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Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
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BMC Nephrology
Published in: BMC Nephrology 1/2015

Open Access 01-12-2015 | Study protocol

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

Authors: Trudi Aspden, Martin J Wolley, Tian M Ma, Edwin Rajah, Samantha Curd, Dharni Kumar, Sophia Lee, Krenare Pireva, Olita Taule’alo, Porsche Tiavale, Angela L Kam, Jun S Suh, Julia Kennedy, Mark R Marshall

Published in: BMC Nephrology | Issue 1/2015

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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.
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Literature
1.
2.
Viswanathan M, Golin CE, Jones CD, Ashok M, Blalock SJ, Wines RCM, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157(11):785–95.PubMedCrossRef
3.
DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794–811.PubMedCrossRef
4.
Granger BB, Swedberg K, Ekman I, Granger CB, Olofsson B, McMurray JJV, et al. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial. Lancet. 2005;366(9502):2005–11.PubMedCrossRef
5.
Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med. 2013;126(4):357. e357-357.e327.PubMedCrossRef
6.
Chiu Y-W, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol. 2009;4(6):1089–96.PubMedPubMedCentralCrossRef
7.
Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant. 2004;19(7):1842–8.PubMedCrossRef
8.
Schmid H, Hartmann B, Schiffl H. Adherence to prescribed oral medication in adult patients undergoing chronic hemodialysis: a critical review of the literature. Eur J Med Res. 2009;14(5):185–90.PubMedPubMedCentralCrossRef
9.
Mirkov S. Implementation of a pharmacist medication review clinic for haemodialysis patients. N Z Med J. 2009;122(1297):25–37.PubMed
10.
Weinhandl ED, Arneson TJ, St Peter WL. Clinical outcomes associated with receipt of integrated pharmacy services by hemodialysis patients: a quality improvement report. Am J Kidney Dis. 2013;62(3):557–67.PubMedCrossRef
11.
Kripalani S, Yao X, Haynes R. Interventions to enhance medication adherence in chronic medical conditions: A systematic review. Arch Intern Med. 2007;167(6):540–9.PubMedCrossRef
12.
Matteson ML, Russell C. Interventions to improve hemodialysis adherence: a systematic review of randomized-controlled trials. Hemodial Int. 2010;14(4):370–82.PubMedCrossRef
13.
Browne T, Merighi JR. Barriers to adult hemodialysis patients’ self-management of oral medications. Am J Kidney Dis. 2010;56(3):547–57.PubMedCrossRef
14.
Grace B, Hurst K, McDonald S, Clayton P. Stock and Flow. In: Clayton P, McDonald S, Hurst K, editors. ANZDATA Registry. 36th Report, 2013. Adelaide, Australia: Australia and New Zealand Dialysis and Transplant Registry; 2014;1–8.
15.
Green SB. How Many Subjects Does It Take To Do A Regression Analysis? Multivar Behav Res. 1991;26(3):499–510.CrossRef
16.
Tabachnick BG, Fiddel LS. Using Multivariate Statistics. 5th ed. Boston, MA: Pearson/Allyn & Bacon; 2007.
17.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10(5):348–54.CrossRef
18.
Al-Qazaz H, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE. The eight-item Morisky Medication Adherence Scale MMAS: translation and validation of the Malaysian version. Diabetes Res Clin Pract. 2010;90(2):216–21.PubMedPubMedCentralCrossRef
19.
Krousel-Wood M, Islam T, Muntner P, Holt E, Joyce C, Morisky DE, et al. Association of depression with antihypertensive medication adherence in older adults: cross-sectional and longitudinal findings from CoSMO. Ann Behav Med. 2010;40(3):248–57.PubMedPubMedCentralCrossRef
20.
Oliveira-Filho AD, Barreto-Filho JA, Neves SJ, Lyra Junior DP. Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control. Arq Bras Cardiol. 2012;99(1):649–58.PubMedCrossRef
21.
Ministry of Health. Ethnicity Data Protocols for the Health and Disability Sector. Wellington: Ministry of Health; 2004.
22.
Tan L, Blakely T, Atkinson J. Ethnic counts on mortality and census data 2001–06: New Zealand census-mortality study update. N Z Med J. 2010;123(1320):37–44.PubMed
23.
Cormack D. Making ethnicity data count. Best Pract J. 2007;9:44–6.
24.
Salmond CE, Crampton P. Development of New Zealand’s deprivation index (NZDep) and its uptake as a national policy tool. Can J Public Health. 2012;103(8 Suppl 2):S7–11.PubMed
25.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef
26.
Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4:94.PubMedPubMedCentralCrossRef
27.
Brice JH, Foster MB, Principe S, Moss C, Shofer FS, Falk RJ, et al. Single-item or two-item literacy screener to predict the S-TOFHLA among adult hemodialysis patients. Patient Educ Couns. 2014;94(1):71–5.PubMedCrossRef
28.
Jain D, Sheth H, Bender FH, Weisbord SD, Green JA. Evaluation of a single-item screening question to detect limited health literacy in peritoneal dialysis patients. Adv Perit Dial. 2014;30:27–30.PubMed
29.
Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD. Brief report: screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006;21(8):874–7.PubMedPubMedCentralCrossRef
30.
Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561–6.PubMedPubMedCentralCrossRef
31.
Marshall MR, Rajah E, Wolley M, Reid S, Aspden T. Validation of a 3-item health literacy screener in a multiethnic New Zealand dialysis population. Nephrol Dial Transplant. In Press.
32.
McPherson ML, Smith SW, Powers A, Zuckerman IH. Association between diabetes patients’ knowledge about medications and their blood glucose control. Res Social Adm Pharm. 2008;4(1):37–45.PubMedCrossRef
33.
Okuyan B, Sancar M, Izzettin FV. Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings. Pharmacoepidemiol Drug Saf. 2013;22(2):209–14.PubMedCrossRef
34.
Okuyan B, Sancar M, Izzettin FV, Morisky DE. Erratum to and corrections on the article entitled “Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings”. Pharmacoepidemiol Drug Saf. 2013;22(2):218–20.PubMedCrossRef
35.
Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41(2):192–9.CrossRef
36.
Horne R. Patients’ beliefs about treatment: the hidden determinant of treatment outcome? J Psychosom Res. 1999;47(6):491–5.PubMedCrossRef
37.
Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555–67.PubMedCrossRef
38.
Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1–24.CrossRef
39.
Weinman J, Petrie KJ, Moss-morris R, Horne R. The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychol Health. 1996;11(3):431–45.CrossRef
40.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Ceameron LD, Buick D. The Revised Illness Perception Questionnaire (IPQ-R. Psychol Health. 2002;17:1–16.CrossRef
41.
Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631–7.PubMedCrossRef
42.
Iskandarsyah A, de Klerk C, Suardi DR, Sadarjoen SS, Passchier J. Consulting a traditional healer and negative illness perceptions are associated with non-adherence to treatment in Indonesian women with breast cancer. Psycho-Oncology. 2014;23(10):1118–24.PubMedCrossRef
43.
Pesut DP, Bursuc BN, Bulajic MV, Solovic I, Kruczak K, Duarte R, et al. Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire - a TBNET study. SpringerPlus. 2014;3:664.PubMedPubMedCentralCrossRef
44.
Hair JF, Black WC, Babin B, Anderson RE, Tatham RL. Multivariate Data Analysis. Upper Saddle River, NJ: Prentice Hall; 2006.
45.
Nunnally JC, Bernstein IH. Psychometric Theory. 3rd ed. New York: McGraw-Hill; 1994.
46.
Field AP. Discovering statistics using SPSS. Thousand Oaks, CA: SAGE publications Ltd; 2009.
47.
Tabachnick BG, Fidell LS. Using Multivariate Statistics. 6th ed. Boston: Pearson; 2012.
48.
Hayes AF. Introduction to mediation, moderation and conditional process analysis: a regression based approach. New York: The Guildford Press; 2013.
49.
Thomas DR. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Eval. 2006;27(2):237–46.CrossRef
50.
Christensen AJ, Moran PJ, Lawton WJ, Stallman D, Voigts AL. Monitoring attentional style and medical regimen adherence in hemodialysis patients. Health Psychol. 1997;16(3):256–62.PubMedCrossRef
51.
Christensen AJ, Smith TW. Personality and patient adherence: correlates of the five-factor model in renal dialysis. J Behav Med. 1995;18(3):305–13.PubMedCrossRef
52.
Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS ONE. 2013;8(12):e80633.PubMedPubMedCentralCrossRef
53.
Neri L, Martini A, Andreucci VE, Gallieni M, Rey LAR, Brancaccio D, et al. Regimen complexity and prescription adherence in dialysis patients. Am J Nephrol. 2011;34(1):71–6.PubMedCrossRef
54.
Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med. 2004;59(6):1307–13.PubMedCrossRef
55.
Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274(21):1677–82.PubMedCrossRef
56.
57.
Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014;48(6):741–51.PubMedCrossRef
58.
Bains SS, Egede LE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes Technol Ther. 2011;13(3):335–41.PubMedPubMedCentralCrossRef
59.
Karamanidou C, Clatworthy J, Weinman J, Horne R. A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease. BMC Nephrol. 2008;9:2.PubMedPubMedCentralCrossRef
60.
Christensen AJ, Smith TW, Turner CW, Cundick KE. Patient adherence and adjustment in renal dialysis: a person x treatment interactive approach. J Behav Med. 1994;17(6):549–66.PubMedCrossRef
61.
AlGhurair SA, Hughes CA, Simpson SH, Guirguis LM. A systematic review of patient self-reported barriers of adherence to antihypertensive medications using the world health organization multidimensional adherence model. J Clin Hypertens. 2012;14(12):877–86.CrossRef
62.
Bailey SC, Wolf MS, Lopez A, Russell A, Chen AH, Schillinger D, et al. Expanding the Universal Medication Schedule: a patient-centred approach. BMJ Open. 2014;4(1):e003699.PubMedPubMedCentralCrossRef
63.
64.
Wyld M, Morton RL, Hayen A, Howard K, Webster AC. A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med. 2012;9(9):e1001307.PubMedPubMedCentralCrossRef
Metadata
Title
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
Authors
Trudi Aspden
Martin J Wolley
Tian M Ma
Edwin Rajah
Samantha Curd
Dharni Kumar
Sophia Lee
Krenare Pireva
Olita Taule’alo
Porsche Tiavale
Angela L Kam
Jun S Suh
Julia Kennedy
Mark R Marshall
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2015
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-015-0097-2

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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