International Journal of Clinical Pharmacy

, Volume 40, Issue 1, pp 26–35 | Cite as

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

  • Saurav Ghimire
  • Colin Banks
  • Matthew D. Jose
  • Ronald L. Castelino
  • Syed Tabish R. ZaidiEmail author
Research Article


Background Medication nonadherence is a major problem in chronic kidney failure patients undergoing dialysis. Pharmacists play a vital role in improving medication-related patient outcomes, reducing drug-related problems, and improving medication adherence. 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. Setting Australian renal-specialised pharmacists. Method An online survey was conducted between March and May 2016. Survey included five psychometric scales measuring perceived prevalence, contributors, effective methods, barriers, and confidence to assess adherence on a 10-point Likert scale (1 = strongly disagree; 10 = strongly agree). Current practices were identified using 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 (response rate, 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 monitoring was 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 assessment in dialysis settings. Established self-report methods were under-utilised compared to objective methods. Future research should investigate the effectiveness of pharmacists’ involvement in facilitating adherence promotion and early identification of medication-related issues in dialysis patients.


Australia Dialysis Kidney failure, chronic Medication adherence Renal pharmacists 



The authors thank all the pharmacists for their participation in this study. Sincere thanks goes to Society of Hospital Pharmacists of Australia (SHPA) for their support during the conduct of the study. Also, a sincere gratitude goes to Division of Pharmacy, University of Tasmania for providing pre-paid gift vouchers for the survey participants.



Conflicts of Interest


Supplementary material

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Supplementary material 1 (DOCX 73 kb)


  1. 1.
    Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organisation; 2003. Accessed 6 Dec 2017.
  2. 2.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.CrossRefPubMedGoogle Scholar
  3. 3.
    Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304–14.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Wileman V, Farrington K, Wellsted D, Almond M, Davenport A, Chilcot J. Medication beliefs are associated with phosphate binder non-adherence in hyperphosphatemic haemodialysis patients. Br J Health Psychol. 2015;20(3):563–78.CrossRefPubMedGoogle Scholar
  5. 5.
    Ghimire S, Peterson GM, Castelino RL, Jose MD, Zaidi ST. Medication regimen complexity and adherence in Haemodialysis patients: an exploratory study. Am J Nephrol. 2016;43(5):318–24.CrossRefPubMedGoogle Scholar
  6. 6.
    Williams AF, Manias E, Walker R. Adherence to multiple, prescribed medications in diabetic kidney disease: a qualitative study of consumers’ and health professionals’ perspectives. Int J Nurs Stud. 2008;45(12):1742–56.CrossRefPubMedGoogle Scholar
  7. 7.
    Burnier M, Pruijm M, Wuerzner G, Santschi V. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant. 2015;30(1):39–44.CrossRefPubMedGoogle Scholar
  8. 8.
    Chiu YW, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol. 2009;4(6):1089–96.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi ST. Nonadherence to medication therapy in haemodialysis patients: a systematic review. PLoS ONE. 2015;10(12):e0144119.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kammerer J, Garry G, Hartigan M, Carter B, Erlich L. Adherence in patients on dialysis: strategies for success. Nephrol Nurs J. 2007;34(5):479–86.PubMedGoogle Scholar
  11. 11.
    Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Exploring the role of renal pharmacists in outpatient dialysis centres: a qualitative study. Int J Clin Pharm. 2012;34(4):569–78.CrossRefPubMedGoogle Scholar
  12. 12.
    Pai AB, Boyd A, Depczynski J, Chavez IM, Khan N, Manley H. Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study. Pharmacotherapy. 2009;29(12):1433–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Leung WY, So WY, Tong PC, Chan NN, Chan JC. Effects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy. Am J Med. 2005;118(12):1414.CrossRefPubMedGoogle Scholar
  14. 14.
    Yokum D, Glass G, Cheung CF, Cunningham J, Fan S, Madden AM. Evaluation of a phosphate management protocol to achieve optimum serum phosphate levels in hemodialysis patients. J Ren Nutr. 2008;18(6):521–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Bucaloiu ID, Akers G, Bermudez MC, Mainali R, Brown BL, Roberts SS, et al. Outpatient erythropoietin administered through a protocol-driven, pharmacist-managed program may produce significant patient and economic benefits. Manag Care Interface. 2007;20(6):26–30.PubMedGoogle Scholar
  16. 16.
    Suleiman A, Melaibari M, Alkhaldi T, Almuhisen S, Alharbi S, Kharshid A, et al. Pharmacist-perceived barriers to pharmaceutical care of chronic and end-stage kidney disease patients in Saudi Arabia. Arch Pharma Pract. 2016;7(2):54–60.CrossRefGoogle Scholar
  17. 17.
    Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Patel UD, Davis MM. Physicians’ attitudes and practices regarding adherence to medical regimens by patients with chronic illness. Clin Pediatr. 2006;45(5):439–45.CrossRefGoogle Scholar
  19. 19.
    Berben L, Dobbels F, Kugler C, Russell CL, De Geest S. Interventions used by health care professionals to enhance medication adherence in transplant patients: a survey of current clinical practice. Prog Transplant. 2011;21(4):322–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Mangan MN, Powers MF, Lengel AJ. Student pharmacists’ perceptions of barriers to medication adherence counseling. J Pharm Pract. 2013;26(4):376–81.CrossRefPubMedGoogle Scholar
  21. 21.
    Brar A, Babakhani A, Salifu MO, Jindal RM. Evaluation of non-adherence in patients undergoing dialysis and kidney transplantation: United States transplantation practice patterns survey. Transplant Proc. 2014;46(5):1340–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Nunes V, Neilson J, O’Flynn N, Calvert N, Kuntze S, Smithson H et al. Clinical guidelines and evidence review for medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009. Available at Accessed 24 June 2017.
  23. 23.
    Burns KE, Duffett M, Kho ME, Meade MO, Adhikari NK, Sinuff T, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ. 2008;179(3):245–52.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004;328(7451):1312–5.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Dunn OJ. Multiple comparisons using rank sums. Technometrics. 1964;6:241–52.CrossRefGoogle Scholar
  26. 26.
    Grabe DW, Low CL, Bailie GR, Eisele G. Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997;47(2):117–21.PubMedGoogle Scholar
  27. 27.
    Touchette DR. Improving adherence in the community and clinic pharmacy settings: an emerging opportunity. Pharmacotherapy. 2010;30(5):425–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Lindberg M, Lindberg P. Overcoming obstacles for adherence to phosphate binding medication in dialysis patients: a qualitative study. Pharm World Sci. 2008;30(5):571–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Griva K, Ng HJ, Loei J, Mooppil N, McBain H, Newman SP. Managing treatment for end-stage renal disease—a qualitative study exploring cultural perspectives on facilitators and barriers to treatment adherence. Psychol Health. 2013;28(1):13–29.CrossRefPubMedGoogle Scholar
  30. 30.
    Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant. 2004;19(7):1842–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB. Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis. 2010;56(3):439–46.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Martin LR, Williams SL, Haskard KB, Dimatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(3):189–99.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Bajorek BV, Lemay KS, Magin PJ, Roberts C, Krass I, Armour CL. Preparing pharmacists to deliver a targeted service in hypertension management: evaluation of an interprofessional training program. BMC Med Educ. 2015;15:157.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Dayer L, Dunn E, Pace A, Flowers S. Pharmacists’ perceived knowledge of and confidence in dispensing oral antineoplastic agents. J Am Pharm Assoc. 2016;56(2):141-4.e2.CrossRefGoogle Scholar
  35. 35.
    Pai AB, Cardone KE, Manley HJ, St Peter WL, Shaffer R, Somers M, et al. Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach. Clin J Am Soc Nephrol. 2013;8(11):1988–99.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Chevalier B, Neville HL. Evaluating clinical pharmacy services on a surgical patient-care area: a nurses’ satisfaction survey. Int J Pharm Pract. 2011;19(1):61–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Sulick JA, Pathak DS. The perceived influence of clinical pharmacy services on physician prescribing behavior: a matched-pair comparison of pharmacists and physicians. Pharmacotherapy. 1996;16(6):1133–41.PubMedGoogle Scholar
  38. 38.
    Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Exploring the role of pharmacists in outpatient dialysis centers: a qualitative study of nephrologist views. Nephrol Dial Transplant. 2013;28(2):397–404.CrossRefPubMedGoogle Scholar
  39. 39.
    Roberts AS, Benrimoj S, Chen TF, Williams KA, Aslani P. Implementing cognitive services in community pharmacy: a review of facilitators used in practice change. Int J Pharm Pract. 2006;14:163–70.CrossRefGoogle Scholar
  40. 40.
    Emsley R, Alptekin K, Azorin JM, Canas F, Dubois V, Gorwood P, et al. Nurses’ perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey. Ther Adv Psychopharmacol. 2015;5(6):339–50.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Saurav Ghimire
    • 1
  • Colin Banks
    • 2
  • Matthew D. Jose
    • 2
    • 3
  • Ronald L. Castelino
    • 1
    • 4
    • 5
  • Syed Tabish R. Zaidi
    • 1
    Email author
  1. 1.Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, Faculty of HealthUniversity of TasmaniaHobartAustralia
  2. 2.Department of NephrologyRoyal Hobart HospitalHobartAustralia
  3. 3.School of Medicine, Faculty of HealthUniversity of TasmaniaHobartAustralia
  4. 4.Sydney Nursing SchoolThe University of SydneySydneyAustralia
  5. 5.Blacktown HospitalWestern Sydney Local Health DistrictSydneyAustralia

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