Cherriday G Joson1, Shayna L Henry2, Sue Kim3, Mandy Y Cheung4, Prajakta Parab3, Antoine C Abcar1, Steven J Jacobsen5, Donald E Morisky6, John J Sim1. 1. Division of Nephrology & Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. 2. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California. Electronic address: shayna.l.henry@kp.org. 3. Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. 4. Renal Business Group, Kaiser Permanente Southern California, Pasadena, California. 5. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California. 6. Department of Community Health Sciences, University of California Los Angeles Fielding School of Public Health, Los Angeles, California.
Abstract
OBJECTIVE: The purpose of this study was to determine the influence of patient-reported medication adherence and phosphorus-related knowledge on phosphorus control and pharmacy-reported adherence to phosphorus binding medication among patients on maintenance hemodialysis. DESIGN: Retrospective, cross-sectional cohort study. SUBJECTS: Seventy-nine hemodialysis patients (mean age 64.2 years, SD = 14 years; 46.8% female) in a stand-alone hemodialysis unit within an integrated learning healthcare system. Ten percent (10%) of subjects were Caucasian, 42% Latino, 19% African American, and 29% Asian. Forty-eight percent had diabetes; 72% had BMI ≥ 30. Inclusion criteria included the provision of survey data and having medication refill data available in the pharmacy system. 77.2% had mean phosphorus levels ≤ 5.5 mg/dL; 22.8% had mean phosphorus levels > 5.5 mg/dL. INTERVENTION: Subjects were administered the 8-item Morisky Medication Adherence Scale (MMAS-8) and also reported on their phosphorus-related knowledge. MAIN OUTCOME MEASURE: Phosphorus levels within an adequate range. RESULTS: The mean serum phosphorus level was 4.96 mg/dL (SD = 1.21). In the well-controlled group, mean phosphorus was 4.44 mg/dL (SD = 0.76). In the poorly controlled group, mean phosphorus was 6.69 mg/dL (SD = 0.74). A total of 61% of patients reported at least some unintentional medication nonadherence, and 48% reported intentional medication nonadherence. Phosphorus-specific knowledge was low, with just under half of patients reporting that they could not name two high-phosphorus foods or identify a phosphorus-related health risk. Phosphorus binder-related nonadherence was substantially higher in the uncontrolled than the controlled group. Adjusting for age, individuals with poorer self-reported binder adherence were less likely to have controlled phosphorus levels (odds ratio = 0.71, P = .06). CONCLUSION: Phosphorus-related non-adherence, but not low phosphorus-specific knowledge, was associated with poorer phosphorus control. Such findings provide important information for the development of evidence-based strategies for improving phosphorus control among patients on dialysis.
OBJECTIVE: The purpose of this study was to determine the influence of patient-reported medication adherence and phosphorus-related knowledge on phosphorus control and pharmacy-reported adherence to phosphorus binding medication among patients on maintenance hemodialysis. DESIGN: Retrospective, cross-sectional cohort study. SUBJECTS: Seventy-nine hemodialysis patients (mean age 64.2 years, SD = 14 years; 46.8% female) in a stand-alone hemodialysis unit within an integrated learning healthcare system. Ten percent (10%) of subjects were Caucasian, 42% Latino, 19% African American, and 29% Asian. Forty-eight percent had diabetes; 72% had BMI ≥ 30. Inclusion criteria included the provision of survey data and having medication refill data available in the pharmacy system. 77.2% had mean phosphorus levels ≤ 5.5 mg/dL; 22.8% had mean phosphorus levels > 5.5 mg/dL. INTERVENTION: Subjects were administered the 8-item Morisky Medication Adherence Scale (MMAS-8) and also reported on their phosphorus-related knowledge. MAIN OUTCOME MEASURE: Phosphorus levels within an adequate range. RESULTS: The mean serum phosphorus level was 4.96 mg/dL (SD = 1.21). In the well-controlled group, mean phosphorus was 4.44 mg/dL (SD = 0.76). In the poorly controlled group, mean phosphorus was 6.69 mg/dL (SD = 0.74). A total of 61% of patients reported at least some unintentional medication nonadherence, and 48% reported intentional medication nonadherence. Phosphorus-specific knowledge was low, with just under half of patients reporting that they could not name two high-phosphorus foods or identify a phosphorus-related health risk. Phosphorus binder-related nonadherence was substantially higher in the uncontrolled than the controlled group. Adjusting for age, individuals with poorer self-reported binder adherence were less likely to have controlled phosphorus levels (odds ratio = 0.71, P = .06). CONCLUSION:Phosphorus-related non-adherence, but not low phosphorus-specific knowledge, was associated with poorer phosphorus control. Such findings provide important information for the development of evidence-based strategies for improving phosphorus control among patients on dialysis.
Authors: Ebele M Umeukeje; Joseph R Merighi; Teri Browne; Marcus Wild; Hafez Alsmaan; Kausik Umanath; Julia B Lewis; Kenneth A Wallston; Kerri L Cavanaugh Journal: J Behav Med Date: 2016-05-11
Authors: Andrew J King; Matthew Siegel; Ying He; Baoming Nie; Ji Wang; Samantha Koo-McCoy; Natali A Minassian; Qumber Jafri; Deng Pan; Jill Kohler; Padmapriya Kumaraswamy; Kenji Kozuka; Jason G Lewis; Dean Dragoli; David P Rosenbaum; Debbie O'Neill; Allein Plain; Peter J Greasley; Ann-Cathrine Jönsson-Rylander; Daniel Karlsson; Margareta Behrendt; Maria Strömstedt; Tina Ryden-Bergsten; Thomas Knöpfel; Eva M Pastor Arroyo; Nati Hernando; Joanne Marks; Mark Donowitz; Carsten A Wagner; R Todd Alexander; Jeremy S Caldwell Journal: Sci Transl Med Date: 2018-08-29 Impact factor: 17.956