Journal de néphrologie et thérapeutique

Medication adherence to phosphate binders: The cheobs study- A Guerraoui - Francois Rabelais University Tours

Abstract

A Guerraoui

Purpose: Noncompliance (NC) is not always intentional. The medical team, in the absence of objective evidence, rarely takes into account the non-intentional NC linked to the difficulty of taking drugs regularly and feelings of the patient, unless objective evidence is present. Better understanding of the triggers and determinants of NC would allow elaboration of educational tools designed to help out chronic patients with their treatment. Methods: 340 hemodialysis patients in 9 centers in three areas in France were included on a voluntary basis in this descriptive study. Among them, 10 patients responded to a qualitative interview focused on individual beliefs, attitudes and motivations towards phosphate binders? therapy. 26% of patients attended an educational program. Statistical methods consist of frequencies analysis and Exploratory Factor Analysis to determine combination of factors which significantly influence the compliance to phosphate binders. The semi-structured interviews were analyzed according to qualitative content analysis. Results: 329 self-administered questionnaires (50 items) were analyzed, 297 were complete for analysis (mean age 61 years, 62% male, dialysis duration 4.5 years, number of medication 9 per day) . The majority of patients consider treatment as important (80%). However, they mostly relativize the treatment as vital (45%). Factor analysis helped to identify two kind of independent behaviors: those which indicate concerns for the treatment and those relative to the use of the treatment as a necessity. Age, level of education and gender influence these two factors. Older patients are more compliant. The higher the level of education the more frequently patients adapt the treatment. The swallowable tablets are preferred (75%). The shape and color has little influence on decision. 60% of the patients consider they received enough pre therapeutic information. The involvement into educational formation has a not high enough influence on adherence. Conclusion: In conclusion, this large study provides clues to better understanding of non-compliance to phosphate binder determinants. Based on these assumptions, educational program should be more efficient and fruitful to chronic dialyzed patients