Medication adherence among hemodialysis patients: the impact of pharmacist-led motivational interviewing
Ganesh Sritheran PANEERSELVAM*. MClinPharm. Senior
Lecturer in Faculty of Health and Medical Science, School of Pharmacy, Taylor’s University, Malaysia; Digital Health and Innovation Impact Lab, Taylor’s University, Malaysia.
Lee Kwing Chin KENNETH. PhD.
Professor in Faculty of Health and Medical Science, School of Pharmacy, Taylor’s University, Malaysia.
Raja Ahsan AFTAB*. PhD,
Senior Lecturer in Faculty of Pharmacy, Universiti Malaya, Malaysia.
Roland Gamini SIRISINGHE. PhD.
Professor in Faculty of Health and Medical Science, School of Medicine, Taylor’s University, Malaysia.
*Corresponding Author:
Ganesh Sritheran PANEERSELVAM
Senior Lecturer in Faculty of Health and Medical Science, School of Pharmacy, Taylor’s University, Malaysia; Digital Health and Innovation Impact Lab, Taylor’s University, Malaysia.
Email: [email protected].
Abstract
Background: Significant proportion of haemodialysis (HD) patients fails to comply with their prescribed medication regimens, leading to poor health outcomes and survival rates. This highlights the need for interventions that improve medication adherence thereby leading to improved patient outcomes. Objectives: To evaluate the impact of motivational interviewing, a skilful clinical method to improve medication adherence among HD patients. Methods: A pre-post study was conducted prospectively among 63 HD patients at multicentre dialysis units. The recruited patients received three sessions of MI which helps in addressing patient beliefs around medication and overcome barriers for nonadherence. General medication adherence scale (GMAS) was used to evaluate the medication adherence among enrolled patients. An independent t-test was used to analyze the impact of MI in improving adherence among HD patients. In this study, the level of significance was 0.05. Results: A total of 63 patients (27 males and 36 females; mean age 48.5±13.9 years) were included in the study. While the mean of dialysis duration and number of medications was 7.7±6.0 years and 8.1±2.2 respectively. Paired t-test showed a significant increase in medication adherence score from a baseline for nonadherence domain of patient’s attitude and nonadherence domain of additional illness and pill overload at the end of the study (p<0.05). However, the non-adherence domain of financial constraints, was not statistically significant, p=0.507. Motivational interviewing was effective in increasing intrinsic positive attitude by resolving their ambivalence thus improving the adherence towards medication. Conclusion: This study emphasized that MI conducted by pharmacist effectively improves HD patients’ medication adherence. Healthcare professionals ought to employ this strategy in order to assist HD patients in better taking their medications.
Keywords: Pharmacists; motivational interviewing; hemodialysis; adherence; medication.
References
1. Bello AK, Okpechi IG, Osman MA, et al. Epidemiology of Haemodialysis Outcomes. Nat Rev Nephrol. 2022;378-395. https://doi.org/10.1038/s41581-022-00542-7
2. Bujang MA, Adnan TH, Hashim NH, et al. Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040. Int J Nephrol. 2017;2017:2735296. https://doi:10.1155/2017/2735296
3. Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev. 2019;8(1):112. https://doi:10.1186/s13643-019-1014-8
4. Nielsen TM, Schjerning N, Kaldan G, et al. Practices and pitfalls in medication adherence in hemodialysis settings - a focusgroup study of health care professionals. BMC Nephrol. 2021;22(1):315. https://doi:10.1186/s12882-021-02514-8
5. Ghimire S, Castelino RL, Lioufas NM, et al. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PloS One. 2015;10(12):e0144119. https://doi.org/10.1371/journal.pone.0144119
6. Tayebi A, Einollahi B, Rahimi A, et al. Non-adherence to treatment among iranian dialysis patients, a systematic review. Iran J Kidney Dis. 2019;13(6):347-361.
7. Ozen N, Cinar FI, Askin D, et al. Nonadherence in Hemodialysis Patients and Related Factors: A Multicenter Study. J Nurs Res.2019;27(4):e36. https://doi:10.1097/jnr.0000000000000309
8. Al Salmi I, Larkina M, Wang M, et al. Missed Hemodialysis Treatments: International Variation, Predictors, and Outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2018;72(5):634-643. https://doi:10.1053/j.ajkd.2018.04.019
9. Ismail S, Al-Subhi A, Youssif E, et al. Patient-centered Pharmacist Care in the Hemodialysis Unit: a quasi-experimental interrupted time series study. BMC Nephrology. 2019;20(1):408. https://doi.org/10.1186/s12882-019-1577-6
10. Ghimire S, Castelino RL, Jose MD, et al. Medication adherence perspectives in haemodialysis patients: a qualitative study. BMC Nephrol. 2017;18(1):167. https://doi:10.1186/s12882-017-0583-9
11. Lu X, Zhang R. Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study. J Med Internet Res. 2019;21(5):e12891. https://doi:10.2196/12891
12. Arbuckle MR, Foster FP, Talley RM, et al. Applying Motivational Interviewing Strategies to Enhance Organizational Readiness and Facilitate Implementation Efforts. Quality Management in Health Care. 2020;29(1):1-6. https://doi.org/10.1097/
QMH.0000000000000234
13. Rodrigues PA, Saji A, Raj P, et al. Impact of pharmacist intervention on medication knowledge and adherence in hemodialysis patients. Int J Pharm Pharm Sci. 2019;11:131-133.
14. Lee WW, Choi KC, Yum RW, et al. Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: A systematic review. Int J Nurs Stud. 2016;53:331-341. https://doi:10.1016/j.ijnurstu.2015.09.010
15. Palacio A, Garay D, Langer B, et al. Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. Journal of General Internal Medicine. 2016;31(8):929-40. https://doi.org/10.1007/s11606-016-3685-3
16. Miller WR, Rollnick S. Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press. 2013.
17. Teeter BS, Kavookjian J. Telephone-based motivational interviewing for medication adherence: a systematic review. Translational Behavioral Medicine. 2014;4(4):372-81. https://doi.org/10.1007/s13142-014-0270-3
18. Naqvi AA, Mahmoud MA, AlShayban DM, et al. Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses. Saudi Pharm J. 2020;28(9):1055-1061. https://doi:10.1016/j.jsps.2020.07.005
19. Alshamrani M, Almalki A, Qureshi M, et al. Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing. Pharmacy. 2018;6(3):76. https://doi.org/10.3390/pharmacy6030076
20. Al Salmi I, Kamble P, Lazarus ER, et al. Kidney Disease-Specific Quality of Life among Patients on Hemodialysis. Int J Nephrol. 2021;2021:8876559. https://doi:10.1155/2021/8876559
21. Weigert A, Drozdz M, Silva F, et al. Influence of gender and age on haemodialysis practices: a European multicentre analysis. Clinical Kidney Journal.2019;13(2):217-224. https://doi.org/10.1093/ckj/sfz069
22. Nayana SA, Balasubramanian T, Nathaliya, et al. A cross sectional study on assessment of health-related quality of life among end stage renal disease patients undergoing hemodialysis. Clinical Epidemiology and Global Health. 2016;5(3):148-153. https://doi.org/10.1016/j.cegh.2016.08.005
23. Marin JG, Beresford L, Lo C, et al. Prescription Patterns in Dialysis Patients: Differences Between Hemodialysis and Peritoneal Dialysis Patients and Opportunities for Deprescription. Can J Kidney Health Dis. 2020;7:2054358120912652. https:// doi:10.1177/2054358120912652
24. Patricia NJ, Foote EF. A pharmacy-based medication reconciliation and review program in hemodialysis patients: a prospective study. Pharmacy Practice. 2016;14(3):785. https://doi:10.18549/PharmPract.2016.03.785
25. Paneerselvam GS, Aftab RA, Baig MA, et al. The Pharmacist Role in Improving Medication Adherence in Dialysis Patients: A Systematic Review. Systematic Reviews in Pharmacy. 2021;12:761-768.
26. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives [published correction appears in Lancet. Lancet. 2013;382(9888):260-272. https://doi:10.1016/S0140-6736(13)60687-X
27. Park H, Rascati KL, Lawson KA, et al. Adherence and persistence to prescribed medication therapy among Medicare part D beneficiaries on dialysis: comparisons of benefit type and benefit phase. J Manag Care Spec Pharm. 2014;20(8):862-876. https://doi:10.18553/jmcp.2014.20.8.862
28. Sheikh V, Barati M, Khazaei S, et al. Factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan, Iran: the application of the extended theory of planned behavior during Covid-19 pandemic. BMC Nephrology. 2022;23(1):58. https://doi.org/10.1186/s12882-022-02694-x
29. Shahin W, Kennedy GA, Stupans I. The association between social support and medication adherence in patients with hypertension: a systematic review. Pharm Pract (Granada) 2021;19(2):2300. https://doi:10.18549/PharmPract.2021.2.2300
30. Papus M, Dima AL, Viprey M, et al. Motivational interviewing to support medication adherence in adults with chronic conditions: Systematic review of randomized controlled trials. Patient Educ Couns. 2022;105(11):3186-3203. https://doi:10.1016/j.pec.2022.06.013
31. Lee SF, Chong CP. The influence of beliefs about medicines on medication nonadherence among hemodialysis patients: a multicenter study from Malaysia. Eastern J Med. 2022;27(3):446-457. https://doi:10.5505/ejm.2022.57804