TOPIC: – Improving Medication Adherence among Type II Home Healthcare Diabetic Patients

1. I need this research project done as if conducting training with 5 five nurses in Home Health Setting on Improving Medication Adherence among Type II Home Healthcare Diabetic Patients. 

2. I need responses from the nurses. 

3. Sample questions are included, using Medication Adherence Project (MAP) Tools/Resources. These are just SAMPLES. Please come up with real Questions and Responses.

4. The Medication Adherence Project (MAP) Tools/Resources can be downloaded from http://www.nyc.gov/heartworks.

Please see the attached 10 Strategic Points for guidance

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1. Problem Statement: 

It is not known if or to what degree the implementation of the New York City Department of Health and Mental Hygiene Medication Adherence Project (MAP) resources, which include (1) the questions to ask poster, (2) adherence assessment pad, and (3) my medications list, impact patient medication adherence rates when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64 of a home healthcare organization located in urban Texas.

2. Clinical/PICOT Questions: 

To what degree does the implementation of Medication Adherence Project resources, which include the Questions to Ask Pad, the Questions to Ask Poster, an Adherence Assessment Pad, and the My Medications List impact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas over a period of four weeks? The following clinical question will guide this quantitative project: 

Q1: Does using the MAP resources improve medication adherence among home health diabetic patients?

3. Sample (and Location): 

a. Location: The location of this project is in urban Texas. The project site provides a larger percentage of patients with healthcare services who reside in the urban area as compared to the rural area. 

b. At the selected project site, approximately 30 patients have been diagnosed with type II diabetes, though this census changes each month. Patients between the ages of 35 to 64, with no cognitive limitation, who speak English, will be invited to participate in this project. 

c. Inclusion Criteria

i. 35 to 64 years of age

ii. Type II diabetes diagnosis

iii. English speakers

iv. Cognitively abled

d. Exclusion Criteria

▪ Younger than 35 and older than 64 years of age

▪ Not diagnosed with type II diabetes 

▪ Non-English speakers

Cognitively disabled/delayed

4. Define Variables and Level of Measurement:

  1. Intervention: Use of the MAP resources, by nursing staff members, which will be implemented      upon the completion of an educational training session. Starr and Sacks’s (2010) MAP Toolkit and Training Guide resources, include: (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List. 
  2. Outcome: Enhanced medication adherence. 
  3. Variables: Medication adherence, which is the dependent variable explored in this project, will be measured using data attained through the project site’s EHR. The MAP resources, which serve as the independent variables explored in this project, include (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List.

5. Methodology and Design: 

A quantitative methodology, which employs a quasi-experimental design, will be used to examine medication adherence rates pre-project implementation and post-project implementation. Statistical analyses will be used to compare pre-and post-project data. Demographic data will be collected because the prevalence of non-adherence is often high among certain groups (e.g., impacted by socioeconomic status, gender, age, etc.). 

6. Purpose Statement: 

The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of the New York City Department of Health and Mental Hygiene Medication Adherence Project (MAP) resources, which include (1) the questions to ask poster, (2) adherence assessment pad, and (3) my medications list, impact patient medication adherence rates when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64 of a home healthcare organization located in urban Texas.

Demographic Survey of the Patients

What is your age?

· 25-34 years old

· 35-44 years old

· 45-54 years old

· 55-64 years old

· Over 65 years old

How would you describe yourself?

· American Indian or Alaska Native

· Asian

· Black or African American

· Native Hawaiian or Other Pacific Islander

· White

What is your gender?

· Male

· Female

What is your highest level of education?

· High school or GED

· Some college

· Associate degree

· Bachelor’s degree

· Master’s degree

· Doctorate or PhD

· Professional degree (MD, JD. Etc.)

Years diagnosed with Type II diabetes. (Oral medication or insulin)

· Less than one year

· One to three years

· Four to six years

· Seven years and above

                                                                           SAMPLE QUESTIONS

-To the Nurses Participating in the Research

What are the common patient barriers faced by nurses in Medication Adherence?

Provider Barriers

i. ———————–

ii. ———————–

iii. ———————–

iv. ———————-

v. ———————-

Pharmacist Barriers

i. ———————–

ii. ———————–

iii. ———————–

iv. ———————-

v. ———————-

Patient Barriers

vi. ———————–

vii. ———————–

viii. ———————–

ix. ———————-

x. ———————-

Patients Perspectives

i. ———————–

ii. ———————–

iii. ———————–

iv. ———————-

v. ———————-

What are your suggested solutions to Improve Medication Adherence?

i. ———————–

ii. ———————–

iii. ———————–

iv. ———————-

v. ———————-

                                                   Describe Experience & Patient Response

Questions

· How many patients did you use this tool with?

· How did you integrate the tool into the visit?

· Describe the experience

· Characterize the patient response in general * provide specific example

Adherence Assessment

· How many patients did you use this tool with?

· How did you integrate the tool into the visit?

· Describe the experience

· Characterize the patient response in general * provide specific example

Medication List

· How many patients did you use this tool with?

· How did you integrate the tool into the visit?

· Describe the experience

· Characterize the patient response in general * provide specific example

Pocket Guide

· How many patients did you use this tool with?

· How did you integrate the tool into the visit?

· Describe the experience

· Characterize the patient response in general * provide specific example

Which tool was the easiest to use? Why?

Which tools were more challenging to work into the visit? Why? What are some ways that you could get around these obstacles?

Think about patients’ overall responses to the tools. How would you characterize the response?

Describe the difference in your experience this week, as compared to last week.

Which staff members did you involve in testing out the tools? Characterize the experience overall.

Which staff members would you like to involve in testing the tools? How do you envision their roles?

What are your next steps to making the tools a regular part of practice? 

How will MAP lighten your workload?

How will extra work increase the job satisfaction of other team members?

How will the MAP tools help to improve patient outcome?

How do you not “step on any toes”?

How will MAP improve the quality of care?

How can MAP be integrated into other Quality Improvement Initiatives that are already underway?

Do you have any concrete example of how the tools have improved patient care?

Why should we dedicate training time to make MAP practice-wide?

How much will MAP cost?

Reference

http://www.nyc.gov/heartworks.

The 10 Strategic Points
Broad Topic AreaBroad Topic Area/Title of Project: Improving Medication Adherence among Type II Home Healthcare Diabetic Patients
Literature ReviewLiterature Review: Background of the Problem/Gap: Medication adherence is defined as how well patients in home-based care adhere to their medication regimen in the absence of health practitioners. Medication adherence incorporates total adherence and compliance with the medical instructions that patients are given. Proper medication adherence can significantly improve patient-related healthcare outcomes. In the United States, alone, the number of patients who have been diagnosed with type II diabetes cannot be accommodated by hospital settings (Brown & Bussell, 2018). Therefore, to prevent overflowing hospitals, home healthcare programs have been created.Theoretical Foundations (models and theories to be the foundation for the project): Attachment theory: In accordance with Hunter and Maunder (2016), there are two key reasons why the attachment theory is considered effective for the following DPI. First, the theory acts as a solid foundation for the enhanced comprehension regarding the identified development of ineffective coping techniques, as well as the underlying dynamics associated with the emotional difficulties of the person. Clinicians can help people who have attachment anxiety and fail to comprehend past experiences. Through the involvement of caregivers and/or significant others, individuals can help to reshape their coping patterns.Social cognitive theory: The social cognitive theory (SCT) is a critical theory that will be utilized during this DPI project. The SCT is utilized to explain the manner in which human behavior is associated with dynamic, reciprocal, and progressive types of interactions that exist between the person and his/her given surrounding (Bosworth, 2015). Therefore, the SCT is famous because it often proposes that identified behavior aspects are an outcome of the cognitive processes that individuals usually develop. Cognitive processes are developed through social knowledge acquisition.Review of Literature with Key Organizing Themes and sub-themes (Identify at least two themes, with three sub-themes per theme) Theme 1: Medication Adherence – To handle the issue of medication adherence among the diabetic patients who have had an issue with the adherence to medication needs, various strategic should be utilized. The primary focus of this review of literature is to ensure that drug adherence, though understanding why lacking adherence occurs, is improved upon. Drug Adherence: This is the art of sticking to the drug prescription as being presented by the doctors. There are many reasons why home care patients might fail to take drugs as prescribed. For instance, when there is no person to remind them of what is supposed to be taken and at what time (Brown & Bussell, 2018). Some patients go ahead of suffering conditions that make it difficult for them to progress in life.Theme 2: Enhancing Adherence through UnderstandingPatient-Centered Communication Approach: This approach will incorporate the interests and preferences of the patients. It will also serve to determine the possible barriers that patients might be facing related to their medication adherence (Voortman et al., 2017). To address components associated with the patient-centered approach, the following MAP resources will be used: Questions to Ask Poster and an Adherence Assessment Pad.Chronic Care Models: It is important to understand that patients need care when they are dealing with a chronic illness. Therefore, to ensure that proper care resources are provided, the My Medications List will be used.SummaryPrior studies: Prior studies have revealed that medical adherence among home healthcare-based patients is lacking and has been a smooth process. In fact, up to 14% of diabetic patients (nationally) do not adhere to their prescribed medication regimen; however, other sources note that this lacking adherence is much higher than 14%, thereby contributing an issue that must be addressed.Quantitative application: The WHO reports numerical data about medication adherence among home healthcare patients. Furthermore, researchers have cited that medication adherence is often impacted by lacking literacy, poor understanding/knowledge about the importance of one’s medication, etc., thereby resulting in inflated adherence rates.Significance: Using the MAP resources and providing patient-specific care, medical adherence among type II diabetes patients will likely improve, thereby resulting in enhanced health-related outcomes.
Problem StatementProblem Statement: It is not known if or to what degree the implementation of the New York City Department of Health and Mental Hygiene Medication Adherence Project (MAP) resources, which include (1) the questions to ask poster, (2) adherence assessment pad, and (3) my medications list, impact patient medication adherence rates when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64 of a home healthcare organization located in urban Texas.  
Clinical/
PICOT Questions
Clinical/PICOT Questions: To what degree does the implementation of Medication Adherence Project resources, which include the Questions to Ask Pad, the Questions to Ask Poster, an Adherence Assessment Pad, and the My Medications List impact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas over a period of four weeks? The following clinical question will guide this quantitative project: Q1: Does using the MAP resources improve medication adherence among home health diabetic patients?  
SampleSample (and Location): Location: The location of this project is in urban Texas. The project site provides a larger percentage of patients with healthcare services who reside in the urban area as compared to the rural area. At the selected project site, approximately 30 patients have been diagnosed with type II diabetes, though this census changes each month. Patients between the ages of 35 to 64, with no cognitive limitation, who speak English, will be invited to participate in this project. Inclusion Criteria35 to 64 years of ageType II diabetes diagnosisEnglish speakersCognitively abledExclusion CriteriaYounger than 35 and older than 64 years of ageNot diagnosed with type II diabetes Non-English speakersCognitively disabled/delayed  
Define VariablesDefine Variables and Level of Measurement:Intervention: Use of the MAP resources, by nursing staff members, which will be implemented upon the completion of an educational training session. Starr and Sacks’s (2010) MAP Toolkit and Training Guide resources, include: (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List. Outcome: Enhanced medication adherence. Variables: Medication adherence, which is the dependent variable explored in this project, will be measured using data attained through the project site’s EHR. The MAP resources, which serve as the independent variables explored in this project, include (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List.  
Methodology and DesignMethodology and Design: A quantitative methodology, which employs a quasi-experimental design, will be used to examine medication adherence rates pre-project implementation and post-project implementation. Statistical analyses will be used to compare pre-and post-project data. Demographic data will be collected because the prevalence of non-adherence is often high among certain groups (e.g., impacted by socioeconomic status, gender, age, etc.).  
Purpose StatementPurpose Statement: The purpose of this quantitative quasi-experimental project is to determine if or  to what degree the implementation of the New York City Department of Health and Mental Hygiene Medication Adherence Project (MAP) resources, which include (1) the questions to ask poster, (2) adherence assessment pad, and (3) my medications list, impact patient medication adherence rates when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64 of a home healthcare organization located in urban Texas.  
Data Collection ApproachData Collection Approach: The source of data for this project is the electronic medical record. Each week, nursing staff members will record medication adherence information in the patient’s EMR. If the patient expresses that he/she has not adhered to the medication regiment, during the previous week, lacking adherence information will be recorded in the system. Upon the completion of the four-week project, all information, input by nursing staff members into the EMR, will be assessed. The PI will compare pre-project implementation medication adherence rates to post-project implementation medication adherence rates. In addition to exploring medication adherence rates after the implementation of this project, pre-project implementation adherence rates will be explored over four weeks from April 1, 2021 to April 30, 2021. Once pre-project implementation data and post-project implementation data are obtained, the results will be statistically analyzed. The PI will work with a statistician, who will assist in the data analysis process. Data will be compared analyze using various statistical techniques.  
Data Analysis ApproachData Analysis Approach: The facility uses Cradle Solutions, software for home health companies. It serves the specialized needs of home health care providers that give a web-based point-of-contact information entry and management. The data will be collected using the project site’s EHR and will be presented to the PI by the secretary in a Microsoft Excel document. Data will be input into SPSS version 28 and analyzed using a t-test with a p-value of 0.05.  
References  Bosworth, H. B. (2015). Enhancing medication adherence: The public health dilemma. Philadelphia, PA: Springer Healthcare. Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO Cares? Mayo Clinic Proceedings86(4), 304-314. Retrieved from https://doi.org/10.4065/mcp.2010.0575 Hunter, J., & Maunder, R. (2016). Improving patient treatment with attachment theory: A guide for primary care practitioners and specialists. Switzerland: Springer International Publishing. Starr, B., & Sacks, R. (2010). Improving outcomes for patients with chronic diseases: The Medication Adherence Project (MAP). NYC Health. Retrieved from https://www.hfproviders.org/documents/root/pdf_9a3a46fa03.pdf Voortman, T., Kiefte-de Jong, J., Ikram, M. A., Stricker, B. H., van Rooij, F. J. A., Lahousse, L., … Schoufour, J. D. (2017). Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study. European Journal of Epidemiology32(11), 993-1005. https://doi.org/10.1007/s10654-017-0295-2