Medication non-adherence in chronic kidney disease: a mixed-methods review and synthesis using the theoretical domains framework and the behavioural change wheel.

Autor: Tesfaye WH; Health Research Institute, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia. Wubshet.Tesfaye@canberra.edu.au., Erku D; Centre for Applied Health Economics; Centre for Applied Health Economics, School of Medicine & Menzies Health Institute, Griffith University, Gold Coast, Australia., Mekonnen A; School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia., Tefera YG; Schoool of Pharmacy, University of Gondar, Gondar, Ethiopia., Castelino R; Sydney Nursing School, University of Sydney, Sydney, Australia., Sud K; Medicine, Nepean Clinical School, University of Sydney, Sydney, Australia., Thomas J; Faculty of Health, University of Canberra, Canberra, Australia., Obamiro K; Centre for Rural Health, University of Tasmania, Launceston, Australia.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2021 Aug; Vol. 34 (4), pp. 1091-1125. Date of Electronic Publication: 2021 Feb 09.
DOI: 10.1007/s40620-020-00895-x
Abstrakt: Objective: Medication non-adherence is a well-recognised issue in chronic diseases but data in patients with chronic kidney disease (CKD) not receiving kidney replacement therapy (KRT) remains limited. This review summarised the prevalence of medication non-adherence and assessed determinants and outcomes associated with it in adults with CKD, not on KRT.
Method: We searched PubMed, Embase, PsychInfo, Web of Science, and Cochrane (CENTRAL) for studies published until January 2020. Pooled prevalence of medication non-adherence was reported. Determinants of adherence-identified from quantitative and qualitative studies-were mapped into the theoretical domains framework and interventions proposed using the behavioural change wheel.
Results: Twenty-seven studies (22 quantitative and 5 qualitative) were included. The pooled prevalence of medication non-adherence was 39% (95% CI 30-48%). Nine studies reported association between non-adherence and outcomes, including blood pressure, disease progression, adverse events, and mortality. Modifiable determinants of non-adherence were mapped into 11 of the 14 Theoretical Domains Framework-of which, six appeared most relevant. Non-adherence decisions were usually due to lack of knowledge on CKD, comorbidities, and medications; polypharmacy and occurrence of medication side effects; changes in established routines such as frequent medication changes; higher medication cost, poor accessibility to medications, services and facilities; inadequate patient-healthcare professional communication; and forgetfulness. Using the behavioural change wheel, we identified several areas where interventions can be directed to improve medication adherence.
Conclusion: Medication non-adherence is common in adults with CKD, not on KRT and may lead to poor outcomes. Evidence synthesis using mixed study designs was crucial in identifying determinants of non-adherence, drawing on a parsimonious approach from behaviour science.
Prospero Registration: CRD42020149983.
(© 2021. Italian Society of Nephrology.)
Databáze: MEDLINE
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