adherence to phosphate binders in haemodialysis patients ... · 23 questions? • journal of...
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ESPACOMP 2013 Measurement and determinants of the 3 elements of patient adherence to
medications: initiation, implementation and discontinuation
Adherence to phosphate binders in
haemodialysis patients: prevalence and
determinants
15 November 2013
Yoleen PM Van Camp, Bernard Vrijens, Ivo Abraham,
Bart Van Rompaey and Monique M Elseviers
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1
Influence of adherence on mortality
(Simpson et al., 2006 (BMJ))
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INTRODUCTION – PhD study
Map extent of nonadherence + determinants Chronic dialysis: phosphate binders
Diabetes type 2
Chronic heart failure
Improve adherence (nurse-led)
Question 1 Question 2
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INTRODUCTION – phosphate cycle Phosphate binders in dialysis patients
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Phosphate binders in dialysis patients
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METHODOLOGY – study design
135 chronic dialysis patients
2 months passive adherence measure
Baseline questionnaires Demographical Medical and pharmacological Social support Knowledge Health beliefs Side effects Depression Quality of life (SF-36)
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METHODOLOGY – adherence measure
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METHODOLOGY – adherence measure
Vrijens et al. BJCP 2011
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RESULTS
Study population
Typical dialysis population
- Mean 67 years, 64% male, 70% retired
- 20% side-effects and 20% inconveniences
- Mean oral daily pill burden 12
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Intermezzo 1
Self-report vs electronic adherence measure
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Self-reported adherence vs electronic measure
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Question 1
The extent of nonadherence
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RESULTS
Extent of nonadherence
How to?
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Definitions of adherence
Be aware of “false friends”
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Mean percentage of adherence
vs the proportion of adherent patients
Mr. Red: 6/10 = 60%
Ms. Yellow: 10/10 = 100%
Mr. Blue: 8/10 = 80%
Ms. Green: 10/10 = 100%
Ms. Beige: 4/10 = 40%
Mean % of adherence = % of prescribed doses taken
Proportion of adherent patients (cut-off e.g. ≥80%)
3 in 5 patients = 60%
Mean % of adherence
= 60+100+80+100+40 / 5 = 76%
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The proportion of adherent patients
Finding a meaningful cut-off
80% = missing a weekly dose of “1,4”
little clinical relevance
<1 total daily dose / week = adherent
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RESULTS
Extent of nonadherence? 78% prescribed doses taken
1 in 2 patients misses ≥1x/week
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Mean percentage of adherence
vs the proportion of adherent patients
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Intermezzo 2
Consequences of nonadherence
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Mean phosphatemia in adherent
vs nonadherent patients
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Question 2
Determinants of adherence
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RESULTS
Adherence determinants? + Partner and social support (intercorrelated)
+ Physical quality of life (SF-36)
– Intake inconveniences (taste, size, …)
social support + physicial quality of life
= 26% of variance in being adherent
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CONCLUSIONS
Adherence poor Clear definition (% vs proportion)
Meaningful cut-off
Adherence determinants Social support + physical QoL
Need for improvement Social support
Individualised support
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Questions?
• Journal of Nephrology 2013/14 – Van Camp et al. “Adherence to
phosphate binders in hemodialysis patients: prevalence and
determinants” (accepted, soon to be published)
• European Journal of Clinical Pharmacology 2013 – Van Camp et al.
“Nurse-led interventions to enhance adherence to chronic
medication: systematic review and meta-analysis of randomised
controlled trials.” (discussion addresses nonadherence cut-off)
• Journal of Clinical Nursing 2012 – Van Camp et al. “Nurse-led
education and counselling to enhance adherence to phosphate
binders.” (methodology section addresses bias induced by
electronic monitoring)
• CONTACT [email protected] or [email protected]