title: Choosing not to take phosphate binders: the role of dialysis patients' medication beliefs.
abstract: OBJECTIVE
  Patients with end-stage renal disease (ESRD) receiving haemodialysis are at risk of cardiovascular disease and bone disorders related to high levels of serum phosphate (PO(4)). Phosphate binders are an important treatment; however, non-adherence remains a significant issue. This study investigates whether patients' beliefs about medicines predict intentional non-adherence to phosphate binders.
  
  
  METHODS
  This was a cross-sectional study of ESRD patients (n = 76). Non-adherence was measured in two ways: (1) the self-report Medication Adherence Questionnaire (MAQ) and (2) 3-month average level of serum phosphate. The Beliefs about Medicines questionnaire was used to assess general and specific beliefs towards phosphate medicines.
  
  
  RESULTS
  Eleven (14.5% of 76) patients reported being intentionally non-adherent to phosphate binders. Patients' beliefs that phosphate binders were less necessary were significantly associated with intentional self-reported non- adherence. Furthermore, patients with greater concerns about phosphate binders had higher serum phosphate levels.
  
  
  CONCLUSIONS
  Assessing patient beliefs about medicines is a reliable indicator of intentional non-adherence to treatment with phosphate binders. These findings may help in identifying ways in which adherence rates to phosphate binders can be improved.
authors.affiliation: Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield, UK. v.a.wileman@herts.ac.uk
authors.forename: Vari
authors.initials: V
authors.lastname: Wileman
authors.forename: Joseph
authors.initials: J
authors.lastname: Chilcot
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Hughes
authors.forename: David
authors.initials: D
authors.lastname: Wellsted
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002614:Chelating Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000628:therapy; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects; D057566:Self Report; D018709:Statistics, Nonparametric; D016312:Treatment Refusal / Q000523:psychology*; D055815:Young Adult
chemical_list: D002614:Chelating Agents; D010710:Phosphates