Journal List > Perspect Nurs Sci > v.12(1) > 1060409

TOOLS
Seo, Lim, Hyeon, Kim, and Eom: Factors Influencing Medication Adherence in Hemodialysis Patients: Focusing on Primary and Secondary Medical Care
Original Article

Perspectives in Nursing Science 2015;12(1):60-70.

Published online: 19 April 2015

DOI: https://doi.org/10.16952/pns.2015.12.1.60

Factors Influencing Medication Adherence in Hemodialysis Patients: Focusing on Primary and Secondary Medical Care

Yon Hee Seo1, Sun Og Lim2, Eun Hee Hyeon3, Hae Won Kim4, Mi Ran Eom5,

1Assistant Professor, Department of Nursing, Chodang University, Muan

2Team Manager, Department of Nursing, Eulji Hospital, Seoul

3Assistant Professor, Department of Nursing, Mokpo Science University, Mokpo

4Associate Professor, College of Nursing ․ Research Institute of Nursing Science, Seoul National University, Seoul

5Professor, Department of Nursing, Mokpo National University, Mokpo, Korea

Corresponding author: Eom, Mi Ran Department of Nursing, Mokpo National University, 61 Dorim-ri, Cheonggye-myeon, Muan 534-729, Korea. Tel: +82-61-450-2671, Fax: +82-61-450-2679, E-mail: miran@mokpo.ac.kr

Received 16 March 2015       Revised 23 April 2015       Accepted 23 April 2015

Copyright © 2015 The Research Institute of Nursing Science, Seoul National University

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study was to identify the factors influencing medication adherence in hemodialysis patients among primary medical care and secondary medical care. Methods: A cross-sectional survey design was utilized. Data were collected using questionnaires from 280 hemodialysis patients who had taken prescribed medication regularly as a result of chronic renal failure at primary and secondary medical care in Korea. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. Results: There were statistically significant differences in medication adherence according to living area (p=.002), health condition (p<.001), amount of medication (p=.004), inconvenience for taking medication (p<.001), and depression level (p=.001). The mean of medication adherence was 3.72 points. Medication adherence was explained by perceived barrier related to medication taking (β=.338), attitude (β=.250), and depression (β=.132). Conclusion: This study strongly recommended that nursing intervention program to improve medication adherence should be developed and a match control study in improvement of medication adherence for hemodialysis patients needs to be done.

Keywords: Renal dialysis, Medication Adherence

REFERENCES

1.Jang YS., Ko KH., Do SR., Kim NY., Jin DC. Renal failure patients statistics produced in accordance with OECD standards. Working Report. Seoul: Korea Institute for Health and Social Affairs;2008. November. Report No.p. 2008–48.
2.Registry Committee of Korean Society of Nephrology. Current Renal Replacement Therapy in Korea [Internet]. Seoul: Registry Committee of Korean Society of Nephrology;2011. [cited 2013 September 30]. Available from. http://www.ksn.or.kr/journal/2012/report_2011.pdf.
3.Williams A., Manias E., Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs. 2008. 63(2):132–43. http://dx.doi.org/10.1111/j.1365-2648.2008.04656.x.
crossref
4.Park JW. The compliance of patients who have chronic disease according to degree of depression [master's thesis]. Daegu: The Keimyung University of Korea;2006.
5.Bland RJ., Cottrell RR., Guyler LR. Medication compliance of hemodialysis patients and factors contributing to non-compliance. Dialysis & Transplantation. 2008. 37(5):174–8. http://dx.doi.org/10.1002/dat.20207.
crossref
6.Browne T., Merighi JR. Barriers to adult hemodialysis patients' self-management of oral medications. Am J Kidney Dis. 2010. 56(3):547–57. http://dx.doi.org/10.1053/j.ajkd.2010.03.002.
crossref
7.Schmid H., Hartmann B., Schiffl H. Adherence to prescribed oral medication in adult patients undergoing chronic hemodialysis: a critical review of the literature. Eur J Med Res. 2009. 14(5):185–190. http://dx.doi.org/10.1186/2047-783X-14-5-185.
8.Chiu YN., Teitolbaum I., Misra M., Leonn EM., Adzize T., Me-hrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clinic J Am Soc Nephrol. 2009. 4(6):1089–96. http://dx.doi.org/10.2215/CJN.00290109.
crossref
9.Natarajan N., Putnam W., Van Aarsen K., Lawson B., Burge F. Adherence to antihypertensive medications among family practice patients with diabetes mellitus and hypertension. Can Fam Physician. 2013. 59(2):93–100.
10.Boccuzzi SJ., Sung JCY., Wogen J., Shah AB., Fox J., Kim J. Utilization of Oral Hypoglycemic Agents in a Drug-Insured U.S. Population. Diabetes Care. 2001. 24(8):1411–5. http://dx.doi.org/10.2337/diacare.24.8.1411.
11.So HS., Kim AY., Kim EA., Kim SM. Effects of a structured drug education program on knowledge and medication compliance for hemodialysis patients. J Korea Acad Nurs. 2006. 36(7):1135–44.
crossref
12.Munter P., Judd S., Krousel-Wood M., McClellan W., Safford M. Low medication adherence and hypertension control among adults with CKD: data from the REGARDS (Reason for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2010. 56(3):447–57. http://dx.doi.org/10.1053/j.ajkd.2010.02.348.
13.Raymond CB., Wazny LD., Sood AR. Medication adherence in patients with chronic kidney disease. CANNT J. 2011. 21(2):47–50.
14.Kim JH. A study of effect on continuous education for diet and medication control in hemodialysis patient [master's thesis]. Seoul: Ewha Womans University;1993.
15.Kim YS. Factors related to medication adherence in elderly hemodialysis patients [master's thesis]. Seoul: Ewha Womans University;2011.
16.Bae JE. A study on the status of hemodialysis patient education [master's thesis]. Seoul: Ewha Womans University;2005.
17.Jin DC. Current status of dialysis therapy for ESRD patients in Korea. J Korean Med Assoc. 2013. 56(7):562–8. http://dx.doi.org/10.5124/jkma.2013.56.7.562.
crossref
18.Faul F., Erdfelder E., Buchner A., Lang AG. Statistical power analyses using G∗power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009. 41(4):1149–60. http://dx.doi.org/10.3758/BRM.41.4.1149.
crossref
19.Morisky DE., Green LW., Levine DM. Concurrent and predictive validity of a self reported measure of medication adherence. Med Care. 1986. 24(1):67–94.
20.Wu JR., Chung M., Lennie TA., Hall LA., Moser DK. Testing the psychometric properties of the medication adherence scale in patients with heart failure. Heart Lung. 2008. 37(5):334–43. http://dx.doi.org/10.1016/j.hrtlng.2007.10.001.
crossref
21.Hwang JH. Medication adherence in patients with chronic heart failure. [master's thesis]. Seoul: Yonsei University;2009.
22.Lee YH.., Song J. Y. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychol. 1991. 10(1):98–113.
23.Lee GC., Jang C., Kim HS., Kim EY., Kim JH. editors.Statistics for health care. Seoul: Hyunmoonsa;2012.
24.Kim YH., Lee MK., Lee SJ., Cho MS., Hwang MS. Medication status and adherence of the elderly under home care nursing. J Korean Acad Community Health Nurs. 2011. 22(3):290–301. http://dx.doi.org/10.12799/jkachn.2011.22.3.290.
crossref
25.Walker EA., Molitch M., Kramer MK., Kahn S., Ma Y., Edelstein S, et al. Adherence to preventive medications: predictors and outcomes in the diabetes prevention program. Diabetes Care. 2006. 29(9):1997–2002. http://dx.doi.org/10.2337/dc06-0454.
26.Oh H J. Factors affecting medication adherence in the elderly people with chronic disease [master's thesis]. Daegu: Kyungpook National University;2011.
27.Munger MA., Van Tassell BW., LaFleur J. Medication Nonadherence: An Unrecognized Cardiovascular Risk Factor. Med Gen Med. 2007. 9(3):58–66.
28.Katzir Z., Boaz M., Backshi I., Cernes R., Barnen Z., Biro A. Medication apprehension and compliance among dialysis patients-a comprehensive guidance attitude. Nephron Clin Pract. 2010. 114(2):151–7. http://dx.doi.org/10.1159/000254388.

Table 1.
Medication Adherence according to General Characteristics (N=280)
Characteristics Categories n (%) Medication adherence
M±SD t or F p
Gender Male 166 (59.3) 3.71±1.57 0.16 .875
Female 114 (40.7) 3.71±1.56    
Age (year) 20~39 12 (4.3) 2.82±1.81 2.92 .056
40~64 164 (58.6) 3.63±1.45    
≥65 104 (37.1) 3.87±1.51    
Living status Couple 192 (68.6) 3.81±1.46 1.23 .300
Alone 66 (23.6) 3.43±1.61    
Friends or caregiver 22 (7.8) 3.62±1.58    
Living area Metropolisa 91 (32.5) 3.78±1.59 6.27∗ .002
Local small cityb 64 (22.9) 4.14±1.32   b＞a, c
Rural areac 125 (44.6) 3.38±1.53    
Education Illiteracy 32 (11.4) 3.91±1.22 1.40 .234
Elementary school 57 (20.4) 3.34±1.72    
Middle school 52 (18.6) 3.92±1.69    
High school 103 (36.8) 3.71±1.43    
≥University 36 (12.9) 3.80±1.48    
Occupation Yes 39 (13.9) 3.72±1.59 0.14 .888
No 241 (86.1) 3.72±1.58    
Economic status ≥Middle 140 (50.0) 3.81±1.51 1.24 .544
Low 140 (50.0) 3.58±1.55    
Experience of regular medication education program Yes 0 (0.0)      
No 280 (100.0) 3.73±1.52    

∗ Duncan test.

Table 2.
Medication Adherence according to Illness-related Characteristics (N=280)
Characteristics Categories n (%) M±SD t or F p
Period of hemodialysis (year) ＜1 38 (13.6) 4.18±1.20 2.11 .100
≥1~＜3 75 (26.8) 3.81±1.61    
≥3~＜5 78 (27.9) 3.73±1.40    
≥5 89 (31.8) 3.54±1.68    
Perceived health status Gooda 44 (15.7) 4.64±1.10 5.09∗ ＜.001
Moderateb 120 (42.9) 3.68±1.62 a＞b, c  
Badc 113 (40.3) 3.37±1.51    
No respond 3 (1.1)      
No. of chronic illness 1 87 (31.1) 3.51±1.60 2.46 .087
2 121 (43.2) 3.59±1.61    
≥3 71 (25.4) 4.03±1.32    
No respond 1 (0.4)      
Frequency of medication administration 1~2 93 (33.2) 3.87±1.53 0.89 .414
3 154 (55.0) 3.63±1.60    
4 30 (10.7) 3.55±1.57    
No respond 3 (1.1)      
Amount of medication (tablets/day) ＜5a 26 (9.3) 4.04±1.39 1.89∗ .004
6~10b 88 (31.4) 3.91±1.40 a＞c
≥11c 165 (58.9) 3.58±1.59    
No respond 1 (0.4)      
Assistance available for medication administration Unavailable 188 (67.1) 3.61±1.58 0.28 .830
Spouse 62 (22.1) 3.87±1.40    
Offspring 15 (5.4) 3.71±1.32    
Friends or caregiver 14 (5.0) 3.71±1.58    
No respond 1 (0.4)      
Inconvenience for taking medication Yes 160 (57.1) 3.38±1.56 -3.71 ＜.001
No 116 (41.4) 4.12±1.33    
No respond 4 (1.4)      
Depression level Normala 67 (23.9) 4.12±1.31 5.75 .001
Milda 47 (16.8) 4.11±1.29 a＞b, c  
Moderateb 56 (20.0) 3.57±1.59    
Severec 105 (37.5) 3.28±1.58    
No respond 5 (1.8)      

∗ Duncan test.

Table 3.
Medication Adherence & Factors related to Medication Taking (N=280)
Variables Items M±SD Minimum Maximum
Medication adherence 3.72±1.52 0 6
Factors related to medication taking 62.54±3.22    
Attitude ․ Believed that it is important to take all of the pills my doctor prescribed for my health 8.27±2.45 1 10
․ Believed that it is important to take my pills in time 7.85±2.75 1 10
․ Believed that it is okay to skip my pills when I am feeling better∗ 6.86±3.47 1 10
․ Understand why I need to take pills prescribed for me 7.42±2.93 1 10
Subtotal (40) 30.40±3.19    
Knowledge ․ Know all the names of pills that I take everyday 4.09±3.27 0 10
․ Know the dose of each pill that I take everyday 4.70±3.87 0 10
․ Know the side effects of the pills that I take everyday 3.66±3.53 0 10
Subtotal (30) 12.45±3.65    
Perceived barrier ․ Forgetting the time of medication 2.82±3.02 0 10
․ Confusing the medication times 2.07±2.73 0 10
․ Cost of medication 1.37±2.38 0 10
․ Belief that I'll be fine even though I skip one dose of medication 2.00±2.80 0 10
․ Not carrying my medication when I am out 2.11±2.80 0 10
․ Amount of pills that I need to take a day 1.87±2.58 0 10
․ The frequency of my medication schedule 1.49±2.24 0 10
․ Having no support from my family or somebody for eminding me 1.43±2.35 0 10
to take my medication      
․ Belief that my symptoms are better 1.53±2.48 0 10
․ Not trusting the efficacy of medications in my disease 1.49±2.24 0 10
․ Belief that my symptoms are the same even though I skip the 1.36±2.24 0 10
medication      
Subtotal (110) 19.79±2.53    
Table 4.
Factors Influencing Medication Adherence (N=280)
Factors B∗ SE β t (p)
(Constant) 3.11 0.42   7.41 (＜.001)
Attitude 0.19 0.04 .25 4.34 (＜.001)
Perceived barrier -0.27 0.05 -.34 -5.79 (＜.001)
Depression -0.02 0.01 -.13 -2.49 (.013)
Adjusted R2=.31, F=31.00, p＜.001

SE=Standard errors;

∗ Unstanardized coefficients.

TOOLS
Similar articles