Why all prescribed medications are not taken: results from a survey of chronic dialysis patients.
Although medication non adherence is common in all populations, including those on chronic dialysis, the reasons for medication noncompliance in dialysis patients have rarely been examined. We surveyed 54 chronic dialysis patients (15 on peritoneal dialysis, 39 on hemodialysis), asking about their social and financial situations, medication coverage, and reasons for possibly not obtaining all prescribed medications. The study population was 56% female, 52% African American, 67% over 50 years of age, 27% diabetic, and 61% on dialysis for more than 2 years. One patient was unemployed, 33 were retired, 15 were on disability, and 5 were employed. A majority (63%) had a household income of dollars 25,000 or more annually. Most (70%) had some medication coverage through one or more health plans (53% Medicare, 14% Medicaid, 31% private) or a local pharmacy (31% UVA pharmacy program for the medically indigent). However, 39% still spent more than dollars 100 monthly on medications. Co-pays per prescription ranged from nothing (2 patients) to dollars 25 or more (16 patients), with half having a co-pay of more than dollars 11 per prescription. Most (69%) took 11 or more medications daily. Among all our study patients, 91% reported that they knew their medications and the reasons that those medications were prescribed. The choice not to fill a prescription was made by 30% of patients either because they had no money (67%) or no ride to the pharmacy (17%). When asked if they ever chose not to take specific medications, 11 of 53 respondents (21%) said yes because of side effects [4 (36%)] or cost [3 (27%)], or because they already take too many medications [2 (18%)]. Most respondents (91%) reported discussing their medications with their doctors, and a majority (65%) had these discussions at least monthly. We conclude that inadequate prescription coverage, lack of transportation, and medication cost are primary contributors to medication noncompliance among chronic dialysis patients. Patients report knowing their medications and the reasons that those medications are prescribed, and having ample opportunities to discuss their medications with their physicians. Lack of patient education therefore does not seem to be an important factor in medication non adherence.
Holley
Jean L
JL
The University of Virginia Health System, Nephrology Division, Charlottesville 22908, USA. jlh4qs@virginia.edu
DeVore
Cathy C
CC
D000368:Aged; D004358:Drug Therapy; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D006435:Renal Dialysis; D012959:Socioeconomic Factors