title: The delicate balance of keeping it all together: Using social capital to manage multiple medications for patients on dialysis.
abstract: Patients with end-stage kidney disease (ESKD) typically have high medication burdens with numerous medications and specialized instructions. Limited data exist regarding ESKD patient perspectives on medication management. Why can some patients self-manage? Which organizational techniques are used? This project sought to determine experiences and attitudes regarding medication management among hemodialysis patients.
  
  
  
  Group interviews were conducted with adult patients from 3 dialysis facilities. Semi-structured interviews solicited information about medication self-management and views on related services. Interviews were recorded and transcribed and data were analyzed using inductive, thematic coding.
  
  
  
  Participants reported medication regimens complicated by the dialysis schedule, co-morbid conditions and multiple prescribers. Patients engaged in various coping strategies, including reliance on activating social capital and/or family social support, to manage their medications and health. When described, most thought medication management services would be beneficial, but not necessarily for themselves, despite some having histories of medication mismanagement.
  
  
  
  Patients on hemodialysis often develop strategies for managing medications that rely heavily on a social network, and strategies may not be discussed with healthcare providers. Social capital is a useful framework for considering patients' lifestyles and support structure when designing a medication regimen. Future research should explore this idea more proactively.
authors: Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY 12208, USA. Electronic address: Wendy.parker@acphs.edu.
authors: Wendy M
authors: WM
authors: Parker
authors: Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY 12208, USA.
authors: Kristine
authors: K
authors: Ferreira
authors: Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY 12208, USA.
authors: Lauren
authors: L
authors: Vernon
authors: Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY 12208, USA.
authors: Katie E
authors: KE
authors: Cardone
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D015897:Comorbidity; D017281:Cost of Illness; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D054539:Medication Therapy Management; D010361:Patients / Q000523:psychology*; D019338:Polypharmacy; D006435:Renal Dialysis; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D066270:Social Capital; D012944:Social Support
keywords: ESRD; Hemodialysis; Medication management; Social capital; Social support