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