Medication Adherence Barriers in Patients with Chronic Kidney Disease
In Chronic Kidney Disease (CKD) administration of proper medication adherence is very important component for effective disease management. Nonadherence to medications increases the risk of morbidity, mortality, adverse clinical outcomes, increased healthcare costs and hospitalization. In CKD patients, their multiple co-morbidities need to be controlled with pharmacological management (Esteban et al.2018).The significant role of medications is to slow down the progression of the disease and to monitor complications. In 2017 Trine and co-authors states that managing multiple medications and healthcare appointments, with several times of dialysis in a week, is a challenging task for CKD patients (Trine et al. 2017).
Main barriers to medication adherence are the cost of buying medications, lack of understanding and knowledge of medication indications and effects of medications (Trine et al. 2017). Trine et al (2017) identified three analytical themes for medication barriers which are logistics, bench marking the need for medication, quality of the patients and physician relationship
Logistics barriers are challenges of managing complex medication regimens, multiple prescriptions, healthcare appointments and cost of buying medications (Trine et al. 2017).
Inadequate prescription coverage, lack of transportation, cost of buying medications are also barrier to adherence. Financially burdened patients tried to make the supply of their medication last longer by skipping doses, taking lower doses of medicine than prescribed, and asking their doctor to prescribe double strength medications to reduce the cost of medications (Jean et al.2007) & (Trine et al. 2017).
Absence of effect from lay perceptive - Most of the patients prioritized medications that they produced noticeable effects which are pain relief, symptom relief .Previous experiences of effects and side effects causing patients to benchmark which medications are important and which should be omitted (Trine et al. 2017).
Lacking an understanding of medication indications and effect-Patients are unaware about why the medications were prescribed or how they worked, result in their ignorance of taking the medications. Quality of patient and physician relationship is very important for medication adherence. Some patients experienced insufficient time for discussing medications with physicians(Trine et al. 2017).Lack of information, insufficient information about the medications, side effects, effects and interactions cause medication non adherence (Trine et al. 2017).
Please describe the strategies for medication barrier.
The management of chronic kidney disease (CKD) is costly. At present, Cinacalcet has been taken out from the Pharmaceutical Benefit Scheme (PBS) and the patients who have high levels of parathyroid hormone PTH had to go through parathyroidectomy. This increases the overall cost of care and thus patients refuse to opt for a surgery or treatment. The Government should come forward and provide subsidised Cinacalcet medications and cost-effective alternative of the surgery or other subsidised medication in order to effectively manage CKD. The prospective cross-sectional questionnaire based study highlighted that effective measures are required to be undertaken in order to increase the supply of the free-medicines for the non-affording patients. This will help to increase the adherence of medication and thereby promoting effective disease management (Sontakke et al. 2015).
Our haemodialysis unit use intravenous administration of vitamin B12 in order to cut down the costs of Erythropoetin. According to Saifan et al. (2013), use of vitamin B12 supplementation helps to decrease the mean dosage requirement of erythropoietin stimulating agent (ESA) in order to maintain proper haemoglobin level. Using substitutes for ESA not only helps to decrease the overall cost of care for the CKD but also helps to reduce the side-effects associated with ESA. In general, the level of drug adherence is always lower than that of the physicians’ perspectives (Burnier et al. 2014). In order to ensure of full benefit of the treatments cost-effective management of the therapy is mandate like proper regulation of water intake (Lotan et al. 2013).
Burnier, M., Pruijm, M., Wuerzner, G. and Santschi, V., 2014. Drug adherence in chronic kidney diseases and dialysis. Nephrology Dialysis Transplantation, 30(1), pp.39-44.
Lotan, Y., Jiménez, I.B., Lenoir-Wijnkoop, I., Daudon, M., Molinier, L., Tack, I. and Nuijten, M.J.C., 2013. Increased water intake as a prevention strategy for recurrent urolithiasis: major impact of compliance on cost-effectiveness. The Journal of urology, 189(3), pp.935-939.
Saifan, C., Samarneh, M., Shtaynberg, N., Nasr, R., El-Charabaty, E. and El-Sayegh, S., 2013. Treatment of confirmed B12 deficiency in hemodialysis patients improves Epogen® requirements. International journal of nephrology and renovascular disease, 6, p.89.
Sontakke, S., Budania, R., Bajait, C., Jaiswal, K. and Pimpalkhute, S., 2015. Evaluation of adherence to therapy in patients of chronic kidney disease. Indian journal of pharmacology, 47(6), p.668.