OBJECTIVES

To assess the treatment adherence along with its predictors and the impact of patient counselling on End-Stage-Renal-Disease (ESRD) patients undergoing maintenance haemodialysis.

METHODS

It is a prospective, longitudinal-observational, comparative, multicentred study conducted in a tertiary care teaching hospital for a period of 10months. Patients were selected into the study based on eligibility criteria after obtaining their informed consent. Demographic and clinical parameters were collected from medical records followed by their treatment adherence assessed using ESRD-Adherence Questionnaire. The responses were scored and identified patients having low adherence. Patients with poor adherence were counselled 1 month after the baseline with support of patient information leaflet and a booklet which were prepared in layman language and validated by the Nephrologist. Improvement in health outcome assessed after one month of counselling using the same questionnaire.

RESULTS

A total of 121 patients were enrolled, where the mean age was 62.14± 11.41 years. Adherence behavior observed was 63.33%, 60.33%, 97% and 67.77% towards diet, fluids, haemodialysis sessions and medication respectively. A significant correlation existed between clinical biomarkers(which are known as independent predictors) with specific adherence scores which suggest the validity of reported adherence scores. A statistically significant difference in the mean scores of adherences to dialysis (p=0.04), medication(p=0.02), diet(p=0.00) and fluid(p=0.00) were found after patient specific counselling. Awareness of patients regarding diet, fluids and medications through patient counselling was found to be very effective in improving adherence in ESRD populations.

CONCLUSIONS

The study concludes that a huge number of haemodialysis patients are non-adherent to the treatment, diet, fluid restrictions and medication adherence. The study also reveals that periodic counselling by a clinical pharmacist at regular intervals has a significant positive impact on improvement of treatment adherence followed by better quality of life. Pharmacist intervention having vital role in management of functional capacity of ESRD population and quality of life.