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Parker K, Bull-Engelstad I, Aasebø W, von der Lippe N, Reier-Nilsen M, Os I, Stavem K. Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease. Hemodial Int 2019; 23:333-342. [PMID: 30779285 DOI: 10.1111/hdi.12739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD. METHODS This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m2 ) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight-item Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence. Factors associated with the MRCI and MMAS-8 score were determined using either multivariable linear or ordinal logistic regression analysis. FINDINGS In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS-8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS-8. DISCUSSION Female sex, comorbidity and use of phosphate binders were associated with more-complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.
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Affiliation(s)
- Krystina Parker
- Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Ingrid Bull-Engelstad
- Department of Nephrology, Medical Division, Vestre Viken HF, Drammen Hospital, Drammen, Norway
| | - Willy Aasebø
- Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway
| | - Nanna von der Lippe
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Nephrology, Medical Division, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Reier-Nilsen
- Department of Nephrology, Medical Division, Vestre Viken HF, Drammen Hospital, Drammen, Norway
| | - Ingrid Os
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Nephrology, Medical Division, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Stavem
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,HØKH, Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
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Sadowski CA, Lyder C, Yuksel N. Bisphosphonates for Osteoporosis in Patients with Renal Insufficiency: Pharmacists' Practices and Beliefs. Can J Hosp Pharm 2016; 69:14-22. [PMID: 26985084 DOI: 10.4212/cjhp.v69i1.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinicians often face challenges in deciding how to treat osteoporosis in patients with chronic kidney disease. As background to offering guidance to health care providers, it is important to understand their practices and beliefs. OBJECTIVES To describe the practices and beliefs of pharmacists regarding use of bisphosphonates for patients with osteoporosis and chronic kidney disease. METHODS A cross-sectional survey of pharmacists working in hospitals and related health care settings was conducted. A 34-item online questionnaire was developed consisting of 4 sections: demographic characteristics, practices, beliefs, and comfort level with making decisions about osteoporosis treatment. An e-mail invitation was sent to members of the Canadian Society of Hospital Pharmacists (n = 2499) in November 2012. RESULTS A total of 367 pharmacists completed the survey. Most of the respondents were women (258 [70%]), had more than 10 years in practice (213 [58%]), and were providing care to 1 or more osteoporosis patients per week (212 [58%]). Over one-third (150 [41%]) stated that they would use a bisphosphonate for patients with creatinine clearance (CrCl) of 15-30 mL/min, but more than half (207 [56%]) stated that they would avoid a bisphosphonate (and recommend another medication) for patients with CrCl below 15 mL/min. Forty-eight percent (176/363) agreed that oral bisphosphonates could be used for patients with renal failure (defined as CrCl < 30 mL/min), so long as dosage adjustments are made. More than half (206/363 [57%]) believed that the adverse effects of oral bisphosphonates increase for patients with renal failure. Respondents expressed a low level of comfort in assessing and initiating osteoporosis treatment for patients with renal failure. CONCLUSIONS Pharmacists had varying beliefs about managing osteoporosis in patients with chronic kidney disease. This study highlights the need for practice tools and targeted education addressing the use of bisphosphonates for these patients.
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Affiliation(s)
- Cheryl A Sadowski
- BSc(Pharm), PharmD, FCSHP, is Associate Professor with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Catherine Lyder
- BScPharm, MHSA, is Coordinator, Professional and Membership Affairs, Canadian Society of Hospital Pharmacists, Edmonton, Alberta
| | - Nesé Yuksel
- BScPharm, PharmD, FCSHP, NCMP, is Associate Professor, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
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