Understanding reasons and factors for participation and non-participation to a medication adherence program for patients with diabetic kidney disease in Switzerland: a mixed methods study

Abstract

Background An interprofessional medication adherence intervention led by pharmacists, combining motivational interviews and feedback with electronic monitor (EM) drug assessment, was offered to all consecutive patients with diabetic kidney disease (DKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) visiting their nephrologist or endocrinologist. Approximately 73% (202/275) of eligible patients declined to participate, and the factors and reasons for refusal were investigated. Methods Sociodemographic and clinical data of included patients and those who refused were collected retrospectively for those who had previously signed the general consent form. Multivariate logistic regression analysis was performed to identify independent variables associated with non-participation. Patients who refused or accepted the adherence study were invited to participate in semi-structured interviews. Verbatim transcription, thematic analysis, and inductive coding were performed. Results Patients who refused to participate were older (n = 123, mean age 67.7 years, SD:10.4) than those who accepted (n = 57, mean age 64.0 years, SD:10.0, p = 0.027) and the proportion of women was higher among them than among patients who accepted it (30.9% vs 12.3%, p = 0.007). The time from diabetes diagnosis was longer in patients who refused than in those who accepted (median 14.2 years IQR 6.9–22.7 vs. 8.6 years, IQR 4.5–15.9, p = 0.003). Factors associated with an increased risk of non-participation were female sex (OR 3.8, 95% CI 1.4–10.0, p = 0.007) and the time from diabetes diagnosis (OR 1.05, 95% CI 1.01–1.09, p = 0.019). The included patients who were interviewed (n = 14) found the interprofessional intervention useful to improve their medication management, support medication literacy, and motivation. Patients who refused to participate and who were interviewed (n = 16) explained no perceived need, did not agree to use EM, and perceived the study as a burden and shared that the study would have been beneficial if introduced earlier in their therapeutic journey. Other barriers emerged as difficult relationships with healthcare providers, lack of awareness of the pharmacist’s role, and negative perception of clinical research. Conclusions Investigating the factors and reasons for participation and non-participation in a study helps tailor intervention designs to the needs of polypharmacy patients. Patients who refused the adherence intervention may not be aware of the benefits of medication management and medication literacy. There is an urgent need to advocate for interprofessional outpatient collaborations to support medication adherence in patients with DKD. Trial registration Clinicaltrials.gov NCT04190251_PANDIA IRIS.

Relationship Between Family Caregiver Burden and Medication Adherence in Patients with Mechanical Valve Replacement: A Structural Equation Model

“…perception of taking medication. [52][53][54] In addition, a systematic evaluation also pointed out that poor medication adherence was associated with high out-of-pocket expenditures, low income, financial flexibility, or lack of medication insurance. 55 This study found the relationship among medication adherence, family caregiver burden, PTG, ML and provided a basis for understanding the influencing factors that may improve medication adherence in patients after MVR.…”

The differential impact of a 6-versus 12-month pharmacist-led interprofessional medication adherence program on medication adherence in patients with diabetic kidney disease: the randomized PANDIA-IRIS study

“…In groups A and B, respectively, 20 and 26 patients dropped out, mainly due to logistical reasons or because the study was perceived as an additional burden in their care. Of note, patients’ satisfaction about the intervention was reported elsewhere ( Bandiera et al, 2022a ). Patients in groups A and B spent, respectively, a median time of 539 days (IQR 124; 747) and 366 days (IQR 145; 740) in the study.…”

“…The PANDIA-IRIS study was offered to 275 patients, 73 of which accepted to participate. The main reasons for non-participation were investigated as part of the “participation to the PANDIA-IRIS” study, the results of which have been published elsewhere ( Bandiera et al, 2022a ). The sociodemographic and clinical variables of the 73 included patients at baseline (group A n = 35 and group B n = 38) are presented in Table 1 .…”

“…Patients were overall satisfied about the IMAP ( Bandiera et al, 2022a ). A substantial number of patients left the study during the intervention phase, mainly owing to personal reasons (cf.…”

“…The historical eGFR decline per year was calculated from patients’ blood creatinine concentrations available from 2000 to 2021, upon a previously described methodology ( Bandiera et al, 2022a ; Trucello et al, 2023 ).…”