title: Nurse-led education and counselling to enhance adherence to phosphate binders.
abstract: OBJECTIVE
  To investigate whether nurse-led education and counselling enhance phosphate binder adherence in chronic dialysis patients.
  
  
  BACKGROUND
  One in two chronic dialysis patients experiences difficulties in adhering to phosphate binders. The reasons for non-adherence are multifactorial and accordingly require a multifaceted strategy. To date, investigations have been confined primarily to single interventions to promote adherence. This study examines the effect of a multifaceted approach.
  
  
  METHODS
  The design was interventional.
  
  
  METHODS
  Adherence to phosphate binders was blindly and electronically monitored for 17 consecutive weeks with the Medication Event Monitoring System (MEMS). After four weeks baseline monitoring, the effects of the intervention were studied for an additional 13 weeks. In week 5, the study nurse gave all 41 participating patients education on phosphate binders. Thereafter, the study nurse gave bi-weekly personalised counselling to enhance adherence to phosphate binders. The evolution of adherence over time was assessed and compared with historical control data. Secondary outcome variables included serum values of phosphate, calcium and parathyroid hormone and phosphate binder knowledge.
  
  
  RESULTS
  In week 1, mean adherence was 83% in this study (intervention group), compared with 86% in the historical control group. In the intervention group, mean adherence increased from 83-94% after 13 weeks. By contrast, in the historical control group, mean adherence declined from 86-76%. In the intervention group, serum phosphate values decreased from 4·9-4·3 mg/dl and phosphate binder knowledge increased from a mean score of 53-75%.
  
  
  CONCLUSIONS
  Combining education and continuous counselling holds promise in enhancing phosphate binder adherence. Large-scaled and long-term field studies are indicated to determine which nurse-led practices lead to an integral and sustained medication adherence management.
  
  
  CONCLUSIONS
  Nursing strategies to scale up adherence should at least include educating patients and regularly reinforcing adherence behaviour.
authors.affiliation: Center for Research and Innovation in Care, Faculty of Medicine, University of Antwerp, Wilrijk, Belgium. yoleen@gmail.com
authors.forename: Yoleen P
authors.initials: YP
authors.lastname: Van Camp
authors.forename: Sofie A
authors.initials: SA
authors.lastname: Huybrechts
authors.forename: Bart
authors.initials: B
authors.lastname: Van Rompaey
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003956:Dialysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010349:Patient Compliance; D010710:Phosphates / Q000008:administration & dosage*
chemical_list: D010710:Phosphates