Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

Hsu, Kailin L.; Fink, Jeffrey C.; Ginsberg, Jennifer S.; Yoffe, Marni; Zhan, Min; Fink, Wanda; Woods, Corinne; Diamantidis, Clarissa J.

doi:10.1053/j.ajkd.2015.03.026

Cited by 50 publications

(49 citation statements)

References 31 publications

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“…Hsu et al . used a cross‐sectional design to examine the relationship between self‐reported adherence and adverse safety events, including hypoglycaemia. They found that lower adherence by self‐report was associated with more adverse safety outcomes by self‐report (prevalence ratio 1.21, 95% CI 1.04–1.41), but the specific results for hypoglycaemia were not reported, and the temporal relationship could not be established because of the cross‐sectional study design.…”

Section: Discussionmentioning

confidence: 99%

Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea

et al. 2018

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Aim To evaluate whether recent low adherence to metformin monotherapy is associated with hypoglycaemia after addition of a sulfonylurea. Methods We assembled a retrospective cohort of veterans who filled a new prescription for metformin between 2001 and 2011 and intensified treatment with a sulfonylurea after ≥1 year of metformin use. We calculated metformin adherence from pharmacy data using the proportion of days covered in the 180‐day period before intensification. The primary outcome was hypoglycaemia, defined as a hospitalization or emergency department visit for hypoglycaemia or an outpatient blood glucose measurement <3.3 mmol/l in the year following intensification. Cox proportional hazards models were used to compare the risk of hypoglycaemia between participants with low (<80%) and high (≥80%) adherence. Adherence was also modelled as a continuous variable using restricted cubic splines. Results Of 187 267 participants who initiated metformin monotherapy, 49 424 added a sulfonylurea after ≥1 year. The median (interquartile range) rate of treatment adherence was 87 (50–100)% and 43% had adherence <80%. Hypoglycaemia rates per 1000 person‐years were 23.1 (95% CI 21.1–25.4) and 24.5 (95% CI 22.7–26.4) in participants with low and high adherence, respectively (adjusted hazard ratio 0.95, 95% CI 0.84–1.08). The risk of hypoglycaemia was similar across all levels of adherence when adherence was modelled as a continuous variable. Conclusions We found no evidence that past low adherence to metformin monotherapy was associated with hypoglycaemia after intensification with a sulfonylurea.

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Section: Discussionmentioning

confidence: 99%

Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea

et al. 2018

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“…On the other hand, self-reported Morisky et al [15] questionnaire can be susceptible to recall bias and also evoke a social desirability response in the patients, which may result in an overestimation of the actual adherence behavior [30] . Nevertheless, in lack of a gold standard tool for measuring adherence in clinical practice [10] , we considered using both measures and found a relatively strong association between them, further assuring that our assessment of adherence was reliable [16,31] . The crosssectional nature of this study can limit the suitability of measuring adherence behavior due to reverse causation bias [32] .…”

Section: Discussionmentioning

confidence: 99%

Medication Regimen Complexity and Adherence in Haemodialysis Patients: An Exploratory Study

et al. 2016

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Background: The impact of medication regimen complexity on adherence in hemodialysis patients is unknown. We investigated regimen complexity, perceived burden of medicines (PBM) and health-related quality of life (HR-QoL) as potential predictors of adherence. Methods: Adult (≥18 years) hemodialysis patients were included. Data on medication regimen complexity index (MRCI), self-reported and objective adherence, comorbidity index, PBM and HR-QoL were obtained using established measures. Sociodemographic and clinical characteristics were collected during interviews and by reviewing medical records. Predictors of adherence were determined using logistic regression. Results: Fifty-three out of 70 hemodialysis patients participated (response rate 75%; male 58.5%; age 67.9 ± 11.5 years). The mean MRCI, HR-QoL and PBM scores were 27.0 ± 10.9, 0.70 ± 0.13 and 1.7 ± 0.6, respectively. Based on self-reports, 43.4% (n = 23) were adherent, whereas for a subset of patients analyzed using objective measure (n = 33), much lower adherence rate was observed (27.3%, n = 9). The self-reported and objective measures were significantly correlated (r = 0.43, p = 0.01). Older age was the only significant predictor of self-reported adherence (OR 1.05; 95% CI 1.00-1.11) whereas older age (OR 1.10; 95% CI 1.00-1.21), higher comorbidity (OR 1.58; 95% CI 1.03-2.42) and MRCI (OR 1.14; 95% CI 1.02-1.27) were independent predictors of objective adherence. Conclusions: The findings of this exploratory study suggest that older patients with high comorbidities and highly complex regimen are more likely to be adherent based on an objective measure. Future research is needed using objective measures of adherence suitable for all patients and reflecting all medications.

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“…10 Non-adherence, in turn, has been shown to be a significant threat to patient safety increasing the risk of adverse events in CKD. 11 Solutions are needed to facilitate medication reconciliation, adherence, and monitoring of adverse effects related to the heavy medication burden.…”

Section: The Safety Phenotype Of Ckdmentioning

confidence: 99%

Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD

Weiner

Fink

2017

Advances in Chronic Kidney Disease

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Chronic kidney disease (CKD) patients have several features conferring upon them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired renal function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated renal function loss, acute kidney injury, end-stage renal disease and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations which hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review we summarize previous assessments of the pre-dialysis CKD populations’ proficiency in using telemedicine modalities and describe the use of interactive voice-response system (IVRS) to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded IVRS use in CKD to address the safety threats inherent to this population.

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Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

Cited by 50 publications

References 31 publications

Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea

Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea

Medication Regimen Complexity and Adherence in Haemodialysis Patients: An Exploratory Study

Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD

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