Abstract
Serum phosphorus is a challenging mineral to manage in kidney hemodialysis (HD) patients. Excess phosphorus has been significantly associated with all-cause vascular and fracture-related hospitalizations, calciphylaxis, and death. When diet alone is not sufficient to manage increased serum phosphorus, phosphorus binders are prescribed to manage serum phosphorus. Non-adherence to prescribed medication regimen, also an on-going challenge, has been associated with unmet expected outcomes and increased risk to the health and quality of life of the patient. The primary objective of this research was to determine the effect of an environmental reminder on the correct and consistent use of phosphorus binders.
A study based on the Quasi-Experimental Design was conducted between Oct 2011 and Feb 2012 at an outpatient HD clinic in Columbus, Ohio, USA. Nineteen patients met inclusion criteria of: serum phosphorus greater than 5.5 mg/dL, a prescribed phosphorus binder, in control of their own medication dosing regimen, and receiving HD greater than or equal to six months. All completed the data collection period of the study.
Study participants were given an environmental reminder intervention. No statistically significant change in the two months pre Qm comparisons using a CI 0.95, significance <0.05 (0.072 and 0.131, respectively) were identified. In the first month post Qm, a statistically significant change (p= 0.005) was identified. In the second month post Qm, a statistically significant change (p=0.022) was also identified. The change, though statistically significant, did not demonstrate an improvement in serum phosphorus levels as they actually increased rather than decreased after the intervention. As the study was conducted over three major annual holidays, diet was not controlled, and sample was small, the effect of the intervention may have been minimized.
Study participants (71.4%) responded in the Exit Survey that the intervention helped them to remember to take their prescribed phosphorus binder most or all of the time.
This study will encourage continued research into intervention and behavior change to achieve medication adherence, reduced health risk, and increase quality of life.
Key words: serum phosphorus, phosphorus binders, non-adherence,
environmental reminder