End-Stage Renal Disease Patients, Medication Self-management, and Oppression

Abstract

Medication self-management is crucial for end-stage renal disease (ESRD) patients. ESRD patients who do not adhere to their medication regimen as prescribed suffer increased hospitalizations morbidity and mortality. Furthermore, ESRD disproportionately affects historically oppressed groups, and there is some evidence that historically oppressed groups exhibit low medication self-management. In an effort to understand this issue, this paper presents a novel conceptual model using critical consciousness as the theoretical foundation. The conceptual model posits that oppression affects factors associated with medication self-management since it is embedded in our culture, society, and institutions, including the healthcare system. This research is salient to nephrology social workers for several reasons. First, the only Medicare mandate for master’s level social workers on treatment teams is found in dialysis and kidney transplant centers. Thus, every dialysis patient has a social worker who can help them address all barriers affecting their medication self-management, including oppression. Second, social workers are uniquely trained to discuss topics such as oppression and aid patients as they navigate a possibly oppressive healthcare system. Third, social workers, in collaboration with patients, can make positive changes to oppressive healthcare systems which have a negative impact on patients’ health. Lastly, social workers have an ethical obligation to fight social injustice, especially when the outcomes of this social injustice, oppression, can be dire for our patients’ health.