Evaluation of adherence to therapy in patients of chronic kidney disease

Abstract

Objective:To evaluate adherence to medication and study factors associated with non-adherence in chronic kidney disease (CKD) patients.Methods:A prospective, cross-sectional, questionnaire based study was conducted in Nephrology department of a super specialty hospital. Patients above 18 years of age, suffering from CKD from six months or more were interviewed using self-designed, semi-structured questionnaire to get information about adherence to medication, diet restriction and lifestyle modification (n = 150). Morisky medication adherence questionnaire was used to calculate overall adherence. In this higher score indicates poor adherence. Main outcome measures included prevalence of non-adherence and factors associated with the same.Results:Average number of medicines taken by each patient was 8.0+1.612 (mean+SD) per day. Non-adherence to medication schedule was reported in 34% patients. Common causes of non-adherence were high cost (21.3%), complex dosing schedule (20%), fear of adverse effects (16%). Sixty-eight% patients were not aware about importance of taking each medicine. Sixteen% stopped taking medicines due to high cost. Forty-two% suggested that government should adopt measures to provide free medicines to poor patients. In Morisky medication adherence questionnaire high, medium and low adherence was reported in 7.3%, 55.3% and 37.3% of patients, respectively. Moderately positive correlation was observed between poor adherence and number of concurrent illnesses and number of medicines taken.Conclusion:Since majority of patients were not aware about importance of taking each medicine, creating awareness about the same is essential for improving adherence to therapy. Measures to provide free medicines to non-affording patients need to be implemented since high cost was other major cause of non-adherence.

Adherence to Medications in Chronic Kidney Disease: Prevalence, Predictors and Outcomes

“…Additionally, 18% of the patients were taking alternative medicine without the knowledge of the treating physician. Similar finding has been reported by other Indian authors, for example 14% in a study by Sontakke et al 23 Considering only the patients on dialysis, 32% were taking some form of alternative medicine, most common being ayurvedic (48%). In a tertiary care hospital in India, 26% of patients on haemodialysis used alternative medicine, most commonly ayurveda (30.4%).…”

“…22 High cost has a greater impact on non-adherence in Indian studies (up to 62%). 21,23 High pill burden and complex dosing schedule were other common causes of nonadherence in this study. Prescription of ≥ 4-5 pills/day has been significantly associated with non-adherence in CKD patients.…”

Medication Adherence and Associated Factors Among Type II Diabetic Patients in East Azerbaijan, Iran

“…In general, it is defined as at least 80% use of prescribed drugs and other therapies in terms of dosage, frequency, and duration of treatment (5,6). Several factors impede adherence to treatment among diabetic patients, including, but not limited to, need to take more than one drug or multiple doses daily, high cost of treatment, fear of adverse effects, comorbidities, depression, forgetfulness, lack of medication knowledge, health beliefs, and psychological problems (7)(8)(9)(10). Studies suggest that less than 50% of diabetic patients achieve glycemic goals recommended by the American Diabetes Association (ADA) (11).…”

Self-Management Program for People with Chronic Kidney Disease in Vietnam: A Pragmatic Randomised Controlled Trial

“…However, adherence, particularly medication adherence, remains a challenge in CKD with some studies suggesting the prevalence of low adherence to prescribed medications is 30% or higher (Burnier, Pruijm, Wuerzner, & Santschi, 2015;Sontakke, Budania, Bajait, Jaiswal, & Pimpalkhute, 2015). In addition, a recent narrative review indicates that levels of adherence to diet, medication, and treatment ranges from 20% to 70% (Beto, Schury, & Bansal, 2016).…”