Medication adherence assessment practices in dialysis settings: A survey of renal nurses’ perceptions

Ghimire, Saurav; Banks, Colin; Jose, Matthew; Castelino, Ronald L.; Zaidi, Syed Tabish Razi

doi:10.1111/jocn.14642

Cited by 6 publications

(9 citation statements)

References 30 publications

(36 reference statements)

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“…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 – 9 ]. Our findings also enrich exciting knowledge by indicating that residents shy away from practicing deprescribing as a tool to support adherence.…”

Section: Discussionsupporting

confidence: 89%

“…Clear description of the roles and responsibilities of nurses, residents and consultants could even be empowering for nurses and residents. Moreover, it might encourage nurses who interact closely with patients several times weekly to engage more proactively in medication adherence practices during hemodialysis, as also suggested by Ghimire et al [ 6 ]. Internationally, pharmacists have a prominent role in partnering with clinicians in adherence promoting activities [ 6 – 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it might encourage nurses who interact closely with patients several times weekly to engage more proactively in medication adherence practices during hemodialysis, as also suggested by Ghimire et al [ 6 ]. Internationally, pharmacists have a prominent role in partnering with clinicians in adherence promoting activities [ 6 – 8 ]. Traditionally, pharmacists do not have a clinical role in hemodialysis settings in Denmark.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background Medication nonadherence is common among patients with hemodialysis, leading to poorer patient outcomes. Health care professionals have an important role in assessing risk of nonadherence and intervening to support adherence. The aim of this study was to explore physicians’ and nurses’ current medication adherence practices in hemodialysis settings. Method A generic qualitative design with inductive content analysis and focus group methodology. Focus groups with health care professionals were conducted in four Nephrology Centers, representing three different regions of Denmark. An interview guide was developed in collaboration with 3 patient representatives. Results Six focus group interviews involving a total of forty-two health care professionals were conducted. Five main categories were identified; Laboratory tests are the “gold standard” for assessing adherence, suggesting that abnormal results motivated investigation of adherence, Varying practices for supporting adherence, alluding to the impact of individual clinician priority and preference on choice of adherence interventions, Unclear allocation of roles and responsibility, specifically referring to uncertainty in the delegation of roles between physicians and nurses, Navigating time and resource limitations, intimating the resources needed to support medication adherence and Suggestions for future strategies. Conclusions We suggest implementing systematic use of validated patient-reported outcome measures for assessing adherence and deprescribing tools to support adherence, as these instruments might identify the patients who are in most need of support and promote patient adherence to their prescribed medications. The findings also point to a need for interdisciplinary clarification of roles and responsibilities regarding medication adherence, with the aim of building a strong collaborative partnership between professions.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…However, these are often less explored aspects of patient adherence reported in medical literatures. In two separate surveys (Ghimire, Banks, Jose, Castelino, & Zaidi, 2017, renal nurses and pharmacists reported time constraints , lack of support from hospital administration , and patient's unwillingness to discuss medication-related issues with nurses (Ghimire et al, 2018) as potential barriers to assessing adherence during routine care.…”

Section: Introductionmentioning

confidence: 99%

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

Ghimire

Lee

Jose

et al. 2019

Journal of Clinical Nursing

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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.

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Exploring the challenges and needs of home caregivers of hemodialysis patients in the Philippines: A mixed methods study

et al. 2021

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Objectives: Although the importance of home caregivers of chronic kidney disease patients has been increasingly recognized, their perceived caregiving difficulties and requisites remain underexplored. This study investigated the challenges and needs of home caregivers of hemodialysis patients in the Philippines. Methods:We utilized a mixed-method (QUAN + qual), explanatory sequential design. Data were collected from July 2017 to May 2018 from 46 home caregivers of hemodialysis patients. A three-part researcher-made survey were developed from literature search, personal values and cultural context, while some items were generated from a standardized tool that measures caregiver infrastructure and needs of those caring from frail US veterans. The tool developed gathered the participants' profile, caregiving characteristics, and related needs. The tool was validated and pretested for reliability. Fifteen participants were also interviewed to explore caregiving challenges and needs. Descriptive and χ 2 statistics were used for quantitative outcomes, while thematic analysis was employed for qualitative data.Results: Participants provided moderate assistance to patients, spending an average of 10.65 h/day and 5.08 days/week in caregiving. The most difficult caregiving circumstances were having costly expenses (78.26%); missing work (50.00%); and experiencing negative feelings (47.83%), stress (43.48%), and physical difficulties (34.78%). They also had the lowest confidence in deciding when to contact health providers (x̅ = 3.31, SD = 0.94) and finding patient care services (x̅ = 2.93, SD = 1.08).Qualitative findings further revealed caregiving needs and challenges in cost management, physical and psychological health, assumption of multiple roles, lifestyle adjustment, and reinforcement of carer knowledge, skills, and attitudes. Conclusion:Supportive strategies are needed to address the challenges encountered by home caregivers of hemodialysis patients. Findings can be utilized in developing appropriate interventions for home caregivers in low-resource settings

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Medication adherence assessment practices in dialysis settings: A survey of renal nurses’ perceptions

Abstract: Results from this study emphasise the need for proper assessment of dialysis patient's medication-taking behaviour during routine dialysis to ensure the benefits of prescribed therapies.

Cited by 6 publications

References 30 publications

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

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

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

Exploring the challenges and needs of home caregivers of hemodialysis patients in the Philippines: A mixed methods study

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