Bootcongres

Background: Nonadherence is a common issue that health professionals deal with as approximately one third of the patient population is nonadherent. Attitude towards nonadherence is likely to influence professionals' behaviour when treating patients. This study aimed to investigate nephrologists’ and nurses’ attitudes towards medication nonadherence. Methods: All nephrologist and nurses who work in the outpatient clinic were invited to participate in this Q-methodological study. Professionals were asked to rank-order statements on issues associated with (non) adherence in order of agreement. Factor analysis was used to uncover patterns in the ranking of the statements. The resulting factors represent groupings of professionals with the same attitude profile. Results: In this study 16 professionals (12 nephrologists and 4 nurses) participated. Results revealed four attitude profiles in professionals towards nonadherence: (A) The mentor (B) The worrier (C) The believer, and (D) Detached. Professionals with attitude A find it important to discuss nonadherence and the cosequences with their patients, they see themselves as approachable and work together with the patient. Professionals with attitude B do not want to be strict with patients but nevertheless are most in favor of dialysis prior to transplantation if patients were nonadherent. They feel powerless and frustrated if patients do not comply. Professionals with attitude C think that most patients are honest about their medication intake, and that patients who focus too much on their medication regime have lower quality of life. Professionals with profile D are least in favor of dialysis instead of pre-emptive transplantation in nonadherent patients. They think adherence is the patients’ responsibility and that patients who are nonadherent will always be so. There were also statements all professionals agreed with: everyone would change medication for side effects; would ask what the patient actually took; found that nonadherence occurs in patients of all ages and not only in the younger population; and think the patients should have a say in their treatment. 

Conclusion: Varying profiles regarding nonadherence were detected among healthcare professionals. It would be interesting to investigate how these attitudes influence self-management support behaviour and if this is related to patient outcomes.