Chronic drug treatment among hemodialysis patients: A qualitative study of patients, nursing and medical staff attitudes and approaches

Lee Gilad, Lee Gilad, Yosef S. Haviv, Inbal Cohen-Glickman, David Chinitz, Matan J. Cohen, Matan J. Cohen

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Dialysis patients have a high pill burden, increasing their care complexity. A previous study in our institution's dialysis unit found notable discrepancies between medication prescriptions, purchases and patient reports of medication use: overall adherence to medication was 57%, on average; staff reported patients took 3.1 more medication types than actual purchases; concordance of patient purchases and nurse reports was found in 5.7 out of 23.6 months of patient follow-up. We sought to investigate patients and staff concepts and attitudes regarding medication care and to understand better the previously identified inconsistencies. Methods: We performed a qualitative research based on the grounded theory approach, using semi-structured, in-depth, interviews with patients and staff from the same dialysis unit studied previously, at the Hadassah Medical Center, Jerusalem, Israel. Results: Though all respondents described a seemingly synchronized system of care, repeated questioning revealed that staff distrust patient medication reports. Patients, on their part, felt that their monitoring and supervision were bothersome and belittling. Along with patients, nurses and physicians, we identified a "fourth"factor, which influences medication care - the laboratory tests. They serve both as biological parameters of health, but also as parameters of patient adherence to the prescribed medication regimens. Conclusions: Participant responses did not clearly resonate with previous findings from the quantitative study. The central role of laboratory tests should be carefully considered by the staff when interacting with patients. An interaction process, less adversarial, centering on the patient attitudes to medication care, might establish better communication, better cooperation and better patient outcomes.

Original languageEnglish
Article number239
JournalBMC Nephrology
Volume21
Issue number1
DOIs
StatePublished - 26 Jun 2020
Externally publishedYes

Keywords

  • Drug adherence
  • Hemodialysis
  • Medical staff
  • Nursing staff

ASJC Scopus subject areas

  • Nephrology

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