Date of Award
Doctor of Nursing (ND)
Karim Singh, DNP, APRN, FNP-BC
Background: Living with end-stage renal disease can be a daunting experience for the individual; it takes a toll on the caregivers and affects the family dynamics. Patients are predisposed to numerous health comorbidities, resulting in polypharmacy to treat those conditions. Adherence to phosphate binder remains highly important to prevent a high serum phosphate level in patients receiving hemodialysis. According to the American Kidney Fund survey (2018), 75% of patients with end-stage renal disease reported skipping or missing at least one pill or a dose of medicine within the past week. A collaborative conversational style such as motivational interviewing has been found to be very effective at improving medication adherence and cultivating change across a wide range of health behaviors.
Methods: The Plan-Do-Study-Act method of the quality improvement project was utilized for this project. The intervention involved 60-minute face-to-face motivational interviewing (MI) sessions held for 5 consecutive weeks during the first hour of in-center hemodialysis to assess whether MI interventions can enhance medication adherence. Data were collected using a
self-reported medication adherence report scale 5 (MARS-5) to measure medication adherence pre-and post-MI intervention. Higher scores indicated higher self-reported adherence, while patients with scores less than 25 qualified to participate in the Quality Improvement project.
Results: A total of 10 patients were initially enrolled in the QI project, and two dropped out. At the end of the intervention, eight patients completed the post-intervention MARS-5; one patient had a 133.3% improvement and a 22.7% reduction in serum phosphate. Three patients had an improvement in their serum phosphate levels without an improved MARS-5 score.
Conclusion: Even though short-term face-to-face MI enhanced the medication adherence rate in only one patient, the other three patients with improved serum phosphate levels recorded high baseline MARS-5 scores and did not show a significant change in their MARS 5 post- intervention. Several factors may predict non-adherence in this population.
In this QI study, MI improved the patient-provider rapport, increased patients' awareness about complications associated with medication non-adherence, and demonstrated a high tendency to improve serum phosphate levels.
Ogbonna, Pamela O., "Motivational Interviewing During In-Center Hemodialysis to Improve Medication Adherence" (2021). Cohort IX. 5.