Title: Evaluation of Adherence, Knowledge, and Practices towards the Therapy in Patients of Chronic Kidney Disease

Authors: Yogesh B. Magar, Rajesh S. Hiray, Balasaheb B. Ghongane

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i3.12

Abstract

Objective: Chronic kidney disease (CKD) is a prolonged illness with co-morbidities. These patients have to take a large number of pills per day. Hence, this study evaluates the extent of medication adherence and study factors responsible for the same.

Methods: A cross-sectional, questionnaire based study was conducted in a tertiary care hospital. Patients (n = 100) suffering from CKD for three months or more were interviewed. Morisky medication adherence questionnaire was used to assess overall adherence. Scoring was done accordingly: high (score =0), medium (score 1-2) and low (score >2).

Results: 36% patient’s show low adherence. Common causes of low adherence were complex dosing schedule (20%), difficult to take large number (20%) and forgetfulness (18%). 70% patients were not aware about importance of taking each medicine. Average number of medicines taken by each patient was 6.13per day. Only 3% stopped taking medicines due to high cost. Statistically significant positive correlation was observed between poor adherence and number of concurrent illnesses (r=0.68, P<0.0001) and number of medicines (r=0.77, P<0.0001) taken

Conclusion: Since majority of patients were not aware about importance of taking each medicine, creating awareness about same is essential for improving drug adherence. Measures to make patient aware regarding seriousness of the condition, prevention of its complication and management of co-morbidities are essential. Physician should try to avoid poly-pharmacy. Use of long acting preparations and/or fixed dose combinations may be encouraged whenever required.

Keywords: Morisky medication adherence Score, adherence, CKD.

References

1.      KDIGO, CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation, prevention and management of chronic kidney disease‑mineral and bone disorder. Kidney Int 2013;3:1‑150.

2.      Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: Comparisons of USRDS to a large not‑for‑profit dialysis provider. Nephrol Dial Transplant 2004;19:1842‑8.

3.      McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: Scientific review. JAMA 2002;288:2868‑79.

4.      Beena Jimmy, Jimmy Jose Patient Medication Adherence: Measures in Daily Practice Oman Medical Journal (2011) Vol. 26, No. 3: 155-159

5.      Spiro H. Compliance, adherence, and hope. J Clin Gastroenterol 2001 Jan;32(1):5.

6.      Di Matteo MR. Adherence to treatment. In: Feldman MD, Christensen JF, eds. Behavioral medicine in primary care. A practical guide. Stamford, Connecticut: Appleton and Lange, 1997.p.136–140.

7.      Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care 1998 Aug;36(8):1138-1161.

8.      World Health Organization. Adherence to Long‑term Therapies: Evidence for Action. Available from: http://www.who.int/chp/knowledge/publications/ adherence_report/en/. [Last accessed on 2015 Jan 12].

9.      Manley HJ, Wang S, Nissenson AR. Medication Non‑adherence Predicts Hospitalization Rate and Healthcare Costs in Hemodialysis Patients. Renal Week 2010 American Society of Nephrology 43rd Annual Meeting. Denver, Colorado; November, 2010.

10.  Magacho EJ, Ribeiro LC, Chaoubah A, Bastos MG. Adherence to drug therapy in kidney disease. Braz J Med Biol Res 2011;44:258‑62.

11.  Lacey J, Cate H, Broadway DC. Barriers to adherence with glaucoma medications: A qualitative research study. Eye (Lond) 2009;23:924‑32.

12.  Laws MB, Wilson IB, Bowser DM, Kerr SE. Taking antiretroviral therapy for HIV infection: Learning from patients’ stories. J Gen Intern Med 2000;15:848‑58.

13.  DiMatteo MR. Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Med Care 2004;42:200‑9.

14.  Lindberg M, Lindberg P. Overcoming obstacles for adherence to phosphate binding medication in dialysis patients: A qualitative study. Pharm World Sci 2008;30:571‑6.

15.  Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24: 67-74.

16.  Awad GA. Antipsychotic medications: Compliance and attitudes toward treatment. Curr Opin Psychiatry 2004;17:7580.

Corresponding Author

Yogesh Bajirao Magar

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Contact No. +91-9423824213