Abstract: SA-PO837

Health Literacy Improves Medication Adherence and Clinical Outcomes

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Velliyattikuzhi, Sreejith Mohan, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Maan, Dipesh, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Lavudi, Swathi, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Marcus, Richard J., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Clark, Barbara A., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
Background

Poor medication adherence (MA) remains an important issue in end stage renal disease (ESRD) making blood pressure (BP) and phosphorous (P) control a challenge. We speculated the root cause for poor MA as lack of health literacy (HL) and designed a study to measure the extent of MA in ESRD and to determine if HL education improves MA in turn improving clinical outcomes.

Methods

35 dialysis patients at a single center underwent a baseline interview which included open ended questions to assess MA (good MA defined as self-reported missed medication ≤ twice per week) and HL (knowledge of implications of BP and P control and awareness of anti-hypertensives and P binders). Medications were reconciled with the patient's pharmacy and an updated medication list along with verbal and written education materials were provided. In six weeks, a follow up interview was performed to re-assess MA and HL. Average systolic and diastolic BP and P levels were measured before and after the study.

Results

MA at baseline was 54%. Only 66% and 29% understood implications of BP and P control respectively. 56% were not aware of their P binders. Post intervention showed significant improvement in MA (86%, p=0.002), awareness of antihypertensive medications (p=0.01) and P binders (p<0.001). Systolic BP after intervention showed significant improvement (p<0.001). There was a trend towards improvement in diastolic BP, but did not reach statistical significance. No significant difference was observed with P levels and with number of missed hemodialysis sessions after intervention. Refer to table.

Conclusion

MA and HL in ESRD is poor. Open ended questioning identifies gaps in HL and directed education improves MA, HL and clinical outcomes.

VariablePrePostp-value
Medication Adherence(%)54860.002
Understand importance of
BP control(%)
66830.034
Understand importance of
Phosphorus control(%)
29630.001
Systolic BP-2 week average
pre dialyisis in mmhg(mean±SD)
147±21139±18<0.001
Diastolic BP-2 week average
pre dialyisis in mmhg(mean±SD)
83±1580±140.198
Phosphorus Level in mg/dL
(mean±SD)
6.4±1.96.2±1.80.311
Awareness of
anti-hypertensive
medications(%)
None2090.011
Some6060
Good2031
Awareness
of phosphate
binders(%)
None569<0.001
Some2767
Good1724
No: of missed HD days
(mean±SD)
0.88±1.150.74±1.330.431