Dialysis patients have a high pill burden, increasing their care complexity. A previous study in our\ninstitutionâ??s dialysis unit found notable discrepancies between medication prescriptions, purchases and patient\nreports of medication use: overall adherence to medication was 57%, on average; staff reported patients took 3.1\nmore medication types than actual purchases; concordance of patient purchases and nurse reports was found in\n5.7 out of 23.6 months of patient follow-up. We sought to investigate patients and staff concepts and attitudes\nregarding medication care and to understand better the previously identified inconsistencies.\nMethods: We performed a qualitative research based on the grounded theory approach, using semi-structured,\nin-depth, interviews with patients and staff from the same dialysis unit studied previously, at the Hadassah Medical\nCenter, Jerusalem, Israel.\nResults: Though all respondents described a seemingly synchronized system of care, repeated questioning revealed\nthat staff distrust patient medication reports. Patients, on their part, felt that their monitoring and supervision were\nbothersome and belittling. Along with patients, nurses and physicians, we identified a â??fourthâ? factor, which influences\nmedication care - the laboratory tests. They serve both as biological parameters of health, but also as parameters of\npatient adherence to the prescribed medication regimens.\nConclusions: Participant responses did not clearly resonate with previous findings from the quantitative study. The\ncentral role of laboratory tests should be carefully considered by the staff when interacting with patients. An\ninteraction process, less adversarial, centering on the patient attitudes to medication care, might establish better\ncommunication, better cooperation and better patient outcomes.
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