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Increasing Medication Adherence

Nursing 472: Senior Capstone
by

Ginny Jagodzinski

on 7 December 2014

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Transcript of Increasing Medication Adherence

Increasing
Medication
Adherence

Olivia Adamec
Ginny Jagodzinski
Amber Kohnhorst
Student Nurses
University of Wisconsin-Eau Claire
College of Nursing & Health Sciences
NRSG 472: Acute Care Capstone

?
?
?
2x
a day?
AM or
PM?
Take with
food?
Half or
whole?
?
?
Drowsy?
?
?

found that more than

of all Americans live
with at least
one chronic condition
50%

The New England Healthcare Institute (2009)
For BP?
For
Heart?
As we have a moral obligation to follow the
and consider patient


5 North Population

BED UNIT
- adult population

Stroke, Seizures, Multiple Sclerosis, Parkinson's,
Brain Surgery, Back Surgery, Orthopedic Spine,
Trauma
Neurology &
Neurosurgery
34
Poor Adherence
Linked to:

Higher Cost
Hospitalization
Mortality
compared the annual costs of diabetic
adherent patients vs. non-adherent
$8,886
New England Healthcare Institute (2009),
$16,498
New England Healthcare Institute (2009),
found that
non-adherent patients

with
heart disease and diabetes had a
mortality rate
compared to

12.1%
6.7%
Side
Effects
Cognitive
Impairments
Misunderstand
Dosage
Instructions
Medication
Not Covered

Costly
Medication

Complex
Regimen

Forget to Take
Medication
Failure to take
Correct Dose
Failure to Fill or Renew
Medication
Cultural or
Belief System
Multiple Doctors
Prescribing
Reduced Sense of
Urgency
Wrong
Time
Indications & Barriers
of patients with Coronary
Artery Disease discontinued initial
drug therapy
within

(New England Healthcare Institute, 2009).

25%
must ensure the patient
or family understands their list of medications,
and the importance of filling and taking the prescription as directed.




Communication about Meds


Told what medication was for

Staff described med side effects
73.3% 77.8% 62.5%
84.5%

40.0% 33.3% 55.6%
60.4%

Jun-14 Jul-14 Aug-14
75th percentile
5N Inpatient Experience Dimension of Care
Adherence is in patients
with chronic conditions
than
those with acute conditions

of U.S. Healthcare $pending goes
to treatment of chronic disease

(New England Health Care Institute, 2009)

75%
6 months
"20 to 50%
of patients do not take
prescription medication as directed"

(Kripalai et al., 2007)
of Poor Adherence
"any deviation from the
prescribed course of
medical treatment"
POOR
"90 million adult Americans lack
the

skills needed to function effectively
in today's healthcare environment"

Health Literacy
ADHERENCE:
(Kripalani et al., 2007)
each year
in associated hospitalizations

(New England Healthcare Institute, 2009)
$100 billion
Non-adherence results in
Affordable Care Act
establishes a
foundation for improved medical management
Increase adherence rates in
improved outcomes

Reimbursement motivation to
increase adherence

(New England Healthcare Institute, 2009)
Increase literacy and patient safety by
using variety of
65%
population

visual learners
the 5N RN
Before discharge,
NURSES,
CODE OF ETHICS,
SAFETY, WELFARE & HEALTH
LOWER
The New England Healthcare Institute (2009)
suggests WAYS to improve adherence:
Simplify drug regimen
Improve medication education
Discharge counseling
Addition of
to prescription information
increases
patient satification
as well as patient's
ability to recall the regimen, comprehend
dosing instructions, and adhere to the
therapy"
(Kripalani et al., 2007)
Graphic Images
Adherence Comprehension
Pictures


Text-Only

90%
72%
40%
93%
in conjunction with
written
and oral instructions
helps avoid
misinterpretation of instructions
PICTURES,
Learning Styles
References

Centers for Medicare & Medicaid Services. (2014, September). HCAHPS: Patients' perspective of care survey. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-

Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html

**Dowse, R., Ehlers, M. (2005). Medicine labels incorporating pictograms: Do they influence understanding and adherence?
Patient Education and Counseling; 58
(1), 63-70.

Einstein Healthcare Network. (2012, June 15). Einstein’s medication REACH program recognized by the hospital and healthsystem association of Pennsylvania. Retrieved from http://

www.einstein.edu/news/einstein-medication-reach-program-recognized-by-the-hap/

Katz, M. G., Kripalani, S., & Weiss, B. D. (2006). Use of pictorial aids in medication instructions: A review of the literature.
American Society of Health-System Pharmacists, 63,
2391-2397.

http://dx.doi.org/10.2146/ajhp060162

**Kripalani, S., Rashanda, R., Love-Ghaffari, M. H., Henderson, L. E., Praska, J., Strawder, A., Katz, M. G., Jacobson, T.A. (2007). Development of an illustrated medication schedule as a low-

literacy patient education tool.
Patient Education and Counseling, 66,
368-377.

Los Angeles Times. (2008, June). The price of hunger. Retrieved from http://articles.latimes.com/2008/jun/23/opinion/ed-food23

Mohan, A., Riley, B., Boyington, D., & Kripalani, S. (2012). PictureRx: Illustrated medication instructions for patients with limited health literacy.
Journal of American Pharmacists Association,

25
(5), 122-129. http://dx.doi.org/10.1331/JAPhA.2012.11132

Mohan, A. (2013, November 13). PictureRx awarded phase II SBIR contract to improve medication safety. Retrieved from https://mypicturerx.com/blog/picturerx-awarded-phase-ii-sbir-

contract-to-improve-medication-safety/

New England Healthcare Institute. (2009, August). Thinking outside the pillbox a system-wide approach to improving patient medication adherence for chronic disease.

Roebuck, C., Liberman, J. N., Gemmil-Toyama, M., & Brennan, T. A. (2011). Medication adherence leads to a lower health care use and costs despite increased drug spending.
Health Affairs, 30
(1),

91-99. http://dx.doi.org/10.1377/hlthaff.2009.1087



**Primary Study
Grady Memorial Hospital,
Atlanta

REACH Program
Primary study by Dowse & Ehlers (2005), prescribed antibiotics in mostly females (93%) and low-literacy population (n = 87), structured interviews & one time pill counts 5 days later)
Einstein Healthcare Network,
Philadelphia

PACE Program,
New Orleans

PictureRx
PictureRx
Saint Joseph's Hospital,
Marshfield

Reading
Level
Language
Barriers
Access to
Resources
Learning
Styles
med discharge 001.jpg

HCAHPS
Full transcript