The İnfluence of Beliefs About Medicines On Medication Nonadherence Among Hemodialysis Patients: A Multicenter Study From Malaysia

Medication nonadherence can be caused by erroneous medication beliefs. This study aimed to assess the prevalence of medication nonadherence among hemodialysis patients and its association with beliefs about medicines. A cross-sectional multicenter study among hemodialysis patients was performed. Data was collected by using the 5 items medication adherence report scale (MARS-5) and the Beliefs about Medicine Questionnaire (BMQ). The correlation of medication nonadherence with patients‟ beliefs about medicine was assessed by multiple logistic regression. A total of 325 patients were interviewed. The majority of patients were aged 55 years or more (69.0%) and received 6 -10 prescribed medications daily (58.1%). The prevalence of medication nonadherence was 69.5% based on the MARS -5 score. Considering the BMQ score, the total mean score for the Specific–Necessity and Specific–Concern domain was 18.42 ± 2.30 and 13.16 ± 3.13 respectively. Whereas, the General–Overuse and the General–Harm domains showed a total mean score of 11.37 ± 1.98 and 9.44 ± 1.81 respectively. The patients with the belief of medication will protect them from becoming worse showed significantly less medication nonadherence (adjusted OR = 0.543). Medication nonadherence was significantly more prominent among patients who worried about taking medications (adjusted OR = 1.500) but less prominent among patients who perceived medications as addictive to them (adjusted OR = 0.637). In conclusion, medication nonadherence was prevalent among hemodialysis patients. There is a need to address hemodialysis patients‟ necessity, concern, and harm perception towards their prescribed medication to overcome medication nonadherence.

PDF

___

1. Thurlow JS, Joshi M, Yan G, et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol 2021; 52: 98-107.
2. Lv JC, Xhang LX. Prevalence and disease burden of chronic kidney disease. Adv Exp Med Biol 2019; 1165: 3-15.
3. Bujang MA, Adnan TH, Hashim NH, et al. Forecasting the incidence and prevalence of patients with end-stage renal disease in Malaysia up to the year 2040. Int J Nephrol 2017; 2017: 2735296.
4. National Renal Registry of Malaysia. 25th Report of the Malaysian dialysis and transplant registry 2017. Kuala Lumpur: National Renal Registry of Malaysia, 2017. Available from: https://www.msn.org.my/nrr/mdtr2017.jsp (Accessed 19 August 2021).
5. De Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 2009; 302: 1782-1789.
6. Manley HJ, Garvin CG, Drayer DK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant 2004; 19: 1842-1848.
7. Alshamrani M, Almalki A, Qureshi M, Yusuf O, Ismail S. Polypharmacy and medication related problems in hemodialysis patients: a call for deprescribing. Pharmacy (Basel) 2018; 6: 76.
8. Neri L, Martini A, Andreucci VE, et al. Regimen complexity and prescription adherence in dialysis patients. Am J Nephrol 2011; 34: 71-76.
9. Mohammed IA, Hutchison AJ. Phosphate binding therapy in dialysis patients: focus on lanthanum carbonate. Ther Clin Risk Manag 2008; 4: 887-893.
10. Sulowicz W, Radziszewski A. Pathogenesis and treatment of dialysis hypotension. Kidney Int 2006; 70: S36-S39.
11. Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi ST. Nonadherence to medication therapy in haemodialysis patients: a systematic review. PLoS One 2015; 10: e0144119.
12. Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int 2003; 64: 254-262.
13. Ibrahim S, Hossam M, Belal D. Study of non compliance among chronic hemodialysis patients and its impact on patients' outcomes. Saudi J Kidney Dis Transpl 2015; 26: 243-249.
14. Horne R, Sumner S, Jubraj B, Weinman J, Frost S. Haemodialysis patients' beliefs about treatment: implications for adherence to medication and fluid diet restrictions. Int J Pharm Pract 2001; 9: 169-175.
15. Cummings KM, Becker MH, Kirscht JP, Levin NW. Psychosocial factors affecting adherence to medical regimens in a group of hemodialysis patients. Med Care 1982; 20: 567-580.
16. Wileman V, Farrington K, Wellsted D, Almond M, Davenport A, Chilcot J. Medication beliefs are associated with phosphate binder non adherence in hyperphosphatemic haemodialysis patients. Br J Health Psychol 2015; 20: 563-578.
17. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999; 47: 555-567.
18. O'Connor SM, Jardine AG, Millar K. The prediction of self-care behaviors in end-stage renal disease patients using Leventhal's Self Regulatory Model. J Psychosom Res 2008; 65: 191-200.
19. Cea-Calvo L, Marín-Jiménez I, de Toro J, et al. Different associations of intentional and non-intentional non-adherence behaviors with patient experience with healthcare and patient beliefs in medications: a survey of patients with chronic conditions. Patient Prefer Adherence 2020; 14: 2439-2450.
20. Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients‟ adherence-related beliefs about medicines prescribed for long term conditions: a meta-analytic review of necessity-concerns framework. PLoS One 2013; 8: e80633.
21. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 1999; 14: 1-24.
22. Drangsholt SH, Cappelen UW, von der Lippe N, Høieggen A, Os I, Brekke FB. Beliefs about medicines in dialysis patients and after renal transplantation. Hemodial Int 2019; 23: 117-125.
23. Wei L, Champman S, Li X, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China. BMJ Open 2017; 7: e017293.
24. Foot H, La Caze A, Gujral G, Cottrell N. The necessity–concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. Patient Educ Couns 2016; 99: 706-717.
25. Ghimire S, Castelino RL, Jose MD, Zaidi STR. Medication adherence perspectives in haemodialysis patients: a qualitative study. BMC Nephrol 2017; 18: 167.
26. Chan YM, Zalilah MS, Hii SZ. Determinants of compliance behaviours among patients undergoing hemodialysis in Malaysia. PLoS One 2012; 7: e41362.
27. Chan AHY, Horne R, Hankins M, Chisari C. The medication adherence report scale: a measurement tool for eliciting patients' reports of nonadherence. Br J of Clin Pharmacol 2020; 86: 1281-1288.
28. Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open 2017; 7: e016317.
29. The SOLE Study Group, Scribano ML, Caprioli F, et al. Translation and initial validation of the Medication Adherence Report Scale (MARS) in Italian patients with Crohn‟s Disease. Dig Liver Dis 2019; 51: 640- 647.
30. Supramaniam P, Ali A, Chong YL, et al. Reliability and validity of Beliefs on Medicine Questionnaire (BMQ) in diabetes mellitus patients: Malay translated version. Int J Sci Res Publications 2019; 9: 66-73.
31. Tan CS, Hassali MA, Neoh CF, Saleem F, Horne R. Cultural adaptation and linguistic validation of the beliefs about medicines questionnaire in Malaysia. Value Health Reg Issues 2018; 15: 161-168.
32. Naalweh KS, Barakat MA, Sweileh MW, Al Jabi SW, Sweileh WM, Zyoud SH. Treatment adherence and perception in patients on maintenance hemodialysis: a cross–sectional study from Palestine. BMC Nephrol 2017; 18: 178.
33. Wroe AL. Intentional and unintentional nonadherence: a study of decision making. J Behav Med 2002; 25: 355-372.
34. Bai HH, Nie XJ, Chen XL, et al. Beliefs about medication and their association with adherence in Chinese patients with non dialysis chronic kidney disease stages 3-5. Medicine (Baltimore) 2022 ;101: e28491
35. Neame R, Hammond A. Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford) 2005; 44: 762-767.
36. Liu HX, Teng S, Lin XH, et al. The application of the necessity-concerns framework in investigating adherence and beliefs about immunosuppressive medication among Chinese liver transplant recipients. China Nurs Res 2017; 4: 14-17.
37. Sathvik BS, Mangasuli S, Narahari MG, Gurudev KC, Parthasarathi G. Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge. Indian J Pharm Sci 2007; 69: 232-239.
38. Sipos M, Farcas A, Prodan N, Mogosan C. Relationship between beliefs about medicines and adherence in elderly patients with cardiovascular and respiratory diseases: A cross-sectional study in Romania. Patient Educ Couns 2021; 104: 911-918.
39. Sweileh WM, Zyoud SH, Abu Nab'a RJ, et al. Influence of patients‟ disease knowledge and beliefs about medicines on medication adherence: findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health 2014; 14: 94.
40. Fischer W, Brandstetter S, Brandl M, et al. Specific, but not general beliefs about medicines are associated with medication adherence in patients with COPD, but not asthma: cohort study in a population of people with chronic pulmonary disease. J Psychosom Res 2018; 107: 46-52.