Adherence assessment practices in haemodialysis settings: A qualitative exploration of nurses and pharmacists' perspectives

Abstract

Aims and objectives. To explore clinician assessment of patient adherence, and identify strategies to improve adherence assessment practices in haemodialysis settings. Background. Patients with chronic kidney disease undergoing haemodialysis are typically prescribed complex regimens; as such, they are at high risk of medication nonadherence. Current clinical practices focus on prescribing medications, however, little attention is paid to measuring and ensuring patient adherence to their prescribed treatments. Design. A qualitative study. Methods. Semi-structured individual interviews were conducted in November and December 2016, with 12 nurses and six pharmacists, working in Australian haemodialysis settings. The study was conducted and reported in accordance with COREQ guidelines. Results. Participants were 25-60 years old and had 1-27 years of experience in dialysis. Seven themes related to assessing adherence were identified: prioritization of resources, interplay between workload and available time, awareness of formalized adherence measures and training deficits, concerns about practicality/suitability of adherence measures, communication of assessment services, patient participation, and trust. Three themes related to strategies for improving adherence assessment practices were identified: formalization of adherence assessment process, integration of assessment processes and tools into routine, and use of multidisciplinary support to assess and promote adherence. 2 Conclusions. Current adherence assessment practices could be improved through formalization and integration of the assessment process into dialysis unit policy/procedures.

Practices and pitfalls in medication adherence in hemodialysis settings – a focus-group study of health care professionals

“…Time and resource constraints were also found to challenge comprehensive alignment of medications and treatment goals with patients. These findings resonate with prior studies and re-confirm the recommendation of more systematic medication adherence practices with active patient involvement in hemodialysis settings [6][7][8][9]. Our findings also enrich exciting knowledge by indicating that residents shy away from practicing deprescribing as a tool to support adherence.…”

“…Accordingly, it seems important to incorporate the patients perspective of adherence in routine care. Ghimire et al suggested implementing checklists and validated questionnaires as a way forward [ 8 ]. We agree with this suggestion, as this approach might enhance the quality of care [ 17 ].…”

“…Previous studies of HCPs' practice for assessing adherence in hemodialysis settings primarily recruited nurses and pharmacists' [6][7][8]. The studies by Ghimire et al describe that time restraints and shortage of resource combined with insufficient training and lack of awareness challenge adherence assessment in Australia.…”

“…The studies by Ghimire et al describe that time restraints and shortage of resource combined with insufficient training and lack of awareness challenge adherence assessment in Australia. Multidisciplinary support from pharmacists, nurses and physicians working together with active patient involvement is recommended to improving patient adherence to treatment [6][7][8]. Gilad et al interviewed physicians, nurses and patients about their attitudes and approaches to medical care in a dialysis setting in Israel [9].…”

<p>Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review</p>

“…22 A unique addition to this study was the provision of concurrent pharmacist access, known to improve adherence by reducing the risk of medication-record discrepancies and medication-related problems. 23 These different interventions targeted various barriers faced by ESKD patients, especially Black patients, including lack of social or emotional support and limited health literacy preventing an in-depth understanding of medications and importance of hemodialysis treatments.…”