Dialysis patients have a high pill burden, increasing their care complexity. A previous study in our institution’s dialysis unit found notable discrepancies between medication prescriptions, purchases and patient reports of medication use: overall adherence to medication was 57%, on average; staff reported patients took 3.1 more medication types than actual purchases; concordance of patient purchases and nurse reports was found in 5.7 out of 23.6 months of patient follow-up. We sought to investigate patients and staff concepts and attitudes regarding medication care and to understand better the previously identified inconsistencies. We performed a qualitative research based on the grounded theory approach, using semi-structured, in-depth, interviews with patients and staff from the same dialysis unit studied previously, at the Hadassah Medical Center, Jerusalem, Israel. Though all respondents described a seemingly synchronized system of care, repeated questioning revealed that staff distrust patient medication reports. Patients, on their part, felt that their monitoring and supervision were bothersome and belittling. Along with patients, nurses and physicians, we identified a “fourth” factor, which influences medication care – the laboratory tests. They serve both as biological parameters of health, but also as parameters of patient adherence to the prescribed medication regimens. Participant responses did not clearly resonate with previous findings from the quantitative study. The central role of laboratory tests should be carefully considered by the staff when interacting with patients. An interaction process, less adversarial, centering on the patient attitudes to medication care, might establish better communication, better cooperation and better patient outcomes.

中文翻译：

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血液透析患者的慢性药物治疗：患者、护理人员和医务人员态度和方法的定性研究。

透析患者的药物负担很高，增加了他们的护理复杂性。我们机构透析部门之前的一项研究发现，药物处方、购买和患者用药报告之间存在显着差异：药物治疗的总体依从性平均为 57%；工作人员报告说，患者服用的药物种类比实际购买的多 3.1 种；在 23.6 个月的患者随访中，有 5.7 个月发现患者购买和护士报告一致。我们试图调查患者和工作人员关于药物治疗的概念和态度，并更好地了解先前发现的不一致之处。我们基于扎根理论方法进行了一项定性研究，对来自先前研究的同一透析单位的患者和工作人员进行了半结构化、深入的访谈，在以色列耶路撒冷的哈达萨医疗中心。尽管所有受访者都描述了看似同步的护理系统，但反复提问表明工作人员不信任患者用药报告。就患者而言，他们认为他们的监测和监督令人烦恼和贬低。我们与患者、护士和医生一起确定了影响药物治疗的“第四个”因素——实验室检查。它们既可作为健康的生物学参数，也可作为患者对处方药物治疗方案依从性的参数。参与者的反应与先前的定量研究结果没有明显的共鸣。工作人员在与患者互动时应仔细考虑实验室检测的核心作用。一个交互过程，较少对抗，