Effects of treatment adherence and patient activation on health care utilization in chronic kidney disease

ABSTRACT

Introduction

: Health care utilization (HCU), which is an important health outcome indicator, can also reflect the effectiveness of self-management in chronic conditions. Patient-centered care can play an important role in minimizing unnecessary service use.

Objectives

The aim was to determine the effects of treatment adherence, patient activation on HCU in Turkish patients with chronic kidney disease.

Methods

This study had a cross sectional, descriptive exploratory design. It was conducted with 328 patients. Patients’ HCU was evaluated using hospitalization rate, number of hospital nephrology department visits, emergency department visits, and medications used as well as out-of-pocket payments. Multiple regression models were performed to determine the factors affecting HCU.

Results

Older age, having a comorbidity, and non-adherence to nutritional recommendations and drug treatments were associated with increased hospital visits. Non-adherence to fluid constraint was associated with more hospitalizations, visits to the emergency department, and drugs used. Study results showed that HCU was increased in patients with non-adherence and low activation.

Conclusion: Strategies to reduce HCU should aim to improve treatment adherence and activation. It is recommended to train healthcare managers and support nurses organizationally to empower patients, and plan patient-centered care.

KEYWORDS:

• Chronic kidney disease
• health care utilization
• patient activation
• patient-centered care
• treatment adherence
• out-of-pocket payment
• hospitalization

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

This study obtained permission from the Hacettepe University Non-Interventional Clinical Research Ethics Committee (Document Number: 16969557/112; Decision Date: 17 January 2017; Decision Number: GO 16/739-716).

Author contributions

The first author, Dr. Gamze Bayin Donar, was responsible for the data search, extraction, data synthesis, and writing of the manuscript draft. The second author, Prof. Dr. Mehmet Top, was responsible for the conceptualization of the review, data extraction, data synthesis and editing of the final manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Gamze Bayin Donar

Gamze Bayin Donar is an assistant professor at Hacettepe University, Department of Health Policy and Economics. She received her PhD in Health Management from Hacettepe University in 2019. Health care management, health planning, health policy and health economics are her research interests.

Mehmet Top

Mehmet Top is Proffessor of Health Care Management at Hacettepe University. He received his PhD in Health Care Management from Hacettepe University in 2005. He has a postdoctoral degree in Health Policy and Administration from the University of Illinois at Chicago. Health management, health systems, financial management are his research interests.