The medication adherence of PD patients is at a moderate level.
The MMAS-8 score of PD patients in our centre was (7.00 ± 1.21) points, generally at a moderate level. Among them, 36 participants had poor medication adherence, accounting for 15.9%, lower than the 27.74% reported by Zhou et al.'s (Zhou et al., 2023) study. The reason may be related to the fact that our centre is located in a first-tier city in China, and compared to Xinjiang Uygur Autonomous Region of China, which is far from the mainland, the development of PD dialysis technology was earlier and more common, resulting in a relatively higher acceptance rate among patients (Bi et al., 2021). Therefore, the patients may have a higher rate of medication adherence. In the current study, the rates of poor medication adherence were also lower than the Ozen et al.'s (Ozen N, 2019) research, which reported 20.1%. However, the medication adherence scale in Ozen et al.'s study was a four-item Morisky Green Levine Medication Adherence Scale (Morisky et al., 1986), which differs from the survey in this paper. Thus, the data was incomparable.
In addition, the current article may have a situation of high self-rating. We used a face-to-face questionnaire survey, with outpatient follow-up nurses assisting middle-aged and elderly in completing the questionnaire. The questionnaire filling was subjective. Patients might be concerned about encountering unpleasant experiences, such as caution and criticism from medical staff when reporting low medication adherence (Brown et al., 2016). Consequently, there might be a situation of high self-rating, leading to information bias. How to use objective data to evaluate patients' medication compliance; designing an information-based and intelligent "smart pillbox" for patients is an innovative research direction for the future (Goldstein et al., 2020, Musiimenta et al., 2024).
The medication adherence of patients with different PD ages
Univariate analysis revealed that patients with 13–36 months of PD age had the highest percentage of adherence, 90.8%, and an adherence score of 7.26 ± 1.08; patients with < 7 months of PD age had the lowest percentage of adherence, 68.8%, and an adherence score of 6.39 ± 1.54, the difference was statistically significant. The results were inconsistent with Zhou Xiang et al.'s (Zhou et al., 2023) study. The reason may be that the patients who were starting PD had insufficient knowledge of medication and an inadequate understanding of the importance of PD-related medication treatment.
In addition, a qualitative study found that patients new to PD had various concerns because of lifestyle changes (Ling et al., 2023). the psychological status can also impact patients' medication adherence (Li et al., 2019). Hence, we should pay special attention to patients who have just started undergoing PD. The medical staff could consider incorporating PD patients' common medication knowledge into the training courses for new PD patients and retraining courses for all PD patients (Jaelani et al., 2023). In this way, they can understand the role of each medication and the dangers of omitting medication.
The influence of age on medication adherence in PD patients
In the current study, PD patients' medication adherence scores increased with age. PD patients under 45 years old had a medication adherence score of 6.62 ± 1.34, which was relatively the lowest; the proportion of adherence rate was 80.77%. While patients over 75 years old had a score of 7.42 ± 0.86, which was relatively the highest, the proportion of adherence rate was 100%, with statistically significant differences (P = 0.036).
This study found that age was the main influencing factor in medication adherence in PD patients (P < 0.05). Older PD patients had better medication adherence than younger patients, contrary to the findings of Yao Xin et al.(Yao et al., 2022). The reasons for better medication adherence in elderly patients may be as follows:
In our PD centre, 96.5% of the patients lived with their families, which provided more family support and supervision (Tao et al., 2020). The caregivers assisted the elderly patients with routine PD exchange procedures, and their caregivers also reminded them to take their medication. Therefore, the compliance of elderly PD patients in this centre was higher. Indeed, the caregivers' medication adherence level affects the patient's medication taking and treatment effectiveness (Muellers et al., 2019, Liu et al., 2022). However, the medication literacy and adherence levels of caregivers of PD patients are rarely reported and can be explored in future studies.
In this study, patients under 45 had the lowest medication adherence, possibly due to their insufficient awareness of the importance of taking medication on time and in the appropriate amount (Ghimire et al., 2019). The current author conducted a qualitative interview with young PD patients. The author found that due to the variety of medications taken by PD patients when their condition stabilizes or improves, they may forget to take medication or choose the drugs they want to take. The study by Li et al. (李连珍 and 赵建荣, 2016) also found this phenomenon. Additionally, in clinical practice, the current author found that patients cannot identify the types of drugs, which affects the correct use of drugs. Given this, the current author suggested the following interventions.
Firstly, the medical team should pay attention to adopting information technology to increase health education channels. Generally, PD patients only have the opportunity to contact medical staff during monthly follow-up visits to the PD clinic. Compared to hemodialysis patients who go to the hospital three times a week, PD patients receive less attention and education from medical staff. Therefore, the PD team could consider multiple forms of health education such as a WeChat official account (WeChat official account is the most widely used mobile media platform in China; the number of WeChat users has reached 1.26 billion), video ID of the department, PD patient club, Made an atlas or model of Commonly Used Drugs, and so on.
Secondly, pharmacists could be invited to participate in the PD follow-up clinic. Pharmacists guide patients with low medication adherence to improve their medication literacy and compliance behaviour. Finally, medical staff could cooperate with technology companies to design a medication reminder device for patients. Our PD medical team plans to develop a self-management mobile software for PD patients. When the patient needs medication, the phone will emit a prompt sound, and the mobile phone screen will display pictures of the medication. In this way, the software may help patients take the correct medication on time.