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 6 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: prioritisation of resources, interplay between workload and available time, awareness of formalised 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: formalisation 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 formalisation and integration of the assessment process into dialysis unit policy/procedures. Additionally, as barriers to assessing adherence were identified at organisational, 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.
['Ghimire|Saurav|S|https://orcid.org/0000-0002-2538-9433', 'Lee|Kenneth|K|', 'Jose|Matthew D|MD|', 'Castelino|Ronald L|RL|', 'Zaidi|Syed Tabish R|STR|https://orcid.org/0000-0002-2031-1055']
D000328:Adult D001315:Australia D006801:Humans D008297:Male D055118:Medication Adherence D008875:Middle Aged D009726:Nurses D010595:Pharmacists D036301:Qualitative Research D006435:Renal Dialysis D051436:Renal Insufficiency, Chronic
adherence assessment practices haemodialysis chronic dialysis kidney failure medication adherence qualitative research