Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease

Abstract

This study was designed to assess dialysis subjects’ perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects’ perception of their providers’ autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale (MMAS). Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects’ scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.

Phosphate-control adherence in hemodialysis patients: current perspectives

“…Non-white dialysis patients have a lower perception of provider support for phosphate binder adherence as compared to whites. 62 Furthermore, the association between autonomous regulation of phosphate binder therapy and serum phosphorus control is significant in non-whites (β 95% CI: −0.38 [−0.74 to −0.02]; p = 0.04) but not in whites (β 95% CI: 0.49 [−0.00 to 0.99]; p = 0.05). 61 …”

“… 47 , 61 Similarly, the perception of dialysis patients with regard to their providers’ support of autonomy for phosphate binder therapy and patient empowerment are associated with adherence to binders. 62 Moreover, perceived competence or self-efficacy has been associated with adherence to phosphate binder therapy. 63 These factors show great promise to better understand nonadherence as they are associated with self-reported phosphate binder adherence, 61 , 62 and are potentially modifiable using patient-centered approaches, such as motivational interviewing.…”

“… 62 Moreover, perceived competence or self-efficacy has been associated with adherence to phosphate binder therapy. 63 These factors show great promise to better understand nonadherence as they are associated with self-reported phosphate binder adherence, 61 , 62 and are potentially modifiable using patient-centered approaches, such as motivational interviewing. 60 , 64 …”

Treatment adherence and illness self-management: introduction to the special issue

“…For example, Umeukeje and colleagues (Umeukeje, Merighi, Browne, et al, 2016) assessed endstage renal disease patients' perception of their healthcare providers' autonomy support in relation to phosphate binder medication adherence. Another examined race-based medical mistrust and medication beliefs in relation to antiretroviral medication adherence in a sample of HIV patients .…”

“…However, adherence may be compromised by many interpersonal, health system, social/ structural and cultural factors, in addition to those at the patient level. In this issue, Umeukeje et al (2016) consider the importance of health care providers' support of patient autonomy, for example. Although providers were not directly queried, the implication is that provider practice characteristics may play an important role in adherence outcomes.…”