Enhancing medication adherence in older adults at two nurse practitioner-owned clinics.
Journal
Journal of the American Association of Nurse Practitioners
ISSN: 2327-6924
Titre abrégé: J Am Assoc Nurse Pract
Pays: United States
ID NLM: 101600770
Informations de publication
Date de publication:
06 May 2020
06 May 2020
Historique:
received:
29
08
2019
accepted:
06
02
2020
pubmed:
10
5
2020
medline:
25
11
2021
entrez:
9
5
2020
Statut:
epublish
Résumé
The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes. A prior study at two nurse practitioner (NP)-owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker. Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers. Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes. Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change. This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.
Sections du résumé
BACKGROUND
BACKGROUND
The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes.
LOCAL PROBLEM
OBJECTIVE
A prior study at two nurse practitioner (NP)-owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker.
METHODS
METHODS
Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers.
INTERVENTION
METHODS
Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes.
RESULTS
RESULTS
Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change.
CONCLUSIONS
CONCLUSIONS
This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.
Identifiants
pubmed: 32384358
pii: 01741002-202107000-00011
doi: 10.1097/JXX.0000000000000414
doi:
Substances chimiques
Glycated Hemoglobin A
0
Types de publication
Journal Article
Langues
eng
Pagination
553-562Informations de copyright
Copyright © 2020 American Association of Nurse Practitioners.
Déclaration de conflit d'intérêts
Competing interests: The authors report no conflicts of interest.
Références
Gellad W. F., Grenard J. L., Marcum Z. A. (2011). A systematic review of barriers to medication adherence in the elderly: Looking beyond cost and regimen complexity. The American Journal of Geriatric Pharmacotherapy, 9, 11–23.
Lehman A., Aslani P., Ahmed R., Celio J., Gauchet A., Bedouch P., Schneider M. P. (2014). Assessing medication adherence: Options to consider. International Journal of Clinical Pharmacy, 36, 55–69.
Maciejewski M. L., Hammill B. G., Bayliss E. A., Ding L., Voils C. I., Curtis L. H., Wang V. (2017). Prescriber continuity and disease control of older adults. Medical Care, 55, 405–410.
National Community Pharmacists Association. (2013). Medication adherence in America: A national report card. Retrieved from https://www.ncpanet.org/pdf/reportcard/AdherenceReportCard_Abridged.pdf.
Nieuwlaat R., Wilczynski N., Navarro T., Hobson N., Jeffery R., Keepanasseril A., Haynes R. B. (2014). Interventions for enhancing medication adherence. The Cochrane Database of Systematic Reviews, CD000011.
Rao A., Shi Z., Ray K., Mehortra A., Ganguli I. (2019). National trends in primary care visit use and practice capabilities, 2008-2015. Annals of Family Medicine, 17, 538–544.
Rui P., Okeyode T. (2016). National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. Retrieved from http://www.cdc.gov/nchs/ahcd/ahcd_products.htm.
Sarabi R. E., Sadoughi F., Orak R. J., Bahaadinbeigy K. (2016). The effectiveness of mobile phone text messaging in improving medication adherence for patients with chronic diseases: A systematic review. Iran Red Crescent Medical Journal, 18, e25183.
Schroeder K., Fahey T., Ebrahim S. (2004). Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. The Cochrane Database of Systematic Reviews, 2, CD004804.
Tamblyn R., Eguale T., Huang A., Winslade N., Doran P. (2014). The incidence and determinants of primary nonadherence with prescribed medication in primary care. Annals of Internal Medicine, 160, 441–450.
US Department of Health and Human Services (US-HHS). (2015). Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html#safeharborguidance.
US Department of Health and Human Services (US-HHS), Centers for Disease Control and Prevention, National Center for Health Statistics (2017). Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. Retrieved from https://www.cdc.gov/nchs/data/hus/hus16.pdf.
van Driel M. L., Morledge M. D., Ulep R., Shaffer J. P., Davies P., Deichmann R. (2016). Interventions to improve adherence to lipid-lowering medication. The Cochrane Database of Systematic Reviews Resource, 12, 1–126.
Warren J. R., Falster M. O., Tran B., Jorm L. (2015). Association of continuity of primary care and statin adherence. PLoS One, 10, e0140008.
World Health Organization. (2003). Adherence to long term therapies: Evidence for action. Retrieved from http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf.
World Health Organization. (2018). Noncommunicable diseases. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
Wright W. L., Bachmann J. P., Murphy N., Gifford L., Strowman S., White P. (2019). Evaluating quality metrics of patients with type 2 diabetes managed by nurse practitioners in two family nurse practitioner-owned clinics. Journal of the American Association of Nurse Practitioners, 31, 413–419.
Yap A., Thirumoorthy T., Kwan Y. H. (2016). Systematic review of the barriers affecting medication adherence in older adults. Geriatrics & Gerontology International, 16, 1093–1101.