Clinical Rating of Compliance in Chronic Hemodialysis Patients

Abstract

A ssessing and measuring patient compliance is assuming increasing importance in clinical practice. Noncompliance has been shown to be a common cause of relapse in many conditions, for example, in bipolar patients on lithium (1), depressed subjects on antidepressants (2), schizophrenia patients on neuroleptics (3,4), and nephrology patients who have received a kidney transplant (5). It has been found that around 50% ofgeneral medical patients (6), 50% ofpsychiatric patients (3), and an average of 33% of hemodialysis pa- tients (7) fail to comply with the basic requirements of the treatment regimen.Compliance is commonly assessed by asking the patient whether he or she is following the prescribed treatment plan. However, for various reasons patient reports are often unreliable. With reference to medication compliance, reliability is improved by counting pills left over after prescribing known quantities of drugs or by talking to friends and nextofkin. Various electronic devices are available to monitor medication-taking (8). Where feasible, biological measures are used to confirm or corroborate clinical evaluations (9).This latter study noted that clinical ratings tended to beinaccurate and overestimated the degree of compliance in 50% of patients. In dialysis patients, however, nurses' ratings of compliance have been found to be valid and reliable (10). Conversely, biological ratings are intrusive, expensive, and cumbersome, and in the case of psychiatric populations, blood levels of neuroleptics and most antidepressants correlate poorly with clinical effectiveness. A clinical ratingthat was easy to administer, combined subjective report withbehavioural evaluation, and was reliable and valid would be valuable and time-saving in clinical practice. It would also

Nonadherence With Diet and Fluid Restrictions Among Adults Having Hemodialysis

“…The results indicate moderate to strong positive correlations between frequency and degree of nonadherence behavior for diet and fluid restrictions. These study results are consistent with reports from other research groups (Bame et al, 1993; Kimmel et al 2000; Mai et al, 1999). By using both indicators, additional approaches could be designed to identify patients at risk for continuous nonadherence behavior, as well as for “holiday nonadherers.”…”

“…When operational definitions are inconsistent, validity and reliability cannot be documented. Different approaches include the measurement of nonadherence according to demographic characteristics (Bame et al, 1993; Kaplan, DeNour, & Czaczkes, 1974; Leggat et al, 1998), psychological and behavioral variables (Kimmel et al, 1995; Kimmel et al, 1998; O'Brain, 1990), lab values (Arici et al, 1999; Block, Hulbert‐Shearon, Levin, & Port, 1998; Mai, Busby, & Bell, 1999), and comorbid conditions (Kaveh & Kimmel, 2001; Leggat et al, 1998). Demographic characteristics associated with nonadherence include racial group differences (Bame et al, 1993).…”

Nonadherence With Diet and Fluid Restrictions and Perceived Social Support in Patients Receiving Hemodialysis

“…Being married was an important factor in nonadherence to diet and fluid restriction. Conversely, a Canadian study of 48 patients showed no significant relationship between marital status and adherence measures (Mai, Busby, & Bell, 1999). We did not find any other study on the relationship between marital status and treatment adherence in patients receiving HD.…”

An exploration of the relationship between adherence with dietary sodium restrictions and health beliefs regarding these restrictions in Irish patients receiving haemodialysis for end‐stage renal disease

“…Non‐adherence with medications is also a problem in this population group (Laidlaw et al. 1999, Mai et al. 1999, Rahman & Griffin 2004) and can result in dietary deficiencies, hypertension and fluid overload.…”

“…Denhaerynck et al (2007) found that non-adherence in terms of shortening treatments ranged from 7-32% whilst that of skipping dialysis sessions ranged from 0-35%. Non-adherence with medications is also a problem in this population group (Laidlaw et al 1999, Mai et al 1999, Rahman & Griffin 2004 and can result in dietary deficiencies, hypertension and fluid overload. Lastly, non-adherence with dietary and fluid restrictions ranges from 20-78% (Lee & Molassiotis 2002, Durose et al 2004, Kugler et al 2005.…”