Joson Cherriday G, Henry Shayna L, Kim Sue, Cheung Mandy Y, Parab Prajakta, Abcar Antoine C, Jacobsen Steven J, Morisky Donald E, Sim John J
Division of Nephrology & Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.
J Ren Nutr. 2016 May;26(3):141-8. doi: 10.1053/j.jrn.2015.09.004. Epub 2015 Nov 21.
The purpose of this study was to determine the influence of patient-reported medication adherence and phosphorus-related knowledge on phosphorus control and pharmacy-reported adherence to phosphorus binding medication among patients on maintenance hemodialysis.
Retrospective, cross-sectional cohort study.
Seventy-nine hemodialysis patients (mean age 64.2 years, SD = 14 years; 46.8% female) in a stand-alone hemodialysis unit within an integrated learning healthcare system. Ten percent (10%) of subjects were Caucasian, 42% Latino, 19% African American, and 29% Asian. Forty-eight percent had diabetes; 72% had BMI ≥ 30. Inclusion criteria included the provision of survey data and having medication refill data available in the pharmacy system. 77.2% had mean phosphorus levels ≤ 5.5 mg/dL; 22.8% had mean phosphorus levels > 5.5 mg/dL.
Subjects were administered the 8-item Morisky Medication Adherence Scale (MMAS-8) and also reported on their phosphorus-related knowledge.
Phosphorus levels within an adequate range.
The mean serum phosphorus level was 4.96 mg/dL (SD = 1.21). In the well-controlled group, mean phosphorus was 4.44 mg/dL (SD = 0.76). In the poorly controlled group, mean phosphorus was 6.69 mg/dL (SD = 0.74). A total of 61% of patients reported at least some unintentional medication nonadherence, and 48% reported intentional medication nonadherence. Phosphorus-specific knowledge was low, with just under half of patients reporting that they could not name two high-phosphorus foods or identify a phosphorus-related health risk. Phosphorus binder-related nonadherence was substantially higher in the uncontrolled than the controlled group. Adjusting for age, individuals with poorer self-reported binder adherence were less likely to have controlled phosphorus levels (odds ratio = 0.71, P = .06).
Phosphorus-related non-adherence, but not low phosphorus-specific knowledge, was associated with poorer phosphorus control. Such findings provide important information for the development of evidence-based strategies for improving phosphorus control among patients on dialysis.
本研究旨在确定患者报告的药物依从性和磷相关知识对维持性血液透析患者磷控制以及药房报告的磷结合药物依从性的影响。
回顾性横断面队列研究。
综合学习医疗系统中一个独立血液透析单元的79名血液透析患者（平均年龄64.2岁，标准差=14岁；46.8%为女性）。10%的受试者为白种人，42%为拉丁裔，19%为非裔美国人，29%为亚洲人。48%患有糖尿病；72%的体重指数≥30。纳入标准包括提供调查数据且药房系统中有药物 refill 数据。77.2%的患者平均磷水平≤5.5mg/dL；22.8%的患者平均磷水平>5.5mg/dL。
受试者接受8项的Morisky药物依从性量表（MMAS-8）评估，并报告他们的磷相关知识。
磷水平在适当范围内。
血清磷平均水平为4.96mg/dL（标准差=1.21）。在控制良好的组中，平均磷为4.44mg/dL（标准差=0.76）。在控制不佳的组中，平均磷为6.69mg/dL（标准差=0.74）。共有61%的患者报告至少有一些无意的药物不依从，48%的患者报告有意的药物不依从。磷特异性知识水平较低，不到一半的患者报告他们说不出两种高磷食物或识别不出与磷相关的健康风险。未控制组中与磷结合剂相关的不依从率明显高于控制组。调整年龄后，自我报告的结合剂依从性较差的个体磷水平得到控制的可能性较小（比值比=0.71，P=0.06）。
磷相关的不依从而非低磷特异性知识与较差的磷控制相关。这些发现为制定改善透析患者磷控制的循证策略提供了重要信息。
