Adherence to multiple, prescribed medications in diabetic kidney disease: A qualitative study of consumers’ and health professionals’ perspectives

https://doi.org/10.1016/j.ijnurstu.2008.07.002Get rights and content

Abstract

Background

Individuals are adherent to approximately 50% of their prescribed medications, which decreases when multiple, chronic conditions are involved.

Objective

To examine factors affecting adherence to multiple prescribed medications for consumers with co-existing diabetes and chronic kidney disease (diabetic kidney disease) from the time of prescription to the time they took their medications.

Design

A descriptive exploratory design was used incorporating in-depth interviews and focus groups.

Setting

The diabetes and nephrology departments of two metropolitan, public hospitals in Melbourne, Australia.

Participants

A convenience sample of 23 consumers with diabetic kidney disease participated in an in-depth interview. Inclusion criteria involved English-speaking individuals, aged ≥18 years, with co-existing diabetes and chronic kidney disease, and who were mentally competent. Exclusion criteria included impending commencement on dialysis, pregnancy, an aggressive form of cancer, or a mental syndrome that was not stabilised with medication. Sixteen health professionals working in diabetes and nephrology departments in Melbourne, Australia also participated in one of two focus groups.

Methods

In-depth structured interviews and focus groups were conducted and analysed according to a model of medication adherence.

Results

Consumers were not convinced of the need, effectiveness and safety of all of their medications. Alternatively, health professionals focussed on the importance of consumers taking their medications as prescribed and believed that the risk of medication-related adverse effects was over-rated. Accessing prescribed medications and difficulties surrounding continuity of care contributed to consumers’ unintentional medication non-adherence. In particular, it was hard for consumers to persist taking their ongoing medication prescriptions. Healthcare system inadequacies were highlighted, which affected relationships between consumers with diabetic kidney disease and health professionals.

Conclusions

Acknowledging the barriers as perceived by consumers with diabetic kidney disease can facilitate effective communication and partnerships with health professionals necessary for medication adherence and medication safety.

Introduction

Diabetic kidney disease is associated with multiple health problems, such as high blood pressure, and serious and largely irreversible diseases of numerous body systems, requiring adherence to complex regimens. The importance of managing co-existing, medical conditions is critical to prevent further disease and the risk of duplicated, incompatible or conflicting treatments that negatively affect health outcomes. The complexity of managing diabetic kidney disease requires people to consult with numerous health professionals and to use multiple, prescribed medications (Australian Council for Safety and Quality in Health Care, 2002, Johnson et al., 2005). The effectiveness of medications depends on the individual's adherence to the prescribed regimen (Sabaté, 2003). Adherence is the extent to which the person continues taking medications as prescribed under limited supervision when faced with conflicting demands (Grant et al., 2003). However, from the consumer's perspective, medication-related problems such as difficulties in adhering to prescribed regimens and the adverse effects of medications can be more troublesome than the treatments themselves (Williams, 2004).

Researchers have found that medications taken for one chronic condition interact with those taken for other chronic conditions (Bayliss et al., 2003, Williams, 2004). It is also difficult for individuals to manage their schedule of medications required to be taken at different times, and individuals do not like taking all their medications. These issues are compounded by discordant perspectives between health professionals and consumers regarding decision-making in medication adherence (Donovan and Blake, 2002, Manias et al., 2007). Pound et al.’s. (2005) synthesis of qualitative studies on medication adherence found that people were concerned about taking medications for chronic diseases due to potential adverse effects. As a result, such individuals ‘actively resisted’ taking their medications, and concealed modifications they made to their medication regimens, rather than being forgetful as cited in other studies (Lawton et al., 2008). Other reasons for lack of medication adherence include an inability to pay for medications, disagreement about the need for treatment, and poor relationships between consumers and healthcare professionals (Haynes et al., 2008).

Generally, past work on medication adherence has focused on specific medications for single chronic illnesses or polypharmacy in older people without regard for multiple health problems (Haynes et al., 2008, Williams and Manias, 2008). The research of Manias et al. (2007) specifically targeted people with osteoarthritis and assorted comorbid conditions, indicating that consumers did not understand why they were prescribed some medications, and were reluctant to take analgesics as prescribed. However, these studies have not addressed the intricacy of medication adherence in the interest of controlling disease progression when two or more principal diseases co-exist, such as diabetic kidney disease. The aim of this study was to examine factors affecting medication adherence from the perspectives of community-dwelling individuals with diabetic kidney disease and health professionals.

Section snippets

Design

A descriptive exploratory design was used for the study, incorporating structured interviews and focus groups. Focus groups were conducted with health professionals because in the management of diabetic kidney disease, consumers access several health professionals across different health care environments. In addressing the needs of consumers, these health professionals are required to have an interdisciplinary and collaborative focus across the continuum of care. It was perceived a focus group

Purposeful action

Purposeful action involved how consumers intentionally decided to take their medications in relation to perceived need, effectiveness and safety. Consumers’ purposeful action was not strong, which contrasted with health professionals who strived to ensure consumers took their medications and the need for standards of documentation to assist prescribing.

Discussion

Examining the perspectives of consumers with diabetic kidney disease in conjunction with health professionals who care for them has illuminated key differences and attitudes towards medication adherence, generating new insights into this under-researched area. Consumers with diabetic kidney disease articulated a distinct lack of trust in their medications and adverse effects was a major concern. Alternatively, health professionals’ major concern was for the individual to ‘get’ the medications

Conclusion

Complex disease states arising from multiple comorbidities are increasingly common. Specifically, prescribed medications help to control symptoms and slow disease progression in diabetic kidney disease, enabling the individual to maintain their health and live independently for as long as possible. This study has highlighted key difficulties in taking prescribed multiple medications over the long term, and inadequacies in the consumer-health professional partnership necessary for medication

Acknowledgements

We are indebted to the individuals and health professionals who freely gave their time to participate in this research.
Conflict of interest

None declared.
Funding

This work is supported by an Australian Research Council Linkage grant.
Ethical approval

None declared.

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