oral medication and self-management in hemodialysis patients

5/26/2018 Oral Medication and Self-Management in Hemodialysis Patients

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Oral Medication and Self-Management

in Hemodialysis Patients

Source: Browne T, Merighi JR. Barriers

to adult hemodialysis patients self-

management of oral medications.Am JKid Dis. 2010;56(3):547557.


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Overview

Hemodialysis patients, in order to manage their kidney disease andcomorbid illnesses, are required to follow a multi-oral drug regimen on adaily basis.

Most oral medications used daily by these patients are phosphorusbinders.

Findings from a study showed that hemodialysis patients have the highestpill burden among all chronically ill patients.

The adherence to prescribed oral medication regimen is directly linked toseveral unit Quality Assessment and Performance Improvement (QAPI)goals and, more significantly to patient quality of life (QOL), morbidity,mortality and rate and length of hospitalizations.

The perspective about a hemodialysis patient as a passive participant incare planning has changed to a fully collaborative member of theinterdisciplinary team, following the new model of kidney disease care fordialysis units outlined in the 2008 US Centers for Medicare & MedicaidServices conditions for coverage (CfC).


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Barriers to Self-Management of Oral

Drug

Above half of the hemodialysis patients may

not comply with their oral medication

regimens, due to burden of pills, demographic

and socioeconomic reasons, psychosocial

determinants, health literacy, patient

satisfaction and health beliefs (see Fig. 1).


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Pill Burden

The number, size and taste of drugs present as a challenge, andthese are further complicated by strict daily fluid restrictions.

According to the 2008 Medicare CfC, healthrelated QOL should

be measured on an annual basis and addressed in dialysis unit-

QAPI programs. Research suggests that the frequency of medication dosing is

negatively associated with self-management of medication.

Chronically ill patients may forget to take pills, or are not able to

accurately recall all their medications or have difficulty inopening medication bottles.

In addition, drugrelated adverse side-effects also account for

poor oral medication self-management.


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Demographic and Socioeconomic

Variables

Socially disadvantaged chronically ill patients areat a greater risk of unsuccessful self-managementof oral medications.

Research indicates that patients with low incomeor limited formal education, those at a young age,without adequate prescription coverage andthose faced with transportation challenges haveless success with a selfmanaged oral medication

regimen. The relation between sex and management of

oral medication is inconclusive.


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Psychosocial Factors

Patients with diabetes or kidney disease are at a higher risk ofunsuccessful medication self-management due to depression.

Patients habituated to smoking and drinking alcohol, or to otherillicit substances may not follow the prescribed pattern ofmedication, as these substances have an impact on cognition,

including, but not restricted to the ability to make properjudgments.

Social support also plays an important role behind the successfulmedication regimen.

Patients with very busy or erratic social lives may not comply withthe requirement of self-management.

Psychological distress and stressful life events are equally linkedwith the use of suboptimal oral medication in chronically illpatients.


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Health Literacy

Health literacy is a vital predictor of self-managementof medication, as it helps to describe the ability to readand understand health-related words and numbers aswell as the capacity to successfully react on medical

instructions.

For hemodialysis patients, inadequate health literacy isrelated to adverse health outcomes and mortality.

Health literacy has been associated with the adequate

understanding of phosphorus control and the role ofinvolved medications.


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Patient Satisfaction

It has been observed that chronically ill patients, whoare satisfied with the care service received, are morelikely to be successful at self-managing oralmedications.

In addition, patients sharing a satisfactory relationshipwith their medical team and receiving a cooperativeapproach from care-team members can better manageoral medication.

Based on the importance of patient satisfaction, the

2008 Medicare CfC recommends that every dialysisunit should measure each patients level of satisfactionon an annual basis.


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Health Beliefs

Health belief, a model of health behavior, posits that patients areless susceptible to modify their behaviors when a condition is notthought to be as severe.

About 6270% of hemodialysis patients demonstrate inadequateselfmanagement with phosphorus binders.

The asymptomatic nature of many health conditions makes the self-management challenging due to the patients health beliefs.

Cultural beliefs also may affect patient understanding of health dataand self-management of health.

Leventhalscommonsense model of self-regulation posits the

patients accurate linkage of symptoms to a health condition(identity), patients belief of the causes of the health condition,understanding of the consequence, controllability and belief aboutthe timeline of the disease, and factors governing the self-regulation/ self-management.


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Steps to Improve Self-Managed Oral

Medication Dialysis teams should develop and practice a mutual association with

patients and their team members.

Every dialysis unit must have a proper medical team comprising ofhealthcare professionals, as this will help patients prevail over theobstructions to successful health outcomes.

Dialysis units can employ QAPI programs to find out the barriers that lead tounsuccessful self-management of oral medication, and to devise strategiesto prevent these barriers.

Every patient should be examined individually and care plans should be ableto cater to the customized need of each patient related to the uniquelifestyle, barriers and resources.

According to a study, a model for self-management training that includesthe evaluation of patient beliefs, behavior and knowledge, collaborativegoal setting, identifying patient barriers and supports, and developing anaction plan tailored for each patient, could be implemented in dialysis units.


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To reduce the pill burden, dialysis teams can customize medicationdosing that complies with a patients schedule, and reduce thenumber and regularity of pills as possible.

The visual ability and health literacy level of a patient should beconsidered when developing these tools and strategies.

It is also essential to work with patients on plans, and evaluate the

specific burdens posed by the phosphate binders. Further emphasis is required to identify the differences arising due to

the race, age or sex factors among patients with kidney disease.

Evaluating and engaging patients social network members are alsoimportant.

Tools like test of functional health literacy in adults, drug regimenunassisted grading scale, beliefs about medication scale and beliefsabout medicines questionnaire could be employed to evaluate thehealth literacy level.


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Conclusion

Hemodialysis patients are subjected to a multi-oral drugregimen on a daily basis in order to manage the kidneydisease and comorbid illnesses.

Developing and following strategies to overcome barrierslike the burden of pills, demographic and socioeconomicfactors, psychosocial determinants, health literacy levels,patient satisfaction and health beliefs can help patients tocomply with the self-managed oral medication regimens.

Also, proper evaluation of the patients need and factorsthat build the relation between the care team and patientwill also support the successful management of oralmedication in hemodialysis patients.


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oral medication and self-management in hemodialysis patients

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