Adherence assessment practices in haemodialysis settings: a qualitative exploration of nurses and pharmacists' perspectives

AIMS AND OBJECTIVES: To explore clinician assessment of patient adherence, and identify strategies to improve adherence assessment practices in haemodialysis settings.

BACKGROUND: Patients with chronic kidney disease undergoing haemodialysis are typically prescribed complex regimens; as such, they are at high risk of medication nonadherence. Current clinical practices focus on prescribing medications, however, little attention is paid to measuring and ensuring patient adherence to their prescribed treatments.

DESIGN: A qualitative study.

METHODS: Semi-structured individual interviews were conducted in November and December 2016, with 12 nurses and six pharmacists, working in Australian haemodialysis settings. The study was conducted and reported in accordance with COREQ guidelines.

RESULTS: Participants were 25-60 years old and had 1-27 years of experience in dialysis. Seven themes related to assessing adherence were identified: prioritization of resources, interplay between workload and available time, awareness of formalized adherence measures and training deficits, concerns about practicality/suitability of adherence measures, communication of assessment services, patient participation, and trust. Three themes related to strategies for improving adherence assessment practices were identified: formalization of adherence assessment process, integration of assessment processes and tools into routine, and use of multidisciplinary support to assess and promote adherence.

CONCLUSIONS: Current adherence assessment practices could be improved through formalization and integration of the assessment process into dialysis unit policy/procedures. Additionally, as barriers to assessing adherence were identified at organizational, professional and patient levels, there is a need to address barriers from each level in order to improve adherence assessment practices in haemodialysis settings.

RELEVANCE TO CLINICAL PRACTICE: This qualitative study highlights the challenges and practical ways by which adherence assessment practices could be improved in haemodialysis settings. This would encourage renal clinicians to actively participate in adherence assessment and promotion activities to ensure patients benefit from their therapies. This article is protected by copyright. All rights reserved.