Aim: The aim of the pilot study was to train primary care clinic staff to identify and address medication nonadherence among minority patients in a low-income urban community, thereby improving patient adherence through enhanced provider-patient communication.
Rationale: Non-adherence to medications is a common persistent medical problem which has significant association with hospitalization and long-term mortality risk in older adults. Between 50-80% of patients are nonadherent causing 125,000 deaths annually, 10% of hospitalizations, and costing $300 billion annually.
Supporting literature: A systematic review of nurse-led interventions found eight studies significantly improved medication adherence. Another study demonstrated a single educational workshop can result in nurse-led practice change. Research indicates African Americans have higher risk of non-adherence, as do low-income, urban communities; thus, a nurse-led intervention in a low-income urban community may have a significant impact.
Methods: The study used a quasi-experimental mixed methods pre-/post-design. The researchers implemented a one-time training intervention to enable clinic staff to address patient medication adherence during routine patient visits.
Training learning objectives • Recognize the scope and urgency of medication non-adherence. • Apply tools to assess patients for medication non-adherence. • Initiate evidence-based interventions that align with identified barriers. • Implement new conversation techniques to increase patient honesty in reporting medication non-adherence.
Intervention: The project was implemented at a federally qualified health center serving an urban, minority low-income community and approved by the healthcare system’s quality improvement committee. Eight clinicians attended a single session workshop. Pre-intervention, immediate post-intervention, and 4-weeks post-workshop surveys assessed knowledge and commitment to implementing adherence discussions. Challenges included a nursing strike, change in administration, and COVID-19. The New World Kirkpatrick model guided implementation and program evaluation.
Outcomes: The objectives were met with an average increase in clinic staff knowledge of 29% and 77% increase in the number of adherence patient discussions.
Applicability to APRN practice: As leaders in the clinic, APRNs can initiate efforts to train staff to work together as a team toward this collective goal. Findings suggest training with one educational workshop which includes tools to assess for adherence and chosen patient-specific interventions results in nurse-led practice change.
Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.