Abstract: SA-PO837
Health Literacy Improves Medication Adherence and Clinical Outcomes
Session Information
- Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular - II
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
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.
| Variable | Pre | Post | p-value | |
| Medication Adherence(%) | 54 | 86 | 0.002 | |
| Understand importance of BP control(%) | 66 | 83 | 0.034 | |
| Understand importance of Phosphorus control(%) | 29 | 63 | 0.001 | |
| Systolic BP-2 week average pre dialyisis in mmhg(mean±SD) | 147±21 | 139±18 | <0.001 | |
| Diastolic BP-2 week average pre dialyisis in mmhg(mean±SD) | 83±15 | 80±14 | 0.198 | |
| Phosphorus Level in mg/dL (mean±SD) | 6.4±1.9 | 6.2±1.8 | 0.311 | |
| Awareness of anti-hypertensive medications(%) | None | 20 | 9 | 0.011 |
| Some | 60 | 60 | ||
| Good | 20 | 31 | ||
| Awareness of phosphate binders(%) | None | 56 | 9 | <0.001 |
| Some | 27 | 67 | ||
| Good | 17 | 24 | ||
| No: of missed HD days (mean±SD) | 0.88±1.15 | 0.74±1.33 | 0.431 | |