title: Renal stone clinic survey: calcium stone formers' self-declared understanding of and adherence to physician's recommendations.
abstract: Nothing is known about how well stone formers understand physician's explanations of stone formation, and a few data are available on adherence to provided recommendations. In this study, two groups of recurrent calcium stone formers (RCSFs) were compared. Group 1: 153 consecutive RCSF (118 men, 35 women) referred 1/2011-6/2014. At least 3 months after a 60-75 min consultation explaining metabolic evaluation and therapeutic measures, RCSF received a questionnaire by mail, regarding understanding of stone formation and adherence to therapeutic recommendations (diet, lifestyle, drug treatment). Response rate was 62 %. Group 2 (control): 81 consecutive RCSFs referred 7/2014-3/2016 (60 men, 21 women) were asked to answer the same questionnaire in the stone center while waiting for their follow-up consultation 3 months after starting prevention; response rate was 100 %. Alkali citrate was prescribed in 45 %. Answer sheets were analyzed anonymously, and frequencies of answers were compared by Chi-square test.
  
  
  RESULTS
  67 % (group 1) and 62 % (group 2) indicated >80 % understanding of the given information (NS). Over 80 % adherence to recommendations occurred in 26 and 30 % (NS). Most frequent changes in dietary/lifestyle habits were increases in calcium (93 vs. 89 %) and fluid intakes (81 vs. 78 %); lowering psychosocial stress (23 vs. 24 %) was least popular. Adherence to 100 % on 6-7 days/week was significantly more frequent for medication than for dietary/lifestyle interventions, both in group 1 (84 vs. 24 %, p < 0.001) and group 2 (91 vs. 28 %, p < 0.001).
  
  
  CONCLUSIONS
  (1) results do not differ whether RCSFs are voluntarily participating by mail or asked to answer questionnaires in the stone clinic; (2) pathophysiologic explanations of stone disease are understood to >80 % by 2/3 of RCSFs; (3) after 3 months, perfect adherence to recommended treatment is more frequent on alkali citrate than on dietary/lifestyle measures; and (4) increasing calcium and fluid intake are the most popular dietary measures.
authors: Internal Medicine and Nephrology, Kidney Stone Center Zurich, Klinik Im Park, Bellariastrasse 38, 8038, Zurich, Switzerland. bernhard.hess@hirslanden.ch.
authors: Bernhard
authors: B
authors: Hess
mesh_terms: D065096:Calcium Chelating Agents / Q000627:therapeutic use*; D002129:Calcium Oxalate / Q000378:metabolism; D002130:Calcium Phosphates / Q000378:metabolism; D002136:Calcium, Dietary / Q000627:therapeutic use; D019343:Citric Acid / Q000627:therapeutic use; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D000070497:Healthy Lifestyle; D006801:Humans; D007669:Kidney Calculi / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012008:Recurrence; D012017:Referral and Consultation; D057566:Self Report
chemical_list: D065096:Calcium Chelating Agents; D002130:Calcium Phosphates; D002136:Calcium, Dietary; D002129:Calcium Oxalate; D019343:Citric Acid; C020243:calcium phosphate
keywords: Adherence to diet; Adherence to medication; Alkali citrate; Metabolic evaluation; Patients’ understanding of physicians’ advice; Renal stone clinic