Path analysis of treatment adherence and its influencing factors in chronic kidney disease patients without dialysis_West China Medical Journal

Authors：

LI Jing ¹ , DUAN Difei ¹ , CHEN Yi ¹ ,  LI Ling ²

1. Department of Nephrology, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Ling, Email: echoliling@163.com

Keywords：

Treatment adherence; Physician-patient communication; Physician-patient concordance; Chronic kidney disease

DOI：

10.7507/1002-0179.202106107

Video：

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Objective To explore the current status of treatment adherence in patients with chronic kidney disease without dialysis and to analyze its influencing factors.Methods The patients who visited the Outpatient Department of Nephrology of West China Hospital of Sichuan University from September to December 2020 were taken as the research objects. Self-designed general information questionnaire, treatment adherence questionnaire, physician-patient communication satisfaction, health information seeking behavior questionnaire, and physician-patient concordance questionnaire were used to investigate, and path analysis was used to explore the influencing factors of treatment adherence.Results A total of 203 valid questionnaires were obtained. Treatment adherence score was (21.69±2.42) points, self-reported health status was (2.48±0.91) points, physician-patient concordance was (20.39±2.70) points, physician-patient communication satisfaction was (67.73±5.52) points, and health information seeking behavior was (13.17±2.65) points. Health information seeking behavior (r=0.214, P=0.002), physicians-patient concordance (r=0.494, P<0.001), physician-patient communication satisfaction (r=0.229, P=0.001) were positively correlated with treatment adherence. Self-reported health status was negatively correlated with treatment adherence (r=−0.225, P=0.001). Path analysis showed that physicians-patient concordance was the most influencing factor of treatment adherence (total effect=0.474).Conclusion Health information-seeking behavior and physicians-patient concordance are important factors affecting treatment adherence in chronic kidney disease patients without dialysis. In order to improve treatment adherence of chronic kidney disease patients, healthcare providers can provide various ways to provide information, which can help make more disease-related health knowledge available to patients. Moreover, healthcare workers should also further explore ways to improve the concordance related to reaching agreement between doctors and patients on medical and treatment options.

Citation： LI Jing, DUAN Difei, CHEN Yi, LI Ling. Path analysis of treatment adherence and its influencing factors in chronic kidney disease patients without dialysis. West China Medical Journal, 2021, 36(7): 854-858. doi: 10.7507/1002-0179.202106107 Copy

1.	Browne T, Merighi JR. Barriers to adult hemodialysis patients’ self-management of oral medications. Am J Kidney Dis, 2010, 56(3): 547-557.
2.	Burkhart PV, Sabaté E. Adherence to long-term therapies: evidence for action. J Nurs Scholarsh, 2003, 35(3): 207.
3.	Osterberg L, Blaschke T. Adherence to medication. N Engl J Med, 2005, 353(5): 487-497.
4.	Welch JL, Siek KA, Connelly KH, et al. Merging health literacy with computer technology: self-managing diet and fluid intake among adult hemodialysis patients. Patient Educ Couns, 2010, 79(2): 192-198.
5.	Ghimire S, Castelino RL, Lioufas NM, et al. Nonadherence to medication therapy in haemodialysis patients: a systematic review. PLoS One, 2015, 10(12): e0144119.
6.	Ghanbari A, Tabrizi KN, Dalvandi A, et al. Effect of an educational program based on the teach-back method on adherence to treatment regimen in dialysis patients with end stage renal disease referred to Sina Hospital during 2015-2016. Iran J Rehabil Res Nurs, 2017, 4(1): 24-30.
7.	Laugesen J, Hassanein K, Yuan Y. The impact of internet health information on patient compliance: a research model and an empirical study. J Med Internet Res, 2015, 17(6): e143.
8.	Eknoyan, G, Lameire N, Eckardt K, et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int, 2013, 3(1): 5-14.
9.	Hausman A. Modeling the patient-physician service encounter: improving patient outcomes. J Acad Mark Sci, 2004, 32(4): 403-417.
10.	Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the communication assessment tool. Patient Educ Couns, 2007, 67(3): 333-342.
11.	Zhang X, Zhang R, Lu X. Exploring the effects of patient activation in online health communities on patient compliance. Telemed J E Health, 2020, 26(11): 1373-1382.
12.	Khazaee-Pool M, Majlessi F, Montazeri A, et al. Development and psychometric testing of a new instrument to measure factors influencing women’s breast cancer prevention behaviors (ASSISTS). BMC Womens Health, 2016, 16: 40.
13.	Kerse N, Buetow S, Mainous AG 3rd, et al. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med, 2004, 2(5): 455-461.
14.	Wahl C, Gregoire JP, Teo K, et al. Concordance, compliance and adherence in healthcare: closing gaps and improving outcomes. Healthc Q, 2005, 8(1): 65-70.
15.	Lu X, Zhang R, Wu W, et al. Relationship between internet health information and patient compliance based on trust: empirical study. J Med Internet Res, 2018, 20(8): e253.
16.	Brown MT, Bussell J, Dutta S, et al. Medication adherence: truth and consequences. Am J Med Sci, 2016, 351(4): 387-399.
17.	Sousa H, Ribeiro O, Paúl C, et al. Social support and treatment adherence in patients with end-stage renal disease: a systematic review. Semin Dial, 2019, 32(6): 562-574.
18.	Seng JJB, Tan JY, Yeam CT, et al. Factors affecting medication adherence among pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis of literature. Int Urol Nephrol, 2020, 52(5): 903-916.
19.	Garber MC, Nau DP, Erickson SR, et al. The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care, 2004, 42(7): 649-652.
20.	Zhang Z, Yang H, He J, et al. The impact of treatment-related internet health information seeking on patient compliance. Telemed J E Health, 2021, 27(5): 513-524.
21.	张悦, 张云秋. 基于认知风格的网络健康信息搜索行为研究. 情报理论与实践, 2017, 40(7): 103-107.
22.	Jung M, Ramanadhan S, Viswanath K. Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors. Patient Educ Couns, 2013, 92(1): 100-106.
23.	Cvengros JA, Christensen AJ, Hillis SL, et al. Patient and physician attitudes in the health care context: attitudinal symmetry predicts patient satisfaction and adherence. Ann Behav Med, 2007, 33(3): 262-268.
24.	Wroth TH, Pathman DE. Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med, 2006, 19(5): 478-486.
25.	Lu X, Zhang R. Impact of physician-patient communication in online health communities on patient compliance: cross-sectional questionnaire study. J Med Internet Res, 2019, 21(5): e12891.

1. Browne T, Merighi JR. Barriers to adult hemodialysis patients’ self-management of oral medications. Am J Kidney Dis, 2010, 56(3): 547-557.
2. Burkhart PV, Sabaté E. Adherence to long-term therapies: evidence for action. J Nurs Scholarsh, 2003, 35(3): 207.
3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med, 2005, 353(5): 487-497.
4. Welch JL, Siek KA, Connelly KH, et al. Merging health literacy with computer technology: self-managing diet and fluid intake among adult hemodialysis patients. Patient Educ Couns, 2010, 79(2): 192-198.
5. Ghimire S, Castelino RL, Lioufas NM, et al. Nonadherence to medication therapy in haemodialysis patients: a systematic review. PLoS One, 2015, 10(12): e0144119.
6. Ghanbari A, Tabrizi KN, Dalvandi A, et al. Effect of an educational program based on the teach-back method on adherence to treatment regimen in dialysis patients with end stage renal disease referred to Sina Hospital during 2015-2016. Iran J Rehabil Res Nurs, 2017, 4(1): 24-30.
7. Laugesen J, Hassanein K, Yuan Y. The impact of internet health information on patient compliance: a research model and an empirical study. J Med Internet Res, 2015, 17(6): e143.
8. Eknoyan, G, Lameire N, Eckardt K, et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int, 2013, 3(1): 5-14.
9. Hausman A. Modeling the patient-physician service encounter: improving patient outcomes. J Acad Mark Sci, 2004, 32(4): 403-417.
10. Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the communication assessment tool. Patient Educ Couns, 2007, 67(3): 333-342.
11. Zhang X, Zhang R, Lu X. Exploring the effects of patient activation in online health communities on patient compliance. Telemed J E Health, 2020, 26(11): 1373-1382.
12. Khazaee-Pool M, Majlessi F, Montazeri A, et al. Development and psychometric testing of a new instrument to measure factors influencing women’s breast cancer prevention behaviors (ASSISTS). BMC Womens Health, 2016, 16: 40.
13. Kerse N, Buetow S, Mainous AG 3rd, et al. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med, 2004, 2(5): 455-461.
14. Wahl C, Gregoire JP, Teo K, et al. Concordance, compliance and adherence in healthcare: closing gaps and improving outcomes. Healthc Q, 2005, 8(1): 65-70.
15. Lu X, Zhang R, Wu W, et al. Relationship between internet health information and patient compliance based on trust: empirical study. J Med Internet Res, 2018, 20(8): e253.
16. Brown MT, Bussell J, Dutta S, et al. Medication adherence: truth and consequences. Am J Med Sci, 2016, 351(4): 387-399.
17. Sousa H, Ribeiro O, Paúl C, et al. Social support and treatment adherence in patients with end-stage renal disease: a systematic review. Semin Dial, 2019, 32(6): 562-574.
18. Seng JJB, Tan JY, Yeam CT, et al. Factors affecting medication adherence among pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis of literature. Int Urol Nephrol, 2020, 52(5): 903-916.
19. Garber MC, Nau DP, Erickson SR, et al. The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care, 2004, 42(7): 649-652.
20. Zhang Z, Yang H, He J, et al. The impact of treatment-related internet health information seeking on patient compliance. Telemed J E Health, 2021, 27(5): 513-524.
21. 张悦, 张云秋. 基于认知风格的网络健康信息搜索行为研究. 情报理论与实践, 2017, 40(7): 103-107.
22. Jung M, Ramanadhan S, Viswanath K. Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors. Patient Educ Couns, 2013, 92(1): 100-106.
23. Cvengros JA, Christensen AJ, Hillis SL, et al. Patient and physician attitudes in the health care context: attitudinal symmetry predicts patient satisfaction and adherence. Ann Behav Med, 2007, 33(3): 262-268.
24. Wroth TH, Pathman DE. Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med, 2006, 19(5): 478-486.
25. Lu X, Zhang R. Impact of physician-patient communication in online health communities on patient compliance: cross-sectional questionnaire study. J Med Internet Res, 2019, 21(5): e12891.

West China Medical Journal

Path analysis of treatment adherence and its influencing factors in chronic kidney disease patients without dialysis

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