Assessing Patients' ability to learn medication protocols during a hemodialysis session

People on hemodialysis experience high rates of cognitive impairment and are prescribed complex medication regimens, increasing their risk of medication errors. Although hemodialysis units are convenient settings for medication education, it is unclear whether patients can effectively learn a new regimen during a hemodialysis session.

We conducted a secondary analysis of multicenter, cross-sectional data from Toronto, Canada. One hundred one participants completed the Medication Management Ability Assessment (MMAA), Montreal Cognitive Assessment (MoCA), and Lawton-Brody Instrumental Activities of Daily Living (IADL) scale during the first hour of a hemodialysis session. We calculated the proportion of participants who scored as impaired on the MMAA (≤27), examined predictors of impairment, and calculated correlations between the MMAA, MoCA, and the medication management item from the Lawton-Brody IADL scale.

Of 353 patients screened, 101 were eligible and completed all assessments (mean age 67 years; 29% female; median dialysis vintage 36 months). Fifty-five participants (54%; 95% confidence interval [CI]: 44-64%) were impaired on the MMAA, including 23 who reported being independent with medication management in daily life. MMAA scores correlated moderately with the MoCA (r = 0.585, P < 0.001) and were significantly associated with self-reported dependence on the Lawton-Brody medication item (χ2(1, n = 101) = 20.00, P < 0.001). Older age (adjusted odds ratio [OR] = 1.08, 95% CI [1.03, 1.12], P < 0.001) and racialized status (adjusted OR = 3.53, 95% CI [1.23, 10.07], P = 0.019) were significantly associated with impaired MMAA performance in a multivariable logistic regression analysis.

Over half of participants had difficulty learning a new medication regimen during a hemodialysis session. Findings highlight the need to reconsider when and how medication education is delivered to this population, and to develop interventions that support their learning.