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Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study.

ABSTRACT: Older adults with chronic kidney disease (CKD) typically use more than 5 medications and have multiple prescribing physicians. However, little is known about how they prioritize their medical conditions or decide which medications to take.Semistructured interviews (average length, 40 minutes) with 20 community-dwelling adults with CKD stages 3-5D receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physicians, and medication-taking behaviors. We performed thematic analysis to explain patients' decisions regarding medication prioritization, understanding, and adherence decisions.Participants (age range, 55-84 years; mean, 72 years) used 5-14 prescribed medications, had 2-9 physicians, and had 5-11 comorbid conditions. All had assigned implicit priorities to their medications. Although most expressed the intention to be adherent, many regularly skipped medications they considered less important. Most identified the prescribing physician and indication for each medication, but there often was substantial discordance between beliefs about medications and conventional medical opinion. Respondents prioritized medications based on the salience of the particular condition, perceived effects of the treatment, and barriers (physical, logistic, or financial) to using the prescribed drug. Side effects of medications were common and anxiety provoking, but discussions with the prescribing physician often were delayed or unfulfilling for the patient.Polypharmacy in patients with CKD leads to complex medication choices and adherence behaviors in this population. Most patients we interviewed had beliefs or priorities that were nonconcordant with conventional medical opinion; however, patients rarely discussed these beliefs and priorities or the resultant poor medication adherence with their physicians. Further study is needed to provide quantitative data about the magnitude of adherence barriers. It is likely that more effective communication about medication use could improve patients' health outcomes and reduce potential adverse drug events.

SUBMITTER: Rifkin DE

PROVIDER: S-EPMC2935303 | biostudies-other | 2010 Sep

REPOSITORIES: biostudies-other

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Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study.

Rifkin Dena E DE Laws M Barton MB Rao Madhumathi M Balakrishnan V S VS Sarnak Mark J MJ Wilson Ira B IB

American journal of kidney diseases : the official journal of the National Kidney Foundation 20100731 3

<h4>Background</h4>Older adults with chronic kidney disease (CKD) typically use more than 5 medications and have multiple prescribing physicians. However, little is known about how they prioritize their medical conditions or decide which medications to take.<h4>Methods</h4>Semistructured interviews (average length, 40 minutes) with 20 community-dwelling adults with CKD stages 3-5D receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physi ...[more]

PMID: 20674113

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Project description:BACKGROUND:Although dialysis may not provide a large survival benefit for older patients with kidney failure, few are informed about conservative management. Barriers and facilitators to discussions about conservative management and nephrologists' decisions to present the option of conservative management may vary within the nephrology provider community. STUDY DESIGN:Interview study of nephrologists. SETTING & PARTICIPANTS:National sample of US nephrologists sampled based on sex, years in practice, practice type, and region. METHODOLOGY:Qualitative semistructured interviews continued until thematic saturation. ANALYTICAL APPROACH:Thematic and narrative analysis of recorded and transcribed interviews. RESULTS:Among 35 semistructured interviews with nephrologists from 18 practices, 37% described routinely discussing conservative management ("early adopters"). 5 themes and related subthemes reflected issues that influence nephrologists' decisions to discuss conservative management and their approaches to these discussions: struggling to define nephrologists' roles (determining treatment, instilling hope, and improving patient symptoms), circumventing end-of-life conversations (contending with prognostic uncertainty, fearing emotional backlash, jeopardizing relationships, and tailoring information), confronting institutional barriers (time constraints, care coordination, incentives for dialysis, and discomfort with varied conservative management approaches), conservative management as "no care," and moral distress. Nephrologists' approaches to conservative management discussions were shaped by perceptions of their roles and by a common view of conservative management as no care. Their willingness to pursue conservative management was influenced by provider- and institutional-level barriers and experiences with older patients who regretted or had been harmed by dialysis (moral distress). Early adopters routinely discussed conservative management as a way of relieving moral distress, whereas others who were more selective in discussing conservative management experienced greater distress. LIMITATIONS:Participants' views are likely most transferable to large academic medical centers, due to oversampling of academic clinicians. CONCLUSIONS:Our findings clarify how moral distress serves as a catalyst for conservative management discussion and highlight points of intervention and mechanisms potentially underlying low conservative management use in the United States.

Project description:Background and objectivesThe complexity of CKD management in children is increased by the number of comorbid conditions. This study assessed the prevalence of comorbidities in pediatric CKD and the frequency with which multiple comorbidities present together by assessing prevalent medication use by CKD stage and diagnosis and their association with clinical or sociodemographic factors. The association between number and frequency of dosing of medications prescribed and self-report of nonadherence was also assessed.Design, setting, participants, & measurementsIn this cross-sectional analysis of the Chronic Kidney Disease in Children study, medication use at study entry grouped by indication was examined by CKD stage, diagnosis, age, race, ethnicity, income, and CKD duration. Multivariate adjusted predictors of medication use and clustering were examined. Nonadherence was assessed by self-report of missed medications in the past 7 days.ResultsThe 558 eligible participants had a median age of 11 years and median GFR of 44 ml/min per 1.73 m(2); 62% of participants were male and 78% had nonglomerular kidney disease. The number of medications for treatment of CKD comorbidities increased with advanced CKD stage (2.5-fold for stages IV versus II; P<0.001) and glomerular disease (1.4-fold versus nonglomerular; P<0.001). Three distinct medication clusters were identified that corresponded to treatment of glomerular disease, advanced renal tubular dysfunction, and proteinuric complications, respectively. Nonadherence was associated with increased medication dosing frequency (administration >2 times/d; P<0.001) but not the number of medications.ConclusionsMedical therapy for children with CKD is complex and is affected by glomerular diagnosis, CKD stage, and medication frequency. The need for CKD-related medication treatment cannot be easily predicted by CKD staging alone. Poorer adherence was associated with increased medication frequency, but not with the number of medical problems needing treatment. Consolidating medical treatment and reducing medication frequency may improve adherence rates in children with CKD.

Project description:ObjectivesTo give an overview over the associations between self-reported health literacy and medication adherence in older adults.DesignA systematic literature review of quantitative studies published in English and German.Data sourcesMEDLINE via PubMed, CINAHL, Cochrane Library, Epistemonikos and LIVIVO were searched.Eligibility criteriaIncluded studies had to examine the associations between self-reported health literacy and medication adherence in the elderly (samples including ≥66% of ≥60 years old) and had to use a quantitative methodology and had to be written in English or German.Data extraction and synthesisAll studies were screened for inclusion criteria by two independent reviewers. A narrative synthesis was applied to analyse all included studies thematically. Quality assessment was conducted using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsWe found 2313 studies, of which nine publications from eight studies were included in this review. Five studies reported a majority of participants with limited health literacy, one study reported a majority of participants with adequate health literacy, and three publications from two studies only reported mean levels of health literacy. Eight publications from seven studies used self-reports to measure medication adherence, while one study used the medication possession ratio. Overall, six publications from five studies reported significantly positive associations between health literacy and medication adherence while two studies reported positive but non-significant associations between both constructs and one study reported mixed results.ConclusionIn this review, associations between self-reported health literacy and medication adherence are rather consistent, indicating positive associations between both constructs in older adults. However, concepts and measures of health literacy and medication adherence applied in the included studies still show a noteworthy amount of heterogeneity (eg, different use of cutoffs). These results reveal the need for more differentiated research in this area.Prospero registration numberCRD42019141028.

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Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study.

Publications

Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study.

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