Choosing Not to Take Phosphate Binders : The Role of Dialysis Patients' Medication Beliefs

Copyright © 2011 S. Karger AG, Basel.Objective: Patients with end-stage renal disease (ESRD) receiving haemodialysis are at risk of cardiovascular disease and bone disorders related to high levels of serum phosphate (PO(4)). Phosphate binders are an important treatment; however, non-adherence remains a significant issue. This study investigates whether patients' beliefs about medicines predict intentional non-adherence to phosphate binders. Method: This was a cross-sectional study of ESRD patients (n = 76). Non-adherence was measured in two ways: (1) the self-report Medication Adherence Questionnaire (MAQ) and (2) 3-month average level of serum phosphate. The Beliefs about Medicines questionnaire was used to assess general and specific beliefs towards phosphate medicines. Results: Eleven (14.5% of 76) patients reported being intentionally non-adherent to phosphate binders. Patients' beliefs that phosphate binders were less necessary were significantly associated with intentional self-reported non- adherence. Furthermore, patients with greater concerns about phosphate binders had higher serum phosphate levels. Conclusion: Assessing patient beliefs about medicines is a reliable indicator of intentional non-adherence to treatment with phosphate binders. These findings may help in identifying ways in which adherence rates to phosphate binders can be improved.Peer reviewe

Landscape Analysis: What Are the Forefronts of Change in the US Hospitals?

Compilation of information is increasingly becoming more important for health organizations from financial and time aspects. By methodical study of adaptive systems, healthcare organizations can gain new insights of burdensome issues within the organization as well as healthcare delivery management. These actions have become more important with the changes in the healthcare environment in the last couple of decades where several external entities have impacts on healthcare organizations directly and/or indirectly. One of the most onerous tasks ahead of organizations is to anticipate these changes and prepare for them. Knowing the external environment can be the key to leading a successful and competitive health system. However, identifying and behaving toward all the external changes pose great time and resource challenges for organizations. Health organizations can posit the question of “what are the current external changes that have the power to affect them?” This study will take a look into emerging extrinsic changes for the US healthcare environment in different areas. A literature review will be performed in order to pinpoint the different contemporary change perspectives and their sub-criteria. In order to better illustrate these issues, Ishikawa diagram (cause-and-effect diagram) is used in this study