Ghimire Saurav, Castelino Ronald L, Jose Matthew D, Zaidi Syed Tabish R
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.
BMC Nephrol. 2017 May 22;18(1):167. doi: 10.1186/s12882-017-0583-9.
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.
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.
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).
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.
接受血液透析的终末期肾病患者需遵循多种复杂的治疗方案，且极易出现用药依从性差的高风险情况。本研究的目的是探究与用药依从性相关的因素，并考察依从性和非依从性血液透析患者在用药行为上的不同观点。
采用定性探索性设计。在澳大利亚霍巴特的门诊透析机构，对30名血液透析患者进行了一对一的半结构化访谈。使用4项Morisky Green Levine量表测量患者自我报告的依从性。对访谈记录进行主题分析，并对照世界卫生组织（WHO）的用药依从性决定因素进行梳理。
参与者年龄在44至84岁之间，每天需服用4至19种药物。根据自我报告测量，超过一半的参与者存在用药不依从情况（56.7%，n = 17）。对照WHO依从性模型梳理出的主题包括患者相关因素（知识、意识、态度、自我效能、行为控制和促进因素）；卫生系统/医疗团队相关因素（互动质量、不信任和附带安排）；治疗相关因素（药物的物理特性、包装和副作用）；病情相关因素（症状严重程度）；以及社会/经济因素（药物可及性和相对可负担性）。
患者表达了一些导致不依从行为的担忧。所确定的许多问题与患者相关，通过心理教育或认知行为干预可能是可改变的。医疗保健专业人员应更加警惕识别这些担忧，以解决依从性问题。未来的研究应旨在了解医疗保健专业人员对评估透析患者用药依从性的看法和做法，这可能会指导干预措施来解决这一严重的用药不依从问题。
