Adherence to multiple, prescribed medications in diabetic kidney disease: A qualitative study of consumers’ and health professionals’ perspectives

Williams, Allison; Manias, Elizabeth; Walker, Rowan G.

doi:10.1016/j.ijnurstu.2008.07.002

Cited by 68 publications

(160 citation statements)

References 22 publications

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“…The topic guide for semi-structured interviews was adapted from another study of medication adherence in patients with chronic illness. [22] This was reviewed for appropriateness by the team prior to use. All interviews were digitally recorded before being transcribed by cardiology secretarial staff.…”

Section: Qualitative Semi-structured Interviewmentioning

confidence: 99%

Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort

Rushworth

Cunningham

Mort

et al. 2012

International Journal of Pharmacy Practice

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Objective To explore the association between medication adherence and qualitatively characterised patient-specific themes relating to medication adherence in patients following percutaneous coronary intervention (PCI). Methods Data-collection questionnaires and qualitative topic guides were piloted in two patients. A validated questionnaire generated an adherence score for a convenience sample of 20 patients within 7 days of PCI. Semi-structured qualitative interviews were subsequently carried out with all patients to explore patient-specific themes relating to measured medication adherence. Key findings Fourteen out of 20 patients (70%) had scores indicative of good adherence. Key factors associated with good adherence included having a good relationship with the doctor, having an understanding of the condition, knowledge of the indications and consequences of non-adherence, perceived health benefits and medications eliciting tangible symptom control. There were misconceptions of concern regarding adverse drug reactions and the importance of aspirin, both of which had a negative effect on adherence. The role of the community pharmacist was sometimes, although not always, misunderstood. Conclusion This study suggests there is an association between patients' beliefs, knowledge, understanding and misconceptions about medication and their adherence in a post-PCI cohort. To optimise medication adherence it is vital for prescribers to remain patient-focused and cognisant of patient-specific themes relating to medication adherence.

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Section: Qualitative Semi-structured Interviewmentioning

confidence: 99%

Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort

Rushworth

Cunningham

Mort

et al. 2012

International Journal of Pharmacy Practice

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“…CKD expands the universe of risk for adverse safety events because patients with CKD carry their illness, and safety risk, to and from the hospital. These patients take multiple medications (10,11), encounter health care providers in numerous health venues, and face lifestyle hazards throughout their home environment. Surveillance mechanisms are not designed to track patient safety events in the broader health ecosystem of patients with CKD (5).…”

Section: Ckd and Patient Safety: Significance Of The Problemmentioning

confidence: 99%

Finding a Common Language for Patient Safety in CKD

Fink

Joy²,

Peter

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryImproving patient safety has become a primary objective of health systems; however, the frequency of adverse safety events continues to be unacceptable despite the attention and dedicated efforts of many stakeholders. CKD that does not require dialysis increases the risk for adverse safety events, and adverse safety events can account for a substantial portion of the poor outcomes typical of CKD. Because much of CKD care occurs outside the typical health care setting, systems designed to detect and reduce adverse safety events are not necessarily effective in this population. Underrecognition (or underappreciation) of CKD and the associated impairment of renal function contribute to the high risk for adverse safety events. Medication errors are common in CKD and account for many lapses in patient safety, but a wide range of other potentially modifiable care processes in CKD also contribute to the high rate of observed adverse safety events. This review describes the spectrum of safety concerns specific to CKD and the need for a common set of standards to improve on current general constructs and to reduce adverse safety events in this chronic disease. An accepted set of disease-specific indicators is necessary to gauge the extent of the disease-specific patient safety problem and to design means to reduce adverse safety events and improve outcomes in CKD.

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“…As a rule of thumb, once the number of medications reaches approximately 5, the probability of adverse events becomes high enough to counterbalance any positive effects of additional medications. 22 Unfortunately, the list of recommended interventions grows as a multiple of the number of guidelines because each guideline includes multiple recommendations. Boyd and colleagues 23 applied disease-oriented clinical practice guideline recommendations to a simulated 79-year-old woman with 5 common chronic diseases: chronic obstructive pulmonary disease, type 2 diabetes mellitus, osteoporosis, hypertension, and osteoarthritis.…”

Section: Risk Reductionmentioning

confidence: 99%

The Law of Diminishing Returns in Clinical Medicine: How Much Risk Reduction is Enough?

Mold

Hamm²,

McCarthy

2010

The Journal of the American Board of Family Medicine

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The law of diminishing returns, first described by economists to explain why, beyond a certain point, additional inputs produce smaller and smaller outputs, offers insight into many situations encountered in clinical medicine. For example, when the risk of an adverse event can be reduced in several different ways, the impact of each intervention can generally be shown mathematically to be reduced by the previous ones. The diminishing value of successive interventions is further reduced by adverse consequences (eg, drug-drug, drug-disease, and drug-nutrient interactions), as well as by the total expenditures of time, energy, and resources, which increase with each additional intervention. It is therefore important to try to prioritize interventions based on patient-centered goals and the relative impact and acceptability of the interventions. We believe that this has implications for clinical practice, research, and policy. (J Am Board Fam Med 2010;23: 371-375.)

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Adherence to multiple, prescribed medications in diabetic kidney disease: A qualitative study of consumers’ and health professionals’ perspectives

Cited by 68 publications

References 22 publications

Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort

Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort

Finding a Common Language for Patient Safety in CKD

The Law of Diminishing Returns in Clinical Medicine: How Much Risk Reduction is Enough?

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