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

Abstract

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.

Electronic Decision Support for Deprescribing in Patients on Hemodialysis: Clinical Research Protocol for a Prospective, Controlled, Quality Improvement Study

“…37 Because of their chronic renal disease and complex medication regimens, patients on dialysis can also experience cognitive impairment that may affect the clinician’s ability to comprehensively perform medication reconciliation given already limited time constraints. 21 Patients may also lack sufficient resources to learn about the medications they are taking, including their potential harms. The therapeutic relationship between the patient and the clinician can also influence initiation of a deprescribing trial or affect readiness to attempt a drug deprescription.…”

“…Guidelines for deprescribing contain long lists of rules that preclude memorization; some may contain conflicting recommendations for patients taking 10 to 15 medications; and not all guidelines explain how to deprescribe (eg, when and how to taper and what rebound symptoms to watch out for). 2,[21][22][23] We therefore integrated the dialysis-specific deprescribing recommendations into the MedSafer ruleset, coupled them with links to patient deprescribing empowerment brochures, and added instructions for tapering where required.…”

Medication adherence among hemodialysis patients: the impact of pharmacist-led motivational interviewing

“…Due to the complexity of individual regimens, which require the administration of various doses, forms, and frequency, maintaining continuous adherence is a major challenge among HD patient. 4 Studies shown that an average prevalence rate of 52.5% medication non-adherence was reported among HD patients. 5 This shows medication adherence among ESRD patients remains a challenge.…”