Oral Medication Self-Management: Lessons from Patients for Social Work Practice

BACKGROUND & PURPOSE:  Dialysis patients encounter difficulties self-managing their medication regimes and have the highest pill burden of any chronically ill population. In particular, phosphate binders make up the majority of patient pill burden. It is critically important to identify ways that dialysis social workers and other professionals can help patients self-manage their phosphate binder medications to improve patient outcomes. To achieve this goal, a qualitative study was conducted to pinpoint dialysis patient-centered facilitators and barriers to phosphate binder self-management.

METHODS: Primary data were gathered from five, 90-minute, small-group interviews with hemodialysis patients (N = 17) in Atlanta, GA. The majority of patients were female (70%), African American (76%), had a dialysis vintage = 87 months (SD=59), and a daily pill burden of 16 pills (SD=13).  Participants were recruited from attendees at the American Association of Kidney Patients annual meeting. The focus groups were transcribed verbatim. A constant comparative method was used to identify themes that emerged from a line-by-line review of the interview transcripts. 

RESULTS: Participants identified three facilitators to self-managing their phosphate binders:  social support; placing binders in multiple locations; and seeing images that depict health consequences associated with high serum phosphorus.  Patients also identified three main barriers to self-management of phosphate binders: financial burden of medications, privacy concerns about taking medications in a public setting, and medication regimen complexity.

CONCLUSIONS & IMPLICATIONS: The study findings provide the basis for the development of future research and targeted interventions that can improve patient self-management of phosphate binders and improve dialysis patient health outcomes. In particular, this study can inform the development of targeted, social work interventions that can bolster patient self-management, improving health outcomes, and reduce costs associated with medication non-adherence in the end-stage renal disease population, as well as in other chronically ill populations.