LAS VEGAS – The most common reason why end-stage-renal disease patients missed doses of their metabolic bone disease medications was that they forgot to take them, a multicenter study showed.
"Medication adherence is a constant struggle for patients with end-stage renal disease," Maureen McKinley, M.S.W., said in an interview after a meeting sponsored by the National Kidney Foundation, where the study was presented. "Dialysis patients are prescribed an average of 21 pills a day which would be difficult for even a healthy person to track and manage. The average dialysis patient misses one out of every two medication doses, which has a direct impact on their health, frequency of hospitalizations and, in turn, on costs to our health care system."
Maureen McKinley, M.S.W.
Ms. McKinley, a clinical social worker at Irvine, Calif.–based DaVita HealthCare Partners, and her associates interviewed 50 patients across 17 hemodialysis clinics over a period of 12 weeks to determine root causes of missed metabolic bone disease (MBD) medication doses. Of the 50 patients, 70% reported having missed doses of their MBD medication over the 12-week period. Of these, 66% missed a dose fewer than five times while 10% missed doses five times or more.
The most frequent reason for missing doses was "forgot to take" (41%), followed by "ill and not eating that many meals" (10%), "don’t understand importance" (7%), and "difficulty swallowing" (7%). Other reasons included "side effects" (6%), "forgot to refill" (4%), and financial barriers (3%).
"From my background as a social worker, I was expecting financial reasons to be the most common cause for patients not taking all their prescribed medication," Ms. McKinley said. "After years of sitting with families struggling to make ends meet and stay on top of payments, I know the burden that dialysis can place on a patient and their loved ones. Yet, 41% of respondents cited "forgot to take" as the reason for not taking medications."
With the complexity of so many medications and the reality of the disease, "it’s all about keeping it simple and as easy as possible for our patients," Ms. McKinley continued. "Trying to assist with simple reminders, setting an alarm, putting pills where you can see them or carrying your phosphate binders with you. Having a support system is such a help for patients on dialysis. As clinicians, we try to assist in these ways, but having the support of loved ones is a huge benefit for these daily struggles."
The study was supported by DaVita Rx. Ms. McKinley is an employee of DaVita HealthCare Partners.