Interventional study to improve adherence to phosphate binder treatment in dialysis patients.
Adult
Aged
Aged, 80 and over
Counseling
/ methods
Female
Humans
Hyperphosphatemia
/ blood
Male
Medication Adherence
/ psychology
Middle Aged
Norway
/ epidemiology
Patient Education as Topic
/ methods
Pharmacists
/ trends
Phosphates
/ blood
Renal Dialysis
/ adverse effects
Treatment Outcome
Young Adult
Adherence
Beliefs about medicines
Hemodialysis
Hyperphosphatemia
Pharmacist led education
Phosphate binder
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
17 05 2019
17 05 2019
Historique:
received:
26
11
2018
accepted:
12
04
2019
entrez:
19
5
2019
pubmed:
19
5
2019
medline:
1
9
2020
Statut:
epublish
Résumé
Adherence to phosphate binder treatment is important to prevent high serum phosphate level in chronic dialysis patients. We therefore wanted to investigate patient knowledge, beliefs about and adherence to phosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling enhance adherence and lead to changes in serum phosphate levels. A descriptive, interventional, single arm, pre-post study was performed at a hospital in Norway, including chronic dialysis patients aged 18 years or more using phosphate binders. The primary end-point was change in the proportion of patients with serum phosphate below 1.80 mmol/L and the secondary end-points included change in the patient's knowledge, beliefs and adherence after the intervention measured by completion of questionnaires 'Patient Knowledge', Medication Adherence Report Scale (MARS- 5) and Beliefs about Medicines Questionnaire (BMQ). Data was collected both prior to and after one-to-one pharmacist-led education and counselling about their phosphate binders. Other medicines used by the patient was also registered. A total of 69 patients were enrolled in the study. After intervention, the probability of serum phosphate being below the target threshold 1.80 mmol/L (5.58 mg/dL) increased, although no significant change in mean serum phosphate levels was seen. On the other hand, the knowledge regarding phosphate binder treatment and the patients' beliefs about the necessity of the treatment increased, while the concerns decreased (BMQ). This effect did not lead to increase in self-reported adherence measured by MARS-5. However the scores were high before the intervention. Short term one-to-one individualized pharmacist-led education and counselling about phosphate binders increased the probability of serum phosphate concentrations being below the target threshold level 1.80 mmol/L (5.58 mg/dL), although not statistically significant. However, it did not decrease the mean serum phosphate level or increase the patients' self-reported adherence. The patients increased their knowledge about the phosphate binder and their understanding of adherence, and were less concerned about the side effects of the medication. ISRCTN52852596 , registered 11 April 2019. The trial was registered retrospectively.
Sections du résumé
BACKGROUND
Adherence to phosphate binder treatment is important to prevent high serum phosphate level in chronic dialysis patients. We therefore wanted to investigate patient knowledge, beliefs about and adherence to phosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling enhance adherence and lead to changes in serum phosphate levels.
METHODS
A descriptive, interventional, single arm, pre-post study was performed at a hospital in Norway, including chronic dialysis patients aged 18 years or more using phosphate binders. The primary end-point was change in the proportion of patients with serum phosphate below 1.80 mmol/L and the secondary end-points included change in the patient's knowledge, beliefs and adherence after the intervention measured by completion of questionnaires 'Patient Knowledge', Medication Adherence Report Scale (MARS- 5) and Beliefs about Medicines Questionnaire (BMQ). Data was collected both prior to and after one-to-one pharmacist-led education and counselling about their phosphate binders. Other medicines used by the patient was also registered.
RESULTS
A total of 69 patients were enrolled in the study. After intervention, the probability of serum phosphate being below the target threshold 1.80 mmol/L (5.58 mg/dL) increased, although no significant change in mean serum phosphate levels was seen. On the other hand, the knowledge regarding phosphate binder treatment and the patients' beliefs about the necessity of the treatment increased, while the concerns decreased (BMQ). This effect did not lead to increase in self-reported adherence measured by MARS-5. However the scores were high before the intervention.
CONCLUSIONS
Short term one-to-one individualized pharmacist-led education and counselling about phosphate binders increased the probability of serum phosphate concentrations being below the target threshold level 1.80 mmol/L (5.58 mg/dL), although not statistically significant. However, it did not decrease the mean serum phosphate level or increase the patients' self-reported adherence. The patients increased their knowledge about the phosphate binder and their understanding of adherence, and were less concerned about the side effects of the medication.
TRIAL REGISTRATION
ISRCTN52852596 , registered 11 April 2019. The trial was registered retrospectively.
Identifiants
pubmed: 31101020
doi: 10.1186/s12882-019-1334-x
pii: 10.1186/s12882-019-1334-x
pmc: PMC6525353
doi:
Substances chimiques
Phosphates
0
Banques de données
ISRCTN
['ISRCTN52852596']
Types de publication
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
178Références
J Clin Nurs. 2012 May;21(9-10):1304-13
pubmed: 22151410
PLoS One. 2015 Dec 04;10(12):e0144119
pubmed: 26636968
J Ren Care. 2013 Mar;39(1):12-8
pubmed: 23432740
BMC Nephrol. 2008 Jan 31;9:2
pubmed: 18237373
Am J Kidney Dis. 2003 Jun;41(5 Suppl):3-10
pubmed: 12776308
Age Ageing. 2013 Sep;42(5):620-6
pubmed: 23832265
BMC Nephrol. 2015 Apr 16;16:56
pubmed: 25881226
Am J Gastroenterol. 2007 Jul;102(7):1417-26
pubmed: 17437505
Hemodial Int. 2007 Jul;11(3):309-14
pubmed: 17576295
Am J Kidney Dis. 2016 Feb;67(2):182-6
pubmed: 26508681
Neurology. 2006 Jul 25;67(2):216-23
pubmed: 16864811
J Nephrol. 2010 Sep-Oct;23(5):525-34
pubmed: 20119931
J Am Soc Nephrol. 2005 Feb;16(2):520-8
pubmed: 15615819
J Psychosom Res. 2008 Jan;64(1):41-6
pubmed: 18157998
Adv Chronic Kidney Dis. 2008 Apr;15(2):123-32
pubmed: 18334236
Acta Psychiatr Scand. 2009 Jan;119(1):78-84
pubmed: 18983630
J Am Soc Nephrol. 2012 Aug;23(8):1407-15
pubmed: 22822075
J Clin Psychopharmacol. 2010 Apr;30(2):169-75
pubmed: 20520290
Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011
pubmed: 18425859
Int J Behav Med. 2013 Jun;20(2):311-8
pubmed: 22407452
J Ren Nutr. 2006 Jan;16(1):47-53
pubmed: 16414441
Kidney Int. 1986 Nov;30(5):753-9
pubmed: 3784305
Clin J Am Soc Nephrol. 2010 Dec;5(12):2251-7
pubmed: 20688884
Psychol Health Med. 2003 Nov;8(4):453-63
pubmed: 21974735
Br J Health Psychol. 2015 Sep;20(3):563-78
pubmed: 25209368
J Psychosom Res. 1999 Dec;47(6):555-67
pubmed: 10661603
Kidney Res Clin Pract. 2018 Mar;37(1):69-76
pubmed: 29629279
Nephron Clin Pract. 2011;119(3):c205-13
pubmed: 21832846
Scand J Prim Health Care. 2008;26(2):86-91
pubmed: 18570006
Am J Kidney Dis. 2016 Jun;67(6):925-35
pubmed: 26919914
BMJ Open. 2013 Sep 24;3(9):e003551
pubmed: 24068768
JAMA. 2011 Mar 16;305(11):1119-27
pubmed: 21406649
Am J Kidney Dis. 2011 Apr;57(4):612-20
pubmed: 21295896