six articles meeting eligibility criteria were reviewed and remained in this systematic review. The present review found that despite different tools being used to measure ESRD's perception of medication's necessity and beliefs, there was a profound association between perception and beliefs with medication adherence behavior. There is a positive relationship between knowledge, belief, educational level, ethnicity, female, and medication adherence behavior. Mixed finding was reported between perception, age, and medication adherence behavior. However, there were no studies on patients' attitudes and medication adherence behavior as suggested in the WHO adherence model. Conclusion Only a limited number of patient-related factors were available for evaluation in the current systematic review. Additional research is needed to advance the understanding of medication adherence behavior affected by patient-related factors on the medication and illness. However, the findings must be taken with caution because of the limited studies included in this review.
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Affiliation(s)
- Anis A'lliya Latif
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Kelly Phang
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Selangor, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nee Nee Chan
- Department of Education, Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
| | - Suat Cheng Peh
- Jeffrey Sachs Center, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia
| | | | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia,Department of General Studies, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia,Address for correspondence: Dr. Pei Boon Ooi, Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 5, Jalan Universiti, Bandar Sunway, 47500 Selangor, Malaysia. E-mail:
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Alshogran OY, Shatnawi EA, Altawalbeh SM, Jarab AS, Farah RI. Medication non-adherence and the achievement of therapeutic goals of anemia therapy among hemodialysis patients in Jordan. Hosp Pract (1995) 2022; 50:82-88. [PMID: 35061551 DOI: 10.1080/21548331.2022.2032073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients. METHODS A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016-2017) were also retrieved from patients' medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy. RESULTS More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05). CONCLUSION The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Esraa A Shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Randa I Farah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Sales I, Bawazeer G, Tarakji AR, Ben Salha FK, Al-Deaiji NH, Saeed M, Idris RS, Aljawadi MH, Aljohani MA, Mahmoud MA, Syed W. Assessment of Dietary Folate Intake and Pill Burden among Saudi Patients on Maintenance Hemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312710. [PMID: 34886434 PMCID: PMC8657290 DOI: 10.3390/ijerph182312710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the adequacy of dietary folate intake and perceptions of pill burden among Saudi patients on maintenance hemodialysis (MHD). This was a cross-sectional study of adults (>18 years) on MHD (>3 months) attending the dialysis unit at King Saud University Medical City. Patient demographics, dietary folic acid intake, and perceptions of pill burden were collected. Fifty-four patients met the eligibility criteria, with a mean age of 57 ± 15.5 years. The majority were females (63%), and the most prevalent comorbidities were diabetes (43%) and hypertension (76%). The average number of medications/patients was 11 ± 2.9, and most patients were receiving folate supplementation (68.5%). The average dietary folate intake was 823 ± 530 mcg/day. Pill burden was bothersome, primarily due to taking too many medications (57%) while taking medications at the workplace was the least bothersome burden (17%). The reported high pill burden and adequate dietary folate intake by Saudi patients on MHD indicates that the omission of folate supplementation may be advantageous for this special population.
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Affiliation(s)
- Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (M.H.A.); (W.S.)
- Correspondence:
| | - Ghada Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (M.H.A.); (W.S.)
| | - Ahmad R. Tarakji
- Consultant Nephrologist, St. George Medical Centre, Kitchener, ON N2R 0H3, Canada;
| | - Feriel K. Ben Salha
- Primary Point of Contact, Roche Tunisia & Libya, Roche Tunisie SA, Les Arcades, Lac Loch Ness Street, Berges du Lac, Tunis 1053, Tunisia;
| | - Nourah H. Al-Deaiji
- Pharmaceutical Care Division, National Care Hospital, Riyadh 11461, Saudi Arabia;
| | - Marwah Saeed
- Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre, Riyadh 11564, Saudi Arabia;
| | - Rawan S. Idris
- Pharmaceutical Care Division, Green Crescent Hospital, Riyadh 12711, Saudi Arabia;
| | - Mohammad H. Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (M.H.A.); (W.S.)
| | - Majidah A. Aljohani
- Pharmaceutical Care Division, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Mansour Adam Mahmoud
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah 42353, Saudi Arabia;
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (M.H.A.); (W.S.)
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Paik JM, Zhuo M, York C, Tsacogianis T, Kim SC, Desai RJ. Medication Burden and Prescribing Patterns in Patients on Hemodialysis in the USA, 2013-2017. Am J Nephrol 2021; 52:919-928. [PMID: 34814147 DOI: 10.1159/000520028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The medication burden of patients with end-stage renal disease (ESRD) on hemodialysis, a patient population with a high comorbidity burden and complex care requirements, is among the highest of any of the chronic diseases. The goal of this study was to describe the medication burden and prescribing patterns in a contemporary cohort of patients with ESRD on hemodialysis in the USA. METHODS We used the United States Renal Data System database from January 1, 2013, and December 31, 2017, to quantify the medication burden of patients with ESRD on hemodialysis aged ≥18 years. We calculated the average number of prescription medications per patient during each respective year (January-December), number of medications within classes, including potentially harmful medications, and trends in the number of medications and classes over the 5-year study period. RESULTS We included a total of 163,228 to 176,133 patients from 2013 to 2017. The overall medication burden decreased slightly, from a mean of 7.4 (SD 3.8) medications in 2013 to 6.8 (SD 3.6) medications in 2017. Prescribing of potentially harmful medications decreased over time (74.0% with at least one harmful medication class in 2013-68.5% in 2017). In particular, the prescribing of non-benzodiazepine hypnotics, benzodiazepines, and opioids decreased from 2013 to 2017 (12.2%-6.3%, 23.4%-19.3%, and 60.0%-53.4%, respectively). This trend was consistent across subgroups of age, sex, race, and low-income subsidy status. CONCLUSIONS Patients with ESRD on hemodialysis continued to have a high overall medication burden, with a slight reduction over time accompanied by a decrease in prescribing of several classes of harmful medications. Continued emphasis on assessment of appropriateness of high medication burden in patients with ESRD is needed to avoid exposure to potentially harmful or futile medications in this patient population.
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Affiliation(s)
- Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Min Zhuo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Renal Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Cassandra York
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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11
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Reixach-Aumatell L, Cufí-Vallmajor M, Martín-Rabassa E, Rey-Miguel A. Efectividad de una intervención educativa con prescripción enfermera para el control del fósforo en pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El control del fósforo en pacientes en hemodiálisis es muy importante para la prevención de complicaciones. Objetivo principal: Evaluar los niveles de fósforo en sangre antes, durante y después de las intervenciones médica y enfermera-médica. Material y Método: Estudio cuantitativo, analítico, cuasi experimental, longitudinal y prospectivo en una población de pacientes en hemodiálisis hospitalaria. El estudio tuvo una duración de 18 meses donde enfermeras y médicos en diferentes meses controlaron la prescripción de los quelantes del fósforo. Se recogieron datos de los resultados analíticos y se reforzó la pauta dietética por parte de las enfermeras. Se administró el test de Morisky Green para valorar la adherencia al tratamiento, así como un “check list” para valorar los efectos secundarios de los quelantes. Resultados: Se estudiaron 19 pacientes. Los niveles de fósforo (mediana; rango intercuartílico) en los distintos periodos fueron de: (4,8; 1,3) mg/dl en el periodo previo, (4,5; 1,9) mg/dl en el periodo médico y (4,5; 0,9 mg/dl) en el periodo enfermera-médico. Se compararon los resultados entre los diferentes periodos y no se observaron diferencias estadísticamente significativas entre los niveles de fósforo. Tampoco se observaron diferencias en dichos niveles al separar los pacientes cumplidores de los no cumplidores. Conclusiones: Aunque los resultados no fueron estadísticamente diferentes, se observó una disminución del fósforo con el refuerzo de dieta continuo por parte de las enfermeras. Por lo que se concluye que las enfermeras, junto con el apoyo médico, podrían implicarse en la prescripción y el control de fósforo mensual de los pacientes.
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Affiliation(s)
- Laia Reixach-Aumatell
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
| | - Maria Cufí-Vallmajor
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
| | - Esther Martín-Rabassa
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
| | - Alicia Rey-Miguel
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
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12
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Colombijn JMT, Bonenkamp AA, van Eck van der Sluijs A, Bijlsma JA, Boonstra AH, Özyilmaz A, Abrahams AC, van Jaarsveld BC. Impact of Polypharmacy on Health-Related Quality of Life in Dialysis Patients. Am J Nephrol 2021; 52:735-744. [PMID: 34518456 DOI: 10.1159/000518454] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dialysis patients are often prescribed a large number of medications to improve metabolic control and manage coexisting comorbidities. However, some studies suggest that a large number of medications could also detrimentally affect patients' health-related quality of life (HRQoL). Therefore, this study aims to provide insight in the association between the number of types of medications and HRQoL in dialysis patients. METHODS A multicentre cohort study was conducted among dialysis patients from Dutch dialysis centres 3 months after initiation of dialysis as part of the ongoing prospective DOMESTICO study. The number of types of medications, defined as the number of concomitantly prescribed types of drugs, was obtained from electronic patient records. Primary outcome was HRQoL measured with the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score (range 0-100) of the Short Form 12. Secondary outcomes were number of symptoms (range 0-30) measured with the Dialysis Symptoms Index and self-rated health (range 0-100) measured with the EuroQol-5D-5L. Data were analysed using linear regression and adjusted for possible confounders, including comorbidity. Analyses for MCS and number of symptoms were performed after categorizing patients in tertiles according to their number of medications because assumptions of linearity were violated for these outcomes. RESULTS A total of 162 patients were included. Mean age of patients was 58 ± 17 years, 35% were female, and 80% underwent haemodialysis. The mean number of medications was 12.2 ± 4.5. Mean PCS and MCS were 36.6 ± 10.2 and 46.8 ± 10.0, respectively. The mean number of symptoms was 12.3 ± 6.9 and the mean self-rated health 60.1 ± 20.6. In adjusted analyses, PCS was 0.6 point lower for each additional medication (95% confidence interval [95% CI]: -0.9 to -0.2; p = 0.002). MCS was 4.9 point lower (95% CI: -8.8 to -1.0; p = 0.01) and 1.0 point lower (95% CI: -5.1-3.1; p = 0.63) for the highest and middle tertiles of medications, respectively, than for the lowest tertile. Patients in the highest tertile of medications reported 4.1 more symptoms than in the lowest tertile (95% CI: 1.5-6.6; p = 0.002), but no significant difference in the number of symptoms was observed between the middle and lowest tertiles. Self-rated health was 1.5 point lower for each medication (95% CI: -2.2 to -0.7; p < 0.001). DISCUSSION/CONCLUSION After adjustment for comorbidity and other confounders, a higher number of medications were associated with a lower PCS, MCS, and self-rated health in dialysis patients and with more symptoms.
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Affiliation(s)
- Julia M T Colombijn
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,
| | - Anna A Bonenkamp
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Joost A Bijlsma
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Dianet Dialysis Centre, Amsterdam, The Netherlands
| | | | - Akin Özyilmaz
- Dialysis Centre Groningen, Groningen, The Netherlands
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Diapriva Dialysis Centre, Amsterdam, The Netherlands
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13
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Hurt AW, March DS, Cooper NJ, Burton JO. Is Exercise a Cost-Effective Intervention for People Receiving Hemodialysis? A Narrative Review. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021. [DOI: 10.1249/tjx.0000000000000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Alikari V, Matziou V, Tsironi M, Theofilou P, Giannakopoulou N, Tzavella F, Fradelos EC, Zyga S. Patient Knowledge, Adherence to the Therapeutic Regimen, and Quality of Life in Hemodialysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:259-272. [DOI: 10.1007/978-3-030-78771-4_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Varghese A, Lacson E, Sontrop JM, Acedillo RR, Al-Jaishi AA, Anderson S, Bagga A, Bain KL, Bennett LL, Bohm C, Brown PA, Chan CT, Cote B, Dev V, Field B, Harris C, Kalatharan S, Kiaii M, Molnar AO, Oliver MJ, Parmar MS, Schorr M, Shah N, Silver SA, Smith DM, Sood MM, St Louis I, Tennankore KK, Thompson S, Tonelli M, Vorster H, Waldvogel B, Zacharias J, Garg AX. A Higher Concentration of Dialysate Magnesium to Reduce the Frequency of Muscle Cramps: A Narrative Review. Can J Kidney Health Dis 2020; 7:2054358120964078. [PMID: 33149925 PMCID: PMC7585892 DOI: 10.1177/2054358120964078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose of review: Strategies to mitigate muscle cramps are a top research priority for patients receiving hemodialysis. As hypomagnesemia is a possible risk factor for cramping, we reviewed the literature to better understand the physiology of cramping as well as the epidemiology of hypomagnesemia and muscle cramps. We also sought to review the evidence from interventional studies on the effect of oral and dialysate magnesium-based therapies on muscle cramps. Sources of information: Peer-reviewed articles. Methods: We searched for relevant articles in major bibliographic databases including MEDLINE and EMBASE. The methodological quality of interventional studies was assessed using a modified version of the Downs and Blacks criteria checklist. Key findings: The etiology of muscle cramps in patients receiving hemodialysis is poorly understood and there are no clear evidence-based prevention or treatment strategies. Several factors may play a role including a low concentration of serum magnesium. The prevalence of hypomagnesemia (concentration of <0.7 mmol/L) in patients receiving hemodialysis ranges from 10% to 20%. Causes of hypomagnesemia include a low dietary intake of magnesium, use of medications that inhibit magnesium absorption (eg, proton pump inhibitors), increased magnesium excretion (eg, high-dose loop diuretics), and a low concentration of dialysate magnesium. Dialysate magnesium concentrations of ≤0.5 mmol/L may be associated with a decrease in serum magnesium concentration over time. Preliminary evidence from observational and interventional studies suggests a higher dialysate magnesium concentration will raise serum magnesium concentrations and may reduce the frequency and severity of muscle cramps. However, the quality of evidence supporting this benefit is limited, and larger, multicenter clinical trials are needed to further determine if magnesium-based therapy can reduce muscle cramps in patients receiving hemodialysis. In studies conducted to date, increasing the concentration of dialysate magnesium appears to be well-tolerated and is associated with a low risk of symptomatic hypermagnesemia. Limitations: Few interventional studies have examined the effect of magnesium-based therapy on muscle cramps in patients receiving hemodialysis and most were nonrandomized, pre-post study designs.
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Affiliation(s)
- Akshay Varghese
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Eduardo Lacson
- Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA
| | - Jessica M Sontrop
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Rey R Acedillo
- Department of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Ahmed A Al-Jaishi
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Sierra Anderson
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Amit Bagga
- Division of Nephrology, Department of Medicine, Windsor Regional Hospital, ON, Canada
| | - Katie L Bain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | | | - Clara Bohm
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Pierre A Brown
- Department of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, ON, Canada
| | - Brenden Cote
- Patient Partner, London Health Sciences Centre, London, ON, Canada
| | - Varun Dev
- Department of Nephrology, Humber River Hospital, Toronto, ON, Canada
| | - Bonnie Field
- Patient Partner, Patient and Family Advisory Council, London Health Sciences Centre, London, ON, Canada
| | - Claire Harris
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Mercedeh Kiaii
- Division of Nephrology, Department of Medicine, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Malvinder S Parmar
- Department of Medicine, Timmins & District Hospital, Timmins, ON, Canada
| | - Melissa Schorr
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Samuel A Silver
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - D Michael Smith
- Patient Partner, Patient and Family Advisory Council, London Health Sciences Centre, London, ON, Canada
| | - Manish M Sood
- Department of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Irina St Louis
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Stephanie Thompson
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marcello Tonelli
- Division of Nephrology, Department of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada
| | | | - Blair Waldvogel
- Patient Partner, Home Hemodialysis Department, Health Sciences Centre, Winnipeg, MB, Canada
| | - James Zacharias
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.,ICES Western, London, ON, Canada
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Neri L, Ponce P, Matias N, Stuard S, Cromm K. Clinical target achievement is associated with better quality of life among dialysis patients: results from a continuous quality improvement program in a Portuguese healthcare network. Qual Life Res 2020; 29:2705-2714. [DOI: 10.1007/s11136-020-02543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
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17
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Pellicer-Valero OJ, Cattinelli I, Neri L, Mari F, Martín-Guerrero JD, Barbieri C. Enhanced prediction of hemoglobin concentration in a very large cohort of hemodialysis patients by means of deep recurrent neural networks. Artif Intell Med 2020; 107:101898. [PMID: 32828446 DOI: 10.1016/j.artmed.2020.101898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022]
Abstract
Erythropoiesis Stimulating Agents (ESAs) have become a standard anemia management tool for End Stage Renal Disease (ESRD) patients. However, dose optimization constitutes an extremely challenging task due to huge inter and intra-patient variability in the responses to ESA administration. Current data-based approaches to anemia control focus on learning accurate hemoglobin prediction models, which can be later utilized for testing competing treatment choices and choosing the optimal one. These methods, despite being proven effective in practice, present several shortcomings which this paper intends to tackle. Namely, they are limited to a small cohort of patients and, even then, they fail to provide suggestions when some strict requirements are not met (such as having a three month history prior to the prediction). Here, recurrent neural networks (RNNs) are used to model whole patient histories, providing predictions at every time step since the very first day. Furthermore, an unprecedented amount of data (∼110,000 patients from many different medical centers in twelve countries, without exclusion criteria) was used to train it, thus allowing it to generalize for every single patient. The resulting model outperforms state-of-the-art Hemoglobin prediction, providing excellent results even when tested on a prospective dataset. Simultaneously, it allows to bring the benefits of algorithmic anemia control to a very large group of patients.
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Affiliation(s)
- Oscar J Pellicer-Valero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Av. Universitat, sn, 46100 Bujassot, Valencia, Spain.
| | | | - Luca Neri
- Fresenius Medical Care, Else-Kröner-Straße 1, 61352 Bad Homburg, Germany.
| | - Flavio Mari
- Fresenius Medical Care, Else-Kröner-Straße 1, 61352 Bad Homburg, Germany.
| | - José D Martín-Guerrero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Av. Universitat, sn, 46100 Bujassot, Valencia, Spain.
| | - Carlo Barbieri
- Fresenius Medical Care, Else-Kröner-Straße 1, 61352 Bad Homburg, Germany.
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18
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Treatment-resistant hypertension in the hemodialysis population: a 44-h ambulatory blood pressure monitoring-based study. J Hypertens 2020; 38:1849-1856. [DOI: 10.1097/hjh.0000000000002448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Kaku K, Ishida K, Shimizu K, Achira M, Umeda Y. Efficacy and safety of trelagliptin in Japanese patients with type 2 diabetes with severe renal impairment or end-stage renal disease: Results from a randomized, phase 3 study. J Diabetes Investig 2020; 11:373-381. [PMID: 31389201 PMCID: PMC7078116 DOI: 10.1111/jdi.13126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To investigate the efficacy and safety of trelagliptin 25 mg in patients with type 2 diabetes mellitus with severe renal impairment or end-stage renal disease. MATERIALS AND METHODS This multicenter, randomized, phase 3 study comprised a 12-week double-blind phase followed by a 40-week open-label phase. Patients had type 2 diabetes mellitus with severe renal impairment (creatinine clearance <30 mL/min) or end-stage renal disease (undergoing hemodialysis), and were receiving diet and/or exercise therapy with/without one antidiabetic drug. RESULTS Patients were randomized to trelagliptin (A/A, n = 55) or placebo (P/A, n = 52; double-blind phase). Both groups received trelagliptin in the open-label phase. The least square mean change (95% confidence interval [CI]) from baseline in hemoglobin A1c at the end of the double-blind phase was -0.71% (95% CI -0.885, -0.542) and 0.01% (95% CI -0.170, 0.183) in the A/A and P/A groups, respectively (intergroup least square means difference -0.72%, 95% CI -0.966, -0.473; P < 0.0001). Mean hemoglobin A1c decreased after trelagliptin treatment in the P/A group to similar levels observed in the A/A group and remained comparable in both groups versus baseline up to week 52. In the double-blind phase, the incidence of treatment-emergent adverse events (TEAEs) was 72.7% and 61.5% in the A/A and P/A group, respectively; most TEAEs were mild-to-moderate, except in one patient (P/A group), who experienced two severe TEAEs. The incidence of serious TEAEs was 7.3% and 3.8% in the A/A and P/A group, respectively. CONCLUSIONS Once-weekly trelagliptin 25 mg was efficacious, with no major safety concerns, and represents a meaningful treatment option in this patient population.
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Affiliation(s)
- Kohei Kaku
- Department of MedicineKawasaki Medical SchoolOkayamaJapan
| | - Kazuyuki Ishida
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | - Kohei Shimizu
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | | | - Yuusuke Umeda
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
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20
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Tesfaye WH, McKercher C, Peterson GM, Castelino RL, Jose M, Zaidi STR, Wimmer BC. Medication Adherence, Burden and Health-Related Quality of Life in Adults with Predialysis Chronic Kidney Disease: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010371. [PMID: 31935851 PMCID: PMC6981524 DOI: 10.3390/ijerph17010371] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 12/16/2022]
Abstract
This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m2. Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time.
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Affiliation(s)
- Wubshet H. Tesfaye
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7005, Tasmania, Australia; (G.M.P.); (B.C.W.)
- Correspondence: ; Tel.: +61-469033062
| | | | - Gregory M. Peterson
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7005, Tasmania, Australia; (G.M.P.); (B.C.W.)
| | - Ronald L. Castelino
- Sydney Nursing School, The University of Sydney, Sydney 2006, New South Wales, Australia; (R.L.C.); (M.J.)
| | - Matthew Jose
- Sydney Nursing School, The University of Sydney, Sydney 2006, New South Wales, Australia; (R.L.C.); (M.J.)
- Royal Hobart Hospital, Hobart 7000, Tasmania, Australia
| | | | - Barbara C. Wimmer
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7005, Tasmania, Australia; (G.M.P.); (B.C.W.)
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Parker K, Wong J. Is polypharmacy an increasing burden in chronic kidney disease? The German experience. Clin Kidney J 2019; 12:659-662. [PMID: 31584570 PMCID: PMC6768297 DOI: 10.1093/ckj/sfz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 02/07/2023] Open
Abstract
This is a commentary article describing the key findings of the German chronic kidney disease (GCKD) study and how these relate to current practice. With the GCKD study showing high levels of polypharmacy, this article discusses ways to ensure that polypharmacy is appropriate and the difficulties faced within a chronic kidney disease population. Suggestions of ways to minimize medication burden in renal patients provide some practical advice for clinicians.
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Affiliation(s)
- Kathrine Parker
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanne Wong
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
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Ohya M, Iwashita Y, Kunimoto S, Yamamoto S, Mima T, Negi S, Shigematsu T. An Analysis of Medication Adherence and Patient Preference in Long-term Stable Maintenance Hemodialysis Patients in Japan. Intern Med 2019; 58:2595-2603. [PMID: 31178499 PMCID: PMC6794165 DOI: 10.2169/internalmedicine.2676-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective This follow-up survey report describes medication adherence and patient preferences, beliefs, and expectations of maintenance hemodialysis treatment in Japan. Methods This patient-reported questionnaire-based survey was conducted in six regions in Japan from September 2016 to November 2016. Patients The questionnaire was provided to 700 patients (50-79 years old) on maintenance hemodialysis for >3 years who were members of the Japan Association of Kidney Disease Patients. Patients were randomly selected by a stratified sampling method based on patient distribution observed from the Japanese Society for Dialysis Therapy Renal Data Registry. Results A total of 524 (74.9%) complete patient questionnaires were evaluated; the mean (SD) age was 66.6 (7.2) years (men, 63.4%) with a dialysis vintage of 16.9 (9.1) years. Adherence was high for all types of medications: between 76.7% for phosphate binders and 95.7% for antidiabetic medications. The most common reason for a missed dose was forgetting to take medication [52.5% (117/223)]. Patient preference for oral medication was as low as 0.9% (1/110), 9% (31/345), and 2.9% (2/69) for patients who felt mental burden, felt no mental burden, and neither, respectively, with their current treatment regimen. In addition, 37.8% (198/524) of patients responded that the elimination of 1 medication (1 tablet) would reduce their mental burden. Conclusion The results of this survey show that overall medication adherence is high in Japanese patients on maintenance hemodialysis. While many patients perceive an absence of mental burden, they still prefer to avoid oral medication when possible.
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Affiliation(s)
- Masaki Ohya
- Department of Nephrology, Wakayama Medical University, Japan
| | - Yuko Iwashita
- Department of Nephrology, Wakayama Medical University, Japan
| | - Satoko Kunimoto
- Department of Nephrology, Wakayama Medical University, Japan
| | - Shuto Yamamoto
- Department of Nephrology, Wakayama Medical University, Japan
| | - Toru Mima
- Department of Nephrology, Wakayama Medical University, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Japan
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Neri L, Kreuzberg U, Bellocchio F, Brancaccio D, Barbieri C, Canaud B, Stuard S, Ketteler M. Detecting high-risk chronic kidney disease-mineral bone disorder phenotypes among patients on dialysis: a historical cohort study. Nephrol Dial Transplant 2019; 34:682-691. [PMID: 30165528 DOI: 10.1093/ndt/gfy273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The clinical management of chronic kidney disease-mineral bone disorder (CKD-MBD) remains extremely challenging, partially due to difficulties in defining high-risk phenotypes based on serum biomarkers. We evaluated the prevalence and outcomes of 27 mutually exclusive CKD-MBD phenotypes in a large, multi-national cohort of chronic dialysis patients over a 5-year follow-up study. METHODS In this historical cohort study, we enrolled all haemodialysis patients registered in EuCliD® on 1 July 2011 across 28 Europe, the Middle East and Africa (EMEA) and South American countries. We created 27 mutually exclusive phenotypes based on combinations of serum parathyroid hormone (PTH), phosphorus (P) and calcium (Ca) 6-month averages (L, low; T, target; H, high). We tested the association between CKD-MBD phenotypes and 5-year mortality and hospitalization risk by outcome risk score-adjusted proportional hazard regression. RESULTS We enrolled 35 721 eligible patients. Eastern European and South American countries generally achieved poorer CKD-MBD control when compared with Western European countries (prevalence ratio: 0.79; P < 0.001). There were 15 795 deaths [126.7 deaths/1000 person-years; 95% confidence interval (CI) 124.7-128.7]; 18 014 had at least one hospitalization (203.9 hospitalizations/1000 person-years; 95% CI 201.0-206.9); the incidence of the composite endpoint was 280.0 events/1000 person-years (95% CI 276.6-283.5). In the fully adjusted model, relative mortality risk ranged from hazard ratio (HR) = 1.07 (PTH/Ca/P: TLT) to HR = 1.59 (PTH/Ca/P: LTL), whereas the relative composite endpoint risk ranged from HR = 1.07 (PTH/Ca/P: TTH) to HR = 1.36 (PTH/Ca/P: LTL). CONCLUSION We identified several CKD-MBD phenotypes associated with reduced hospitalization-free survival and increased mortality. Ranking of relative risk estimates or excess events concurs in informing healthcare priority setting.
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Affiliation(s)
- Luca Neri
- Care Value Advanced Analytics, Fresenius Medical Care Italia, Palazzo Pignano, Cremona, Italy
| | | | - Francesco Bellocchio
- Care Value Advanced Analytics, Fresenius Medical Care Italia, Palazzo Pignano, Cremona, Italy
| | - Diego Brancaccio
- Care Value Advanced Analytics, Fresenius Medical Care Italia, Palazzo Pignano, Cremona, Italy
| | - Carlo Barbieri
- Care Value Advanced Analytics, Fresenius Medical Care Italia, Palazzo Pignano, Cremona, Italy
| | - Bernard Canaud
- Fresenius Medical Care Italia, Bad Homburg v.d. Hesse, Germany
| | - Stefano Stuard
- Fresenius Medical Care Italia, Bad Homburg v.d. Hesse, Germany
| | - Markus Ketteler
- Division of Nephrology, Klinikum Coburg GmbH, Coburg, Germany.,University of Split School of Medicine unist.hr (USSM), Croatia
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Parker K, Bull-Engelstad I, Aasebø W, von der Lippe N, Reier-Nilsen M, Os I, Stavem K. Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease. Hemodial Int 2019; 23:333-342. [PMID: 30779285 DOI: 10.1111/hdi.12739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD. METHODS This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m2 ) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight-item Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence. Factors associated with the MRCI and MMAS-8 score were determined using either multivariable linear or ordinal logistic regression analysis. FINDINGS In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS-8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS-8. DISCUSSION Female sex, comorbidity and use of phosphate binders were associated with more-complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.
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Affiliation(s)
- Krystina Parker
- Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Ingrid Bull-Engelstad
- Department of Nephrology, Medical Division, Vestre Viken HF, Drammen Hospital, Drammen, Norway
| | - Willy Aasebø
- Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway
| | - Nanna von der Lippe
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Nephrology, Medical Division, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Reier-Nilsen
- Department of Nephrology, Medical Division, Vestre Viken HF, Drammen Hospital, Drammen, Norway
| | - Ingrid Os
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Nephrology, Medical Division, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Stavem
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,HØKH, Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
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25
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Superior Hypertension Management in Pediatric Kidney Transplant Patients After Native Nephrectomy. Transplantation 2019; 102:1172-1178. [PMID: 29953422 DOI: 10.1097/tp.0000000000002093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Native nephrectomy in pediatric kidney transplant recipients is performed for multiple indications. Posttransplant hypertension requiring medical management is common, and the effect of native nephrectomy on posttransplant hypertension is poorly studied. Our aim is to evaluate the impact of native nephrectomy on posttransplant hypertension. METHODS One hundred thirty-six consecutive pediatric kidney transplant recipients from 2007 to 2012 were studied at a single institution and divided into 2 groups: no nephrectomy and native nephrectomy (unilateral and bilateral nephrectomy). Antihypertensive medication use was evaluated before nephrectomy/transplant, at discharge from transplant and at 1, 3, and 5 years posttransplant. RESULTS In a bivariate analysis, nephrectomy was associated with a significant reduction in the percentage of patients requiring antihypertensive medication at the time of discharge (27.3%) and 1 year posttransplant (10.7%) as compared with patients without nephrectomy (71.7%, and 50%, respectively, P < 0.05). This trend toward reduction in antihypertensive medication in the nephrectomy group as compared with the no nephrectomy group persisted at 3 (18.6% versus 43.2%) and 5 years (19.7% versus 37.5%) posttransplant. Multivariable logistic regression demonstrated that patients without native nephrectomy had higher odds of requiring antihypertensive medication at the time of discharge (3.3) and 1 year (5.2) as compared with patients who underwent native nephrectomy (P = 0.036 and P = 0.013, respectively). CONCLUSIONS Native nephrectomy reduces the odds of needing antihypertensive medication after transplant. The impact of native nephrectomy is crucial to the comprehensive management of pediatric transplant recipients where medication compliance is challenging and lifelong hypertension is known to negatively impact cardiovascular health.
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Kefale B, Tadesse Y, Alebachew M, Engidawork E. Management Practice, and Adherence and Its Contributing Factors among Patients with Chronic Kidney Disease at Tikur Anbessa Specialized Hospital: A Hospital Based Cross-Sectional Study. Int J Nephrol 2018; 2018:2903139. [PMID: 30805215 PMCID: PMC6362475 DOI: 10.1155/2018/2903139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/18/2018] [Accepted: 05/30/2018] [Indexed: 01/10/2023] Open
Abstract
The objective of this study was to assess the management practice, medication adherence, and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). Methods. A cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 CKD (stages 1 and 2=50, stage 3=88, stage 4=55, and stage 5=63) patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The rate of adherence was determined using 8-item Morisky medication adherence scale. The data were analyzed using SPSS version 20.0 statistical software. Univariate and multivariate binary logistic regression were used to investigate the potential predictors of medication nonadherence. Results. About 57.3% of diabetes mellitus with hypertension were treated with combination of insulin and ACEI based regimens. Other cardiovascular comorbidities were predominantly treated with Acetyl Salicylic Acid in combination with β-blocker. Only 61.3% (stages 1 and 2=70%, stage 3=73.9%, stage 4=54.5%, and stage 5=43%) of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication nonadherence. Patients who had an average and high monthly income were 4.14 (AOR=4.14, 95% CI: 1.45-11.84, p=0.008) and 6.17 times (AOR=6.17, 95% CI: 1.02-37.46, p=0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR= 0.54, 95% CI: 0.27-1.10, p=0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, or teachers working in private school were about 7.46 times (AOR=7.46, 95% CI: 1.49-37.26, p=0.014) more likely to adhere compared with patients who were farmers. Conclusion. Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension comorbidities. Very low income, increased number of prescribed medications, and being a farmer were the predictors of medication nonadherence.
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Affiliation(s)
- Belayneh Kefale
- Department of Pharmacy, College of Medicine and Health Science, Ambo University, P.O. Box 19, Ambo, Ethiopia
| | - Yewondwossen Tadesse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kefale B, Tadesse Y, Alebachew M, Engidawork E. Management practice, and adherence and its contributing factors among patients with chronic kidney disease at Tikur Anbessa Specialized Hospital: A hospital-based cross-sectional study. PLoS One 2018; 13:e0200415. [PMID: 30044830 PMCID: PMC6059431 DOI: 10.1371/journal.pone.0200415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) has a complicated interrelationship with other diseases and major risk factor for cardiovascular disease. Therapeutic management for CKD patients is complicated due to co-morbidities and dominant risk factors of CKD. Non-adherence to treatment is an increasing problem for patients with CKD and it has not been extensively studied in patients with CKD. Hence, the present study was carried out to assess the management practice, medication adherence and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). METHODS A hospital-based cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The degree of adherence was determined using eight-item Morisky Medication Adherence Scale. The data were entered into Epi Info 7.2.2.2 and analyzed using SPSS version 20.0 statistical software. Descriptive statistics such as frequency, percent, mean and standard deviation were used to summarize patients' baseline characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of medication non-adherence. RESULTS About 55% patients with hypertension only were treated with non-angiotensin converting enzyme inhibition based regimens; 57.3% of diabetes mellitus with hypertension treated with combination of insulin and ACEI based regimens. About three-fourth of patients with anemia and osteodystrophy complications were treated with iron preparations and calcium based phosphate binder. Only 61.3% of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication non-adherence. Patients who had an average and high monthly income were 4.14 (AOR = 4.14, 95% CI: 1.45-11.84, p = 0.008) and 6.17 times (AOR = 6.17, 95% CI: 1.02-37.46, p = 0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR = 0.54, 95% CI: 0.27-1.10, p = 0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, teachers working in private school were about 7.46 times (AOR = 7.46, 95% CI: 1.49-37.26, p = 0.014) more likely to adhere compared with patients who were farmers. CONCLUSION Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension co-morbidities. Very low income, increased number of prescribed medications and being a farmer were the predictors of medication non-adherence.
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Affiliation(s)
- Belayneh Kefale
- Department of Pharmacy, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Yewondwossen Tadesse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Neri L, Peris K, Longo C, Calvieri S, Frascione P, Parodi A, Eibenschuz L, Bottoni U, Pellacani G. Physician-patient communication and patient-reported outcomes in the actinic keratosis treatment adherence initiative (AK-TRAIN): a multicenter, prospective, real-life study of treatment satisfaction, quality of life and adherence to topical field-directed therapy for the treatment of actinic keratosis in Italy. J Eur Acad Dermatol Venereol 2018; 33:93-107. [PMID: 29920789 DOI: 10.1111/jdv.15142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/22/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patients with multiple actinic keratoses (AKs) should be treated with field-directed therapy. Such treatments challenge patients' adherence due to out-of-pocket costs, length of treatment and severity of local skin reactions (LSRs). Effective physician-patient communication (PPC) may buffer therapy-related distress, thus improving quality of life, treatment satisfaction and adherence. OBJECTIVES We evaluated the interplay between PPC, LSR intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple AKs receiving topical field-directed therapies. METHODS In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25 cm2 area), Grade I/II AKs, for whom the attending dermatologist has prescribed treatment with a topical field-directed therapy. We matched self-reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8 days; T2: 25-30 days) RESULTS: Most patients were elderly, married, men with poor socio-economic status and multiple lesions of the scalp or face. The majority (n = 961) had a prescription of ingenol mebutate (IMB) and 175 received either diclofenac 3% in hyaluronic acid (DHA) or imiquimod 5% (IMQ). Clearance rate at 1 month was 84%. Most patients felt very supported (n = 819, 73%) and rated dermatologist's explanations very clear (n = 608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow-up, especially for those on IMB (Δpre-post = -4.00; other: Δpre-post = -0.25; interaction P < 0.001). Communication clarity was associated with higher treatment satisfaction scores (β = 0.4-0.6, P < 0.01) and lower risk of non-adherence among IMB patients (risk difference: 16%, P < 0.01). CONCLUSION Communication clarity was associated with patient-reported outcomes and adherence beyond AK-related clinical parameters. Our study questions the current episodic approach to AK management and provides the rationale to develop chronic care models fostering patients' engagement and treatment alliance.
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Affiliation(s)
- L Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - K Peris
- Department of Dermatology, Catholic University, Rome, Italy
| | - C Longo
- Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - S Calvieri
- Department of Internal Medicine and Clinical Sciences, University of Rome 'La Sapienza', Rome, Italy
| | - P Frascione
- Department of Dermatologic Oncology, Regina Elena National Institute for Cancer Treatment and Research, Rome, Italy
| | - A Parodi
- Division of Dermatology, Università di Genova, DISEM, Genova, Italy
| | - L Eibenschuz
- Department of Dermatologic Oncology, Santa Maria and San Gallicano Dermatologic Institute, Istituto Fisioterapici Ospidalieri (IFO) of Rome, Rome, Italy
| | - U Bottoni
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Umeukeje EM, Mixon AS, Cavanaugh KL. Phosphate-control adherence in hemodialysis patients: current perspectives. Patient Prefer Adherence 2018; 12:1175-1191. [PMID: 30013329 PMCID: PMC6039061 DOI: 10.2147/ppa.s145648] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. METHODS A literature search including the terms "phosphorus", "phosphorus control", "hemo-dialysis", "phosphate binder medications", "phosphorus diet", "adherence", and "nonadherence" was undertaken using PubMed, PsycInfo, CINAHL, and Embase. RESULTS Hyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential "drivers" of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important - yet unaddressed - determinants of adherence behaviors of dialysis patients. CONCLUSION Adherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients.
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Affiliation(s)
- Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
| | - Amanda S Mixon
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
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Nagasawa H, Tachi T, Sugita I, Esaki H, Yoshida A, Kanematsu Y, Noguchi Y, Kobayashi Y, Ichikawa E, Tsuchiya T, Teramachi H. The Effect of Quality of Life on Medication Compliance Among Dialysis Patients. Front Pharmacol 2018; 9:488. [PMID: 29950988 PMCID: PMC6008555 DOI: 10.3389/fphar.2018.00488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/24/2018] [Indexed: 01/13/2023] Open
Abstract
Dialysis treatment is known to lead to reduced quality of life (QOL) among patients. This decreased QOL is believed to influence medication compliance, although this effect has not yet been clarified. In this study, we investigated whether decreased QOL due to dialysis treatment does in fact influence medication compliance. Participants were 92 patients who self-managed their medication and were receiving dialysis treatment at Secomedic Hospital or Chiba Central Medical Center. We surveyed their age, sex, dialysis period, and medication management situation, and administered the EQ-5D and Kidney Disease Quality of Life Instrument-Short Form. A multiple logistic regression analysis with medication compliance as the dependent variable and QOL as the independent variable was conducted. The recovery rate and effective response rate were both 100%. The results indicated that patients with good sleep QOL (mean or above) had higher odds of medication compliance (odds ratio, 3.36; 95% confidence interval, 1.26-8.96; P = 0.016). Therefore, improving the quality of sleep of dialysis patients might help to improve their medication compliance.
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Affiliation(s)
- Hiroyuki Nagasawa
- Department of Pharmacy, Secomedic Hospital, Funabashi, Japan.,Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Tomoya Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Ikuto Sugita
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Hiroki Esaki
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Aki Yoshida
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Yuta Kanematsu
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Yukio Kobayashi
- Department of Pharmacy, Chiba Central Medical Center, Chiba, Japan
| | | | - Teruo Tsuchiya
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.,Community Health Support and Research Center, Gifu, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.,Laboratory of Community Healthcare Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
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Alves KB, Guilarducci NV, Santos TDR, Baldoni AO, Otoni A, Pinto SWL, Zanette C, Sanches C. Is quality of life associated with compliance to pharmacoterapy in patients with chronic kidney disease undergoing maintenance hemodialysis? ACTA ACUST UNITED AC 2018; 16:eAO4036. [PMID: 29694614 PMCID: PMC5968805 DOI: 10.1590/s1679-45082018ao4036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 08/18/2017] [Indexed: 01/20/2023]
Abstract
Objective To analyzed the association of quality of life and compliance to drug treatment in chronic kidney disease patients. Methods The Short Form Health Survey was used to evaluate the quality of life of these patients, and the therapeutic complexity index was verified. The Morisky-Green test and the Brief Medication Questionnaire were applied to check compliance to drug therapy. Results A total of 197 patients were included. The Morisky-Green test and Brief Medication Questionnaire showed that most patients had low compliance to treatment (50.3% and 80.6%, respectively). Compliance was highly associated with gender (male) and slightly associated with complexity of therapy, mental health, and social aspects. Conclusion We observed a slight association between compliance to pharmacotherapy and quality of life and complexity of therapy, and a strong association with gender.
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Affiliation(s)
| | | | | | | | - Alba Otoni
- Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil
| | | | | | - Cristina Sanches
- Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil
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Polikandrioti M, Koutelekos I, Vasilopoulos G, Babatsikou F, Gerogianni G, Zyga S, Panoutsopoulos G. Hemodialysis Patients' Information and Associated Characteristics. Mater Sociomed 2017; 29:182-187. [PMID: 29109663 PMCID: PMC5644202 DOI: 10.5455/msm.2017.29.182-187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction of this study was to explore characteristics associated with hemodialysis patients' degree of information. Material and Methods The sample of the study included 650 patients undergoing hemodialysis. For data collection a questionnaire specially designed for the needs of the research was used. More specifically, socio-demographic, clinical and other patients' characteristics were associated with the degree of information as it was reported by patients. Results of the 650 participants, 55.4% was men while 58.6% of the sample was aged over 60 years. Regarding information level, results showed that only 9.8% was "little" or "not all" informed about their health problem, 61,7% was "enough" informed whereas 28.5% were "very" informed. Statistically significant association was observed between degree of information and age (p=<0.001), family status (p=0.005), education (p=0.001), job (p=0.005) and number of children (p=0.019). In terms of clinical characteristics, statistically significant association was observed between the degree of information and whether patients had other disease or not (p=0.037), whether patients reported adherence to treatment guidelines (p=<0.001). Finally, statistically significant association was observed between the degree of information and relations with nursing staff (p=<0.001), doctors (p=0.007) and other patients (p=0.003), and whether patients faced difficulties in social (p=0.001) and family environment (p=0.002). Conclusion Health professionals when planning information interventions for orienting hemodialysis patients is increasingly important to evaluate socio-demographic, clinical and other patients ' characteristics and incorporate them in their project.
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Affiliation(s)
- Maria Polikandrioti
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
| | - Ioannis Koutelekos
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
| | - George Vasilopoulos
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
| | - Fotoula Babatsikou
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
| | - Georgia Gerogianni
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
| | - Sofia Zyga
- University of Peloponnesus, Peloponnese, Greece
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Drug adherence in hypertension. Pharmacol Res 2017; 125:142-149. [DOI: 10.1016/j.phrs.2017.08.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 01/13/2023]
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Pantuzza LL, Ceccato MDGB, Silveira MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol 2017; 73:1475-1489. [PMID: 28779460 DOI: 10.1007/s00228-017-2315-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this study was to systematically review evidence regarding the association between regimen complexity and adherence. METHODS Articles were searched in MEDLINE, LILACS, Cochrane, CINAHL, PsycINFO and references of included studies. Search terms included medication regimen complexity, medication adherence and their synonyms. Randomized clinical trials, cross-sectional, cohort or case-control studies published until March 2016 in English, Portuguese or Spanish were eligible if quantitatively examined the association between complexity and adherence in patients of any age and sex, under any type of medication therapy. Complexity was defined according to the strategy used to assess it in the individual studies. All types of instruments used to assess complexity and adherence were considered. Data extraction was performed using an electronic spreadsheet. Quality assessment was conducted independently using standard scales. The data were qualitatively synthesized. RESULTS Fifty-four studies were included: 37 cross-sectional and 17 cohorts. Most were conducted in outpatient setting. Most frequently, studies were carried out with HIV-infected individuals or patients with chronic conditions. The most frequent methods used to assess complexity and adherence were complexity index (19) and self-report (27), respectively. Complexity was associated with adherence in 35 studies. Most of them (28) identified that participants with more complex regimens were less likely to adhere to pharmacotherapy; seven studies found a direct correlation. The others found inconclusive results or no association between complexity and adherence. The studies had low to moderate-methodological quality. CONCLUSION Although there was variability regarding the association between complexity and adherence, most studies showed that an increased regimen complexity reduces medication adherence.
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Affiliation(s)
- Laís Lessa Pantuzza
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Luane Mendes Ribeiro Junqueira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
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Ghimire S, Castelino RL, Jose MD, Zaidi STR. Medication adherence perspectives in haemodialysis patients: a qualitative study. BMC Nephrol 2017; 18:167. [PMID: 28532480 PMCID: PMC5440949 DOI: 10.1186/s12882-017-0583-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/12/2017] [Indexed: 12/25/2022] Open
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. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0583-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, 7001, Australia
| | - Ronald L Castelino
- Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, 7001, Australia.,Sydney Nursing School, University of Sydney, Sydney, Australia.,Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Matthew D Jose
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia.,Department of Nephrology, Royal Hobart Hospital, Hobart, Australia
| | - Syed Tabish R Zaidi
- Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, 7001, Australia.
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Cobretti MR, Page RL, Linnebur SA, Deininger KM, Ambardekar AV, Lindenfeld J, Aquilante CL. Medication regimen complexity in ambulatory older adults with heart failure. Clin Interv Aging 2017; 12:679-686. [PMID: 28442898 PMCID: PMC5396835 DOI: 10.2147/cia.s130832] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in "young-old" (60-74 years) versus "old-old" (75-89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM). PATIENTS AND METHODS Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60-89 years with heart failure. Medications were categorized into three types - heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications - and scored using the pMRCI tool. RESULTS The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3-84) and total medication counts (13.3±4.8, range 2-30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P=0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P=0.009; medication count 14.1±4.9 versus 12.2±4.5, P=0.008), which was largely driven by other prescription medications. CONCLUSION Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population.
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Affiliation(s)
| | - Robert L Page
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | - Sunny A Linnebur
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | | | - Amrut V Ambardekar
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplant Program, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
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Bakris GL, Burkart JM, Weinhandl ED, McCullough PA, Kraus MA. Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use. Am J Kidney Dis 2016; 68:S15-S23. [DOI: 10.1053/j.ajkd.2016.05.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/25/2016] [Indexed: 01/30/2023]
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Ruiz García E, Latorre López LI, Delgado Ramírez A, Crespo Montero R, Sánchez Laguna JL. Adherencia al tratamiento farmacológico de los pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2016. [DOI: 10.4321/s2254-28842016000300005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: La mala adherencia a largo plazo es reconocida como uno de los principales problemas clínicos en la gestión de las enfermedades crónicas, y en concreto de la enfermedad renal crónica avanzada.
Objetivo: Conocer la producción científica sobre el grado de adherencia al tratamiento farmacológico en pacientes en hemodiálisis.
Metodología: Se ha realizado una revisión sistemática no metaanalítica mediante una búsqueda en las bases de datos de Scielo, PubMed y Google Académico. Se incluyeron artículos escritos en inglés y español. Se analizaron los artículos que trataban la adherencia al tratamiento en pacientes en hemodiálisis.
Resultados: Se han revisado 19 artículos, 6 revisiones y 13 estudios observacionales, publicados entre el 2007 y 2015. Se estudiaron variables sociodemográficas: edad, género, nivel socioeconómico y estudios, estado civil, raza y situación laboral; variables clínicas y psicosociales y, factores relacionados con la medicación. Se encontró que entre 15-72% de los pacientes en hemodiálisis presentan falta de adherencia al tratamiento farmacológico. La depresión se encuentra asociada a la falta de adherencia. La edad se asocia a mayor adherencia.
Conclusiones: Los pacientes en hemodiálisis presentan con frecuencia falta de adherencia al tratamiento farmacológico, aunque con una gran variabilidad,debido a las diferencias en la definición y medición de la falta de adherencia. La depresión parece ser el predictor más influyente en la falta de adhesión. Los factores demográficos y clínicos no están consistentemente asociados con la falta de adherencia, a excepción de la edad, siendo los pacientes de mayor edad los que presentan mayor adherencia.
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Adhérence aux chélateurs des phosphates en hémodialyse. Effet « paradoxal » de la posologie journalière : enquête nationale auprès de 1290 patients en hémodialyse chronique. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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40
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Bryant BM, Libby AM, Metz KR, Page RL, Ambardekar AV, Lindenfeld J, Aquilante CL. Evaluating Patient-Level Medication Regimen Complexity Over Time in Heart Transplant Recipients. Ann Pharmacother 2016; 50:926-934. [PMID: 27371949 DOI: 10.1177/1060028016657552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Medication regimen complexity describes multiple characteristics of a patient's prescribed drug regimen. Heart transplant recipients must comply with a lifelong regimen that consists of numerous medications. However, a systematic assessment of medication regimen complexity over time has not been conducted in this, or any other, transplant population. OBJECTIVE The objective of this study was to quantify patient-level medication regimen complexity over time following primary heart transplantation and heart retransplantation, using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool. METHODS Medication lists were reviewed at transplant discharge and years 1, 3, and 5 post-primary heart transplant, and at transplant discharge and years 1 and 3 post-heart retransplantation. Medications were categorized as transplant-specific, other prescription, and over-the-counter (OTC). RESULTS In primary heart transplant recipients (n = 60), mean total medication count was 14.3 ± 3.4 at transplant discharge and did not change significantly over time ( P = 0.64). Transplant-specific medication count decreased significantly from discharge (2.9 ± 0.4) to year 5 (2.3 ± 0.6); P = 0.02. However, 32% of patients were taking 16 or more total medications at year 5 posttransplant. More than 70% of the pMRCI score was attributed to other prescription and OTC medications, which was largely driven by dosing frequency in this cohort. Medication complexity did not differ significantly between heart retransplant recipients (n = 11) and matched primary heart transplant controls (n = 22). CONCLUSION Together, these data highlight the substantial medication burden after heart transplantation and reveal opportunities to address medication regimen complexity in this, and other, transplant populations.
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Affiliation(s)
- Brittney M Bryant
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Anne M Libby
- 2 University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelli R Metz
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Robert L Page
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | | | - Christina L Aquilante
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Chao CT, Huang JW. Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients. PeerJ 2016; 4:e2122. [PMID: 27326380 PMCID: PMC4911948 DOI: 10.7717/peerj.2122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/19/2016] [Indexed: 12/20/2022] Open
Abstract
Background. Geriatric syndromes (GS) exhibit high prevalence in patients with end-stage renal disease (ESRD) under chronic dialysis irrespective of age. We sought to determine whether GS influences medication adherence in ESRD patients. Methods. A prospective cohort of chronic dialysis patients was assembled. The presence of GS components, including frailty/prefrailty, polypharmacy, and malnutrition, were ascertained through a validated questionnaire, electronic records and chart abstraction, and laboratory tests. The severity of medication non-adherence was defined using the eight-item Morisky Medication Adherence Scale (MMAS). Multiple logistic regression analysis was performed targeting MMAS results and incorporating relevant clinical features and GS. Results. The prevalence of frailty/pre-frailty, polypharmacy, and hypoalbuminemia/ malnutrition among the enrolled participants was 66.7%, 94%, and 14%, respectively. The average MMAS scores in these dialysis patients were 2 ± 1.7 (range, 0–6), with only 15.7% exhibiting high medication adherence. Multiple regression analyses showed that the absence of frailty/pre-frailty (P = 0.01) were significantly associated with poorer medication adherence, while the presence of polypharmacy (P = 0.02) and lower serum albumin, a potential sign of malnutrition (P = 0.03), were associated with poor adherence in another model. Conclusion. This study is among the very few reports addressing GS and medication adherence, especially in ESRD patients. Interventions targeting frailty, polypharmacy, and malnutrition might potentially improve the medication non-adherence and symptom control in these pill-burdened patients.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan; Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenq-Wen Huang
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
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Atrial fibrillation in dialysis patients: time to abandon warfarin? Int J Artif Organs 2016; 39:99-105. [PMID: 27079417 DOI: 10.5301/ijao.5000487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis. Ideally the most promising therapy would be based on direct inhibitors of factor IIa or Xa; however, at the moment, none of these drugs can be safely prescribed in dialysis patients, because of their potentially dangerous accumulation, and the lack of sufficient experience with apixaban or rivaroxaban, two drugs showing a favorable pharmacokinetic profile in end-stage renal disease. Hence, the use of vitamin K inhibitors is currently the only pharmacological option for stroke prevention in dialysis patients with atrial fibrillation, leaving the clinicians in a management conundrum.This review discusses the trade-offs implicated in warfarin use for this population, the promises of newly developed drugs, the role of dialysis as atrial fibrillation trigger, as well as potential non-pharmacological management options suitable in selected clinical situations.
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Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi STR. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PLoS One 2015; 10:e0144119. [PMID: 26636968 PMCID: PMC4670103 DOI: 10.1371/journal.pone.0144119] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.
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Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Ronald L. Castelino
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | | | - Gregory M. Peterson
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Syed Tabish R. Zaidi
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
- * E-mail:
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44
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Chiolero A, Burnier M, Santschi V. Improving treatment satisfaction to increase adherence. J Hum Hypertens 2015; 30:295-6. [PMID: 26290276 DOI: 10.1038/jhh.2015.89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- A Chiolero
- Chronic Diseases Division, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - M Burnier
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - V Santschi
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.,La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
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Aspden T, Wolley MJ, Ma TM, Rajah E, Curd S, Kumar D, Lee S, Pireva K, Taule'alo O, Tiavale P, Kam AL, Suh JS, Kennedy J, Marshall MR. Understanding barriers to optimal medication management for those requiring long-term dialysis: rationale and design for an observational study, and a quantitative description of study variables and data. BMC Nephrol 2015; 16:102. [PMID: 26162369 PMCID: PMC4499205 DOI: 10.1186/s12882-015-0097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 06/25/2015] [Indexed: 12/05/2022] Open
Abstract
Background Rates of medication non-adherence in dialysis patients are high, and improving adherence is likely to improve outcomes. Few data are available regarding factors associated with medication adherence in dialysis patients, and these data are needed to inform effective intervention strategies. Methods/design This is an observational cross-sectional study of a multi-ethnic dialysis cohort from New Zealand, with the main data collection tool being an interviewer-assisted survey. A total of 100 participants were randomly sampled from a single centre, with selection stratified by ethnicity and dialysis modality (facility versus home). The main outcome measure is self-reported medication adherence using the Morisky 8-Item Medication Adherence Scale (MMAS-8). Study data include demographic, clinical, social and psychometric characteristics, the latter being constructs of health literacy, medication knowledge, beliefs about medications, and illness perceptions. Psychometric constructs were assessed through the following survey instruments; health literacy screening questions, the Medication Knowledge Evaluation Tool (Okuyan et al.), the Beliefs about Medication Questionnaire (Horne et al.), the Brief Illness Perception Questionnaire (Broadbent et al.). Using the study data, reliability analysis for internal consistency is satisfactory for the scales evaluating health literacy, medication knowledge, and beliefs about medications, with Chronbach’s α > 0.7 for all. Reliability analysis indicated poor internal consistency for scales relating to illness perceptions. MMAS-8 and all psychometric scores are normally distributed in the study data. Discussion This study will provide important information on the factors involved in medication non-adherence in New Zealand dialysis patients. The resulting knowledge will inform long-term initiatives to reduce medication non-adherence in dialysis patients, and help ensure that they are addressing appropriate and evidence based targets for intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0097-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Trudi Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Martin J Wolley
- School of Medicine, University of Queensland, 288 Herston Road, Brisbane, 4006, Australia.
| | - Tian M Ma
- Department of Renal Medicine, Counties Manukau District Health Board, Hospital Road, Otahuhu, Auckland, 1640, New Zealand.
| | - Edwin Rajah
- Marketing Department, Faculty of Business, Auckland University of Technology, 46 Wakefield St, Auckland, 1010, New Zealand.
| | - Samantha Curd
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Dharni Kumar
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Sophia Lee
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Krenare Pireva
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Olita Taule'alo
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Porsche Tiavale
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Angela L Kam
- Pharmacy Services, Counties Manukau District Health Board, Hospital Road, Otahuhu, Auckland, 1640, New Zealand.
| | - Jun S Suh
- Department of Renal Medicine, Counties Manukau District Health Board, Hospital Road, Otahuhu, Auckland, 1640, New Zealand.
| | - Julia Kennedy
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
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Rafiee Vardanjani L, Parvin N, Mahmoodi Shan G. The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients. Disabil Rehabil 2015; 38:768-772. [PMID: 26122544 DOI: 10.3109/09638288.2015.1061601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. METHOD In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. RESULTS At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p < 0.05). In demographic characteristic, only age indicated a positive correlation with adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p < 0.05). CONCLUSIONS Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. Implications for Rehabilitation Adherence to treatment means that all patients' behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. Individual structured programs are most likely to be successful in encouraging adherence to treatment.
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Affiliation(s)
| | - Neda Parvin
- a Department of Nursing , Shahrekord University of Medical Sciences , Shahrekord , Iran and
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Pârvan A. Patients' substantialization of disease, the hybrid symptom and metaphysical care. J Eval Clin Pract 2015; 21:380-8. [PMID: 25312387 DOI: 10.1111/jep.12250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 11/26/2022]
Abstract
In the context of current scholarship concerned with facilitating integration between the biomedical and the patient-centred models of care, the article suggests that disease brings about an ontological disruption in patients, which is not directly addressed in either model, and may interfere with treatment and therapy outcomes if not met with a type of care termed here as 'metaphysical'. The receipt of diagnosis and medical care can give patients the sense that they are ontologically diminished, or less of a human, and along with physicians' approaches to and discourses about disease, may prompt them to seek ontological restoration or security in the same way as psychologically traumatized patients sometimes do: by treating the disease and/or the experience of harm associated with it as a thing that exists per se. I call this 'substantialization' of disease (or harm) and draw on Augustine's theory of non-substantial deficiencies (physiological and moral) and on Plato's and Plotinus's different takes on such defects in order to discuss what substantialization can do for patients. Based on literature that examines patients' ways of talking about and living with their disease, I speculate that substantialization can generate a 'hybrid symptom', consisting in patterns of exercising agency which may predispose to non-adherence. Ways in which physicians could provide metaphysical care are proposed, along with an understanding of chronic patients as hybrid ontological and agentic units, which draws on theories of enactive cognition. I opine that metaphysical care may facilitate integration between the depersonalized and personalized models of care.
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Affiliation(s)
- Alexandra Pârvan
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK; Faculty of Social Sciences and Humanities, University of Piteşti, Piteşti, Romania
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48
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Efficiency of delivery observed treatment in hemodialysis patients: the example of the native vitamin D therapy. J Nephrol 2015; 29:99-103. [DOI: 10.1007/s40620-015-0196-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/28/2015] [Indexed: 01/21/2023]
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Thomson BK, Nolin TD, Velenosi TJ, Feere DA, Knauer MJ, Asher LJ, House AA, Urquhart BL. Effect of CKD and Dialysis Modality on Exposure to Drugs Cleared by Nonrenal Mechanisms. Am J Kidney Dis 2015; 65:574-82. [DOI: 10.1053/j.ajkd.2014.09.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/11/2014] [Indexed: 01/17/2023]
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Parker K, Nikam M, Jayanti A, Mitra S. Medication burden in CKD-5D: impact of dialysis modality and setting. Clin Kidney J 2014; 7:557-61. [PMID: 25859372 PMCID: PMC4389130 DOI: 10.1093/ckj/sfu091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Medication adherence is thought to be around 50% in the general and dialysis population. Reducing the pill burden (PB) reduces regime complexity and can improve adherence. Increased adherence should lead to improvement in treatment outcomes and patient quality of life. There is currently little published data on PB in CKD-5D across dialysis modalities. METHODS This is a retrospective, single renal network study. All in-centre HD (MHD), peritoneal dialysis (PD) and home HD (HHD) patients were identified in the Greater Manchester East sector renal network. Information collected included age, sex, comorbidities, daily PB, dialysis vintage and adequacy. Data were retrieved from a customized renal database, clinic and discharge letters with cross validation from the general practitioner when needed. RESULTS Two hundred and thirty-six prevalent dialysis patients were studied. HHD patients had a significantly lower PB (11 ± 7 pills/day) compared with PD and MHD (16 ± 7 pills/day). The HHD patients required fewer BP medications to meet the recommended target. HD setting was the only significant factor for reducing PB. For home therapies (HHD versus PD), weekly Kt/v and serum phosphate were significant factors influencing PB. When comparing all modalities, OR of PB ≥ 15/day for MHD versus HHD was 3.9 and PD versus HHD was 4.9. The influence of HHD is dominant above factors such as comorbidities or clinical variables in reducing PB for MHD. Higher clearances achieved by HHD could explain differences in PB with PD. CONCLUSION This is the first comparative study of PB across all dialysis modalities and factors that influence it. The PB advantage in HHD may result in greater adherence and might contribute to the outcome benefit often seen with this modality. Higher clearances achieved by HHD could explain differences in PB with PD but the precise reasons for lower PB remain speculative and deserve further research in larger settings.
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Affiliation(s)
- Kathrine Parker
- Department of Nephrology , Manchester Institute of Nephrology and Transplantation , Manchester , UK
| | - Milind Nikam
- Department of Nephrology , Manchester Institute of Nephrology and Transplantation , Manchester , UK
| | - Anuradha Jayanti
- Department of Nephrology , Manchester Institute of Nephrology and Transplantation , Manchester , UK
| | - Sandip Mitra
- Department of Nephrology , Manchester Institute of Nephrology and Transplantation , Manchester , UK
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