Medication non-adherence and the achievement of therapeutic goals of anemia therapy among hemodialysis patients in Jordan

ABSTRACT

Objectives

Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients.

Methods

A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016–2017) were also retrieved from patients’ medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy.

Results

More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05).

Conclusion

The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.

KEYWORDS:

• Hemodialysis
• medication adherence
• medication possession ratio
• anemia
• Jordan

Supplementary material

Supplemental data for this article can be accessed here.

Acknowledgments

Authors are thankful to the participants of the study.

Declaration of funding

This work was supported by the Deanship of Scientific Research at Jordan University of Science and Technology (grant number 241/2017).

Disclosure of financial/other competing interests

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical approval

The study protocol was approved by the institutional review board committees at Jordan University of Science and Technology and The Ministry of Health (reference number: 29/107/2017).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Data availability statement

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.