Renal pharmacists' perceptions and current practices of assessing medication adherence in dialysis patients

Background: Medication nonadherence is a major problem in chronic kidney failure patients undergoing dialysis. Pharmacistsplay a vital role in improving medication-related patient outcomes, reducing drug-related problems, and improving medicationadherence. However, little is known about how pharmacists assess medication adherence in dialysis patients. Objective:To measure pharmacists’ perceptions, current practices, and barriers to assessing adherence in dialysis patients. SettingAustralian renal-specialised pharmacists. Method: An online survey was conducted between March and May 2016. Surveyincluded five psychometric scales measuring perceived prevalence, contributors, effective methods, barriers, and confidenceto assess adherence on a 10-point Likert scale (1 = strongly disagree; 10 = strongly agree). Current practices were identifiedusing a 4-point graded response (1 = do not practice; 4 = practice for all). Main outcome measure: Perception scores,scale reliability, and responses to current practices questionnaire. Results: 41 pharmacists completed the survey (responserate, 91.1%). The majority (91.9%, n = 34; median = 8.0) agreed patients were nonadherent to medication. Time constraints(43.8%, n = 14) and hospital support (31.3%, n = 10) were perceived as barriers to assessment. Objective: blood monitoringwas frequently used to determine nonadherence (57.1%, n = 16), whereas subjective interviews were rarely conducted (27.6%,n = 8). Though all pharmacists support the presence of dedicated pharmacist for assessing adherence (100.0%, n = 33),only 24.2% were actually performing this function. Conclusion: Pharmacists were rarely assigned for adherence assessmentin dialysis settings. Established self-report methods were under-utilised compared to objective methods. Future researchshould investigate the effectiveness of pharmacists’ involvement in facilitating adherence promotion and early identificationof medication-related issues in dialysis patients