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Contracting with outpatient hemodialysis patients to improve adherence to treatment

J K Laidlaw1, J E Beeken, F W Whitney

  • 1Southeastern Wyoming Dialysis Center, Cheyenne, USA.

ANNA Journal
|May 1, 1999
PubMed

Insights

Contingency contracting improved adherence to phosphate-binding medications for hemodialysis patients. However, it was less effective for fluid restriction adherence, showing varied patient responses to therapy management.

Area of Science:

  • Nephrology
  • Behavioral Medicine
  • Healthcare Management

Background:

  • Adherence to prescribed therapy is critical for managing chronic conditions like hemodialysis.
  • Outpatient chronic hemodialysis patients face challenges adhering to fluid restrictions and medication regimens.
  • Contingency contracting is a behavioral intervention strategy with potential to improve patient adherence.

Purpose of the Study:

  • To investigate the effectiveness of contingency contracting on therapy adherence in outpatient chronic hemodialysis patients.
  • To examine the relationship between contingency contracting and adherence to fluid restrictions and phosphate-binding medication.
  • To identify factors influencing adherence and nonadherence in this patient population.

Main Methods:

  • A quasi-experimental, pretest/posttest design was employed with 15 outpatient chronic hemodialysis patients.
  • Patients were divided into phosphorus and weight-gain groups.
  • Data on interdialytic weight gains and serum phosphorus levels were collected pre- and post-intervention, analyzed using paired t-tests. Weekly interviews and content analysis explored adherence factors.

Main Results:

  • Contingency contracting demonstrated a more favorable impact on adherence to phosphate-binding medications compared to fluid restrictions.
  • Patients developed strategies to improve medication adherence to lower serum phosphorus levels.
  • Identified adherence/nonadherence factors included physiological, psychological, environmental, economic, medical, knowledge, and social support elements.

Conclusions:

  • Contingency contracting can be an effective tool for enhancing medication adherence in hemodialysis patients.
  • The intervention's efficacy may vary depending on the specific therapeutic behavior (medication vs. fluid restriction).
  • Further research is warranted to optimize behavioral interventions for comprehensive adherence in chronic hemodialysis.

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