EVALUATION AND PHARMACIST'S INTERVENTION FOR IMPROVING ADHERENCE AMONG RENAL FAILURE PATIENTS
Keywords:End Stage Renal Disease, Hemodialysis, Nil, Counseling, Adherence, Nil
Objective: Management of renal disease may include pharmacotherapy, dialysis, life style modifications, organ transplants and immunosuppressive therapy. Lack of adherence and proper perception towards prescribed renal failure treatment is a major contributor to poor outcome. A prospective, open labeled, interventional, pre-post study which included 60 patients with Chronic Renal Failure (CRF) on Hemodialysis (HD) was conducted over a period of 6 months with an objective to evaluate the degree of adherence, perception towards various treatment recommendations and to study the effect of pharmacist's intervention in improving compliance among patients on HD.
Methods: Patients were assessed using the End Stage Renal Disease- Adherence Questionnaire (ESRD-AQ) scored questionnaire, where subjects were evaluated before and after counseling with a follow up period of 45 days and their response was scored.
Results: Based on the scored response from 58 subjects who completed the study, overall adherence were grouped into three categories such as good adherence, moderate adherence, poor adherence which at baseline was found to be 69%,24.1%,6.9% of study subjects respectively and was improved to 72.4%,25.9%,1.7% at review.
Conclusion: After pharmacist led patient counseling, patient perception towards medications, diet and fluid on showed improvement. On review the data analyzed for adherence parameters were statistically insignificant but clinically comparable with considerable improvement. Common reason cited by study subjects for non-compliance to medications was forgetfulness. From this study it can be concluded that pharmacist's intervention has a positive impact clinically on patient's perception and adherence.
Chan YM, Zalilah MS, Hii SZ. Determinants of compliance behaviors among patients undergoing hemodialysis in Malaysia. PLoS ONE 2012;7(8):E41362.
Moreira L, Fernandes P, Mota RS, Monte F, GalvÃ£o RI. Medication non-compliance in chronic kidney disease. J Nephrol 2008;21(3):354-62.
Sathvik BS, Mangasuli S, Narahari MG, Gurudev KC, Parthasarathi G. Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge. Indian J Pharm Sci 2007;(69):232-9.
Bleyer AJ. An international study of patient compliance with hemodialysis. JAMA 1999;281(13):1211-3.
Kutner NG. Improving compliance in dialysis patients: does anything work? Semin Dial 2001;14:324-7.
Paul L, Kimmel. Behavioural compliance with dialysis prescription in hemodialysis patients. J Am Soc Nephrol 1995;5:1826-34.
Christiane Kugler, Ilona Maeding Cynthia L. Russell Non adherence in patients on chronic hemodialysis: an international comparison study. J Nephrol 2011;24(03):366-75.
Lam LW, Twinn SF, Chan SW. Self reported adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. J Adv Nurs 2010;66(4):763-73.
Youngmee Kim, Lorraine S. Evangelista. Relationship between illness perceptions, treatment adherence and clinical outcomes in patients on maintenance hemodialysis. Nephrol Nurs J 2010;37(3):271â€“81.
H Schmid, B Hartmann, H Schiffl. Adherence to prescribed oral medication in adult patients undergoing chronic hemodialysis: a critical review of the literature. Eur J Med Res 2009;14:185-90.
BS Sathvik. Impact of clinical pharmacist-provided education on medication adherence behaviour in ESRD patients on haemodialysis. IJPS Winter 2009;5(1):21-30.