Brief ReportPromoting a Shared Medication Adherence Practice: A Call to Action
Introduction
Medication adherence is defined as adhering to a prescribed medication regimen, including dose and dosing interval, at least 80% of the time.1 The World Health Organization2 reports 50% of patients are nonadherent with their prescribed medications. Despite efforts to improve medication adherence, recent United States research found the rate of nonadherence is up to 80% for certain classes of long-term medications.1
Medication nonadherence causes approximately 125,000 deaths, 10% of hospitalizations, significantly increased rates of morbidity, and costs the US health care system an estimated $300 billion annually.3 Rates of nonadherence are reportedly higher among minority, low income, urban communities.4,5 Improving medication adherence increases patient safety and improves management of chronic medical conditions.2
Health care providers, including advanced practice registered nurses/nurse practitioners (APRNs/NPs) and primary care clinic staff, must be able to recognize, intervene, and overcome the barriers to effective medication adherence, especially for those individuals with complex care needs. Primary care providers, working directly with their patients, are in a key position to reduce the poor outcomes associated with medication nonadherence, improve shared patient-provider trust, and ensure patient commitment to treatment care plans developed through shared decision making, open communication, and understanding of patient’s needs.
Optimal care is centered on the strength of the patient-provider relationship. Effective communication builds patient trust, which results in expanded shared responsibility through engaging patients by providing opportunities to express their concerns about treatment options, assuring them they have a voice in contributing to the management of their condition, and in turn, improve their health and quality of life.6
Section snippets
Background and Significance
Primary care APRNs/NPs and clinic staff are on the front line in interactions with patients, making them key players in addressing nonadherence. A literature review was conducted to determine nursing’s role in addressing medication nonadherence, identifying patient risk factors, and initiating evidence-based interventions. A systematic review of nurse-led interventions found 8 studies that significantly improved medication adherence.7
Investigations into successful interventions have
Purpose
Using this framework, we conducted a quality improvement pilot study to train primary care clinic staff to assess, identify, and address medication nonadherence in a low-income, predominantly minority, urban community practice environment with the goal to improve patient-provider trust and ensure patient commitment to treatment care plans, resulting in improvement in long-term medication adherence.
Design
The study used a quasi-experimental, mixed-methods pre-post design. We developed and implemented a single educational workshop intervention for primary care clinic staff to enable them to address patient medication adherence during routine primary care clinic visits. Before implementation of the workshop, support was solicited through a presentation of the program to the Quality Improvement Committee consisting of representatives from each of the health system’s clinic sites. The issue of
Results
Eight participants completed the single educational workshop: 6 completed a live version, and 2 opted for the recorded version. They included 2 CMAs, 4 LPNs, 1 RN, and 1 advanced practice nurse (Supplementary Figure 1, available online at http://www.npjournal.org). Their years in health care practice ranged from 2 to 40, and years in their current position ranged from 2 to 25 (Supplementary Figures 2 and 3, available online at http://www.npjournal.org).
The project aims were successfully met
Discussion
Given research findings that indicate rates of medication nonadherence approach 50% to 80% with long-term medications, it has been hypothesized that increasing medication adherence will improve America’s health more than the introduction of any other new treatment.20 Similar to Smith et al,8 our work demonstrated that training staff in an urban FQHC targeting at-risk populations using a single educational workshop with supportive follow-up made substantial impacts on clinic staff knowledge,
Conclusion
Medication nonadherence exists among the patient population, especially those with complex chronic conditions, and leads to an increase in adverse patient outcomes and substantial unnecessary medical costs. Our findings suggest a single-session nurse-led clinic staff education program incorporating medication adherence assessment tools aligned with patient-specific interventions results in practice behavior change through increased patient engagement and shared decision making resulting in
All authors are at the University of Illinois at Chicago. Elizabeth Ebeywa, DNP, MA, RN, is a DNP Graduate. Valerie Gruss, PhD, GNP-BC, FAAN, is a Clinical Associate Professor, Director of Interprofessional Education College of Nursing and Director, Enhancement of Geriatric Care for All-Illinois (ENGAGE-IL), Department of Biobehavioral Health Science, College of Nursing, and can be contacted at [email protected]. Michael Koronkowski, PharmD, BCGP, is a clinical assistant professor and director,
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All authors are at the University of Illinois at Chicago. Elizabeth Ebeywa, DNP, MA, RN, is a DNP Graduate. Valerie Gruss, PhD, GNP-BC, FAAN, is a Clinical Associate Professor, Director of Interprofessional Education College of Nursing and Director, Enhancement of Geriatric Care for All-Illinois (ENGAGE-IL), Department of Biobehavioral Health Science, College of Nursing, and can be contacted at [email protected]. Michael Koronkowski, PharmD, BCGP, is a clinical assistant professor and director, Interprofessional Education, College of Pharmacy.
Funding: Dr. Gruss' Enhancement of Geriatric Care for All-Illinois (ENGAGE-IL) programs are supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services Geriatric Workforce Enhancement Program grant #U1QHP8730-03.
Dr. Koronkowski has served as a consultant to OptumRx.
In compliance with standard ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.