Fluent Essays

I need help working on the attached project. I have to come up with additional 2 or 3 literature reviews to the project. Please ensure that the literature reviews are related to the topic of the project. You do not need to modify the project just submit the new additional literature reviews as a separate document. Improving Medication Adherence among Type II Home Healthcare Diabetic Patients 1 Improving Medication Adherence among Type II Home Healthcare Diabetic Patients by Bola Odusola-Stephen Investigator's Background The primary investigator is a registered nurse with 18 plus years experience in home healthcare. Also have experience in dealing with Type II diabetic patients and medication adherence issues. Investigator works as a registered nurse in the home healthcare setting. 3 Topic Background The topic on medication adherence among diabetic home healthcare patients using the MAP resources was chosen because there is a continue steady rise in chronic diseases that has resulted in more patient care options (Polonsky & Henry, 2016). Home-based healthcare has existed since 1909 (Choi et al., 2019). Present-day, home-based healthcare is often selected due to an individual’s personal preferences. While home-based healthcare is not appropriate for all patients, Szanton et al. (2016) noted that this care option is best when an individual’s condition can be managed without admission to a hospital. The topic on medication adherence among diabetic home healthcare patients using the MAP resources was chosen because there is a continues steady rise in chronic diseases has resulted in more patient care options (Polonsky & Henry, 2016). Home-based healthcare has existed since 1909 (Choi et al., 2019). Present-day, home-based healthcare is often selected due to an individual’s personal preferences. While home-based healthcare is not appropriate for all patients, Szanton et al. (2016) noted that this care option is best when an individual’s condition can be managed without admission to a hospital. 4 Topic background There is the need of addressing the lack of adherence to medication among type II diabetes patients. The project will address the lack of adherence through the implementation of the MAP resources and evaluate the effectiveness. There is the need of addressing the lack of adherence to medication among type II diabetes patients. The project will address the lack of adherence through the implementation of the MAP resources and evaluate the effectiveness. 5 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 impact patient medication adherence rates when compared to current practice among Type II diabetic home healthcare patients in urban Texas. According to the healthcare agency’s electronic health record (EHR), home healthcare providers documented that ten percent of diabetic home healthcare patients are not adhering to their medication regimen. Medication non-adherence can be ascribed to a lack of drug-related knowledge, high prescription prices, and a lack of understanding of the medication regimen. This is why reinforcing the need for this quality improvement project (Heath, 2019; Sharma et al., 2020). Healthcare providers play a key role in medication adherence and the adherence is improved through introduction for standardized method for healthcare providers to assess patient’s medication adherence. Medication adherence for among type II diabetic patients in an urban healthcare agency in Texas. According to the healthcare agency’s electronic health record (EHR), home healthcare providers documented that ten percent of diabetic home healthcare patients are not adhering to their medication regimen. Medication non-adherence can be ascribed to a lack of drug-related knowledge, high prescription prices, and a lack of understanding of the medication regimen that is why reinforcing the need for this quality improvement project (Heath, 2019; Sharma et al., 2020). Healthcare providers play a key role in medication adherence and the adherence is improved through introduction for standardized method for healthcare providers to assess patient’s medication adherence. 6 Importance of the project The project would increase type II diabetic patient adherence to medication that translates to a better treatment outcome and increase in recovery rate. The project also assists healthcare providers in effectively responding to medication questions and patient concerns, as well as ensuring that patients maintain track of their prescription regimen, resulting in fewer adverse occurrences. The project would improve the quality of patient care received and decrease hospitalization and incurring financial costs. The project would increase the type II diabetic patient adherence to medication that translates to a better treatment outcome and increase in recovery rate. The project also assists healthcare providers in effectively responding to medication questions and patient concerns, as well as ensuring that patients maintain track of their prescription regimen, resulting in fewer adverse occurrences. The project would improve the quality of patient care received and decrease hospitalization and incurring financial costs. 7 Theoretical Foundation This quality improvement project will be guided by Orem's self-care deficit theory. The theory was chosen because it assumes that a person must be self-sufficient and accountable for their own care (Orem, 1985). Self-care, according to Dorothea Orem's thesis, is an action that a person does to preserve, restore, or improve their health (Orem, 1985). Patients should not be viewed as passive recipients of healthcare, according to the theory; rather, they should be viewed as trustworthy, responsible adults who can make educated decisions and participate actively in their health treatment (Orem, 1985). This quality improvement project will be guided by Orem's self-care deficit theory. The theory was chosen because it assumes that a person must be self-sufficient and accountable for their own care (Orem, 1985). Self-care, according to Dorothea Orem's thesis, is an action that a person does to preserve, restore, or improve their health (Orem, 1985). Patients should not be viewed as passive recipients of healthcare, according to the theory; rather, they should be viewed as trustworthy, responsible adults who can make educated decisions and participate actively in their health treatment (Orem, 1985). 8 Change model Roger’s diffusion of innovation theory Knowledge or awareness Persuasion or interest Decision or evaluation Implementation or trial Confirmation or adoption (Rogers, 2003) Diffusion is defined as a social process, which occurs among individuals in response to knowledge regarding a new strategy for improving their health (Dearing & Cox, 2018). It is also the process communicated within a specific timeframe (four weeks) (Dearing & Cox, 2018). This change model can provide the primary investigator with methods to share and educate regarding a new diabetic prevention strategy (Lien & Jiang, 2016). 9 Review of the literature Patient-related factors The World Health Organization (2017) stated patient related factors encompass an individual’s resources, knowledge levels, belief system, perspectives, and expectations. Type II diabetes management involves not just medication adherence but observance to monitoring diet and exercise, follow-up, and self-care (Nduaguba et al., 2017). Medication adherences Providers can avoid medication non-adherence by learning about their patients' needs and providing them with resources to help them overcome non-adherence. Non-pharmacological Indicators All Type II diabetics should consider non-pharmacological treatment options. Nutrition and exercise may be included in the measures. Nutritional therapies are essential for a diabetic to maintain an ideal glucose level (80-120mg). Intervention In order to improve adherence in various ways and achieve self-efficacy among varied patients, it is critical to use techniques and instruments that are considered effective and acceptable. Positive family and social support are important factors in sticking to a diabetic care plan (Rodrguez-Saldana, 2019). Medication adherences Providers can avoid medication non-adherence by learning about their patients' needs and providing them with resources to help them overcome non-adherence. Non-pharmacological Indicators All Type II diabetics should consider non-pharmacological treatment options. Nutrition and exercise may be included in the measures. Nutritional therapies are essential for a diabetic to maintain an ideal glucose level (80-120mg). Intervention In order to improve adherence in various ways and achieve self-efficacy among varied patients, it is critical to use techniques and instruments that are considered effective and acceptable. Positive family and social support are important factors in sticking to a diabetic care plan (Rodrguez-Saldana, 2019). 10 Review of the literature Medical Adherence Project MAP serves patient populations impacted by several chronic diseases (Starr & Sacks, 2010). The resources provide practical tools to help practitioners communicate with patients related to medication adherence. Patient Advocacy Advocacy is a vital aspect in healthcare since it addresses the needs of the patient who need the utmost help and care, thereby allowing them to go back to their previous health state (D’Onofrio et al., 2018).  Advocacy is an aspect that can be referred to as active support, as well as engagement, that aims to effectively develop a cause as well as a policy (Mollaoglu, 2018).  Socioeconomic Factors Socioeconomic-related factors that affect medication adherence include one’s location of residence, medical costs of treatment, and finances (Yeam et al., 2018). Other factors that could influence medication adherence are low health literacy, education level, lack of social support, living conditions, and medication costs (Hennessey & Peters, 2019). Medication Cost Cost-related medication nonadherence (CRMN) is defined as taking medication then indicated or prescribed due to costs (Kang et al., 2018). Social Support However, Linni et al. (2015) emphasized that social support must be considered a core component in interventions that improve the management of Type II diabetic patients. MAP serves patient populations impacted by several chronic diseases (Starr & Sacks, 2010). The resources provide practical tools to help practitioners communicate with patients related to medication adherence. Advocacy is a vital aspect in healthcare since it addresses the needs of the patient who need the utmost help and care, thereby allowing them to go back to their previous health state (D’Onofrio et al., 2018).  Advocacy is an aspect that can be referred to as active support, as well as engagement, that aims to effectively develop a cause as well as a policy (Mollaoglu, 2018). Socioeconomic-related factors that affect medication adherence include one’s location of residence, medical costs of treatment, and finances (Yeam et al., 2018). 11 clinical Question 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 of a home healthcare agency in urban Texas over four weeks? Methodology A quantitative methodology Numerical data being used (Creswell & Creswell, 2018) Data presented using figures, graphs, charts, and tables Will compare the medication adherence rates (pre-implementation/post-implementation) A quantitative methodology will be used for this quality improvement project. According to Creswell and Creswell (2018), a quantitative methodology is appropriate for projects that use data in its numerical form. For this project, the data will be presented using figures, graphs, charts, and tables. This will allow the readers to compare the medication adherence rates pre-implementation and post-implementation of the project. 13 Specifics on Methodology 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. Participants The targeted population are home health patients ages 35 to 64 years old. The selected site serves approximately 100 patients annually. The inclusion criteria are males and females diagnosed with Type II diabetes, oral medication or insulin, and home health patients. The exclusion criteria are individuals with language or cognitive deficits and diagnosed with Type I diabetes. Five registered nurses will help to implement the project. They are individuals who work full-time and have been employed over a year. 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. Participants The targeted population are home health patients ages 35 to 64 years old. The selected site serves approximately 100 patients annually. The inclusion criteria are males and females diagnosed with Type II diabetes, oral medication or insulin, and home health patients. The exclusion criteria are individuals with language or cognitive deficits and diagnosed with Type I diabetes. Five registered nurses will help to implement the project. They are individuals who work full-time and have been employed over a year. 14 Reliability and Validity Reliability refers to the consistency of instrument measuring something (Creswell & Creswell, 2018). If the same results occur regularly by using the same procedures under the same conditions, the measurement is reliable (Creswell & Creswell, 2018). For this project, the MAP toolkit reliability was confirmed by inter-rater reliability (Starr & Sacks, 2010). The observers noted the same results associated with using the instrument, which aligned with the literature findings regarding collecting data for medication adherence rates. Validity conveys how accurate a method is measured (Creswell & Creswell, 2018). If the method measures what it should and the findings correspond closely, it is considered valid. There are four types of validity are constructs, content, face, and criterion (Creswell & Creswell, 2018). For this project, construct and face validity is applicable to the instrument. Reliability refers to the consistency of instrument measuring something (Creswell & Creswell, 2018). If the same results occur regularly by using the same procedures under the same conditions, the measurement is reliable (Creswell & Creswell, 2018). Validity conveys how accurately a method is measured (Creswell & Creswell, 2017). If the method measures what it should and the findings correspond closely, it is considered valid. There are four types of validity are constructs, content, face, and criterion (Creswell & Creswell, 2018). For this project, construct and face validity is applicable to the instrument. 15 Data Collection Methods Once the Grand Canyon University IRB gave approval During week one, the nurses will provide the patients with informed consent, answer questions related to the project, a five-item demographic survey, and a pre-MAP survey. The second to fourth week, the nurses will examine the patient’s medication list and adherence (ten minutes). Each week the nurses will record the medication adherence information in the patient’s electronic medical record. During week one, the nurses will provide the patients with informed consent, answer questions related to the project, a five-item demographic survey, and a pre-MAP survey. The second to fourth week, the nurses will examine the patient’s medication list and adherence (ten minutes). Each week the nurses will record the medication adherence information in the patient’s electronic medical record. 16 Data Analysis Data extracted from Cradle Solutions documentation software Medication adherence rates for comparative and implementation groups Chi-square analysis used 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. 17 Descriptive data Table 1 Descriptive Data for Type II Participants   Variable Comparative (n = 15) Implementation (n = 15) M SD M SD Age 49.94 11.67 52.80 9.47 Years with Type II Diabetes 3.47 1.19 2.93 1.03 The mean age for the comparative group was 49.94 years (SD = 11.67) and the mean age from 35 to 64 and the implementation group was 52.80 years (SD = 9.47) with a range from 35 to 65. The comparative patients had a mean of 3.47 years since diagnosis (SD = 1.19) with a range from 1 to 5 and the implementation group had a mean of 2.93 years since diagnosis (SD = 1.03) with a range from 1 to 5. The descriptive data for gender, education level, and race are displayed in Table 1. It shows 10 males (66.7%) and five females (33.3%) in the comparative group and eight males (53.3%) and seven females (46.7%) in the implementation group. For education level in the comparative group, 2 (13.3%) graduate high school, 9 (60.05) had some college, 2 (13.3$) had an associate degree, 1 (6.7%) had a Bachelor’s degree, and 1 (6.7%) had a doctorate degree. For educational level in the implementation group, 2 (13.3%) graduated high school, nine (60.0%) had some college, 1 (6.7%) had associate degree, and 3 (20.0%) had a doctorate degree. There were three Asian (20.0%), five (33.3%) Black, and seven (56.7%) White participants in the comparative group and there were two (13.3%) Asian, six (40.0%) Black, and seven (46.7%) White participants in the implementation group.   18 Medication adherence rates   Variable Comparative (n = 15) Implementation (n = 15) X2 p-value n % n % Medication Adherence 10 66.7 11 73.3 .159 .999 There was an increase in medication adherence from the comparative (n = 10, 66.7%) to the implementation group (n = 11, 73.3%), X2 (1, N = 30) = .159, p =. 999. There was an increase in medication adherence from the comparative (n = 10, 66.7%) to the implementation group (n = 11, 73.3%), X2 (1, N = 30) = .159, p =. 999. The p-value was greater than .05, which indicates that the increase in medication adherence was not significant. 19 limitations Sample Size Self-reporting from participants Covid-19 Project site Limitations The limitations of the project are self-reporting of medication adherence by the patients. The other limitation is that the healthcare organization delivery model being impacted by the COVID-19 pandemic, and this influences researcher to consider using online platforms. 20 Summary & Conclusion Diabetes impacts approximately one in ten Americans (Centers for Disease Control and Prevention, 2020). The prevalence of the disease continues to rise and is expected to grow by 0.3% annually until 2030 (Lin et al., 2018). This is particularly troublesome for Type II home healthcare patients diagnosed with the disease. Polonsky and Henry (2016) emphasized that roughly 45% of this population fail in sustaining a normal glucose level. Poor medication adherence is associated with increased morbidity and mortality rates, hospital readmissions, and diminished quality of life (Polonsky & Henry, 2016). Diabetes impacts approximately one in ten Americans (Centers for Disease Control and Prevention, 2020). The prevalence of the disease continues to rise and is expected to grow by 0.3% annually until 2030 (Lin et al., 2018). This particularly troublesome for Type II home healthcare patients diagnosed with the disease. Polonsky and Henry (2016) emphasized that roughly 45% of this population fail in sustaining a normal glucose level. Poor medication adherence is associated with increased morbidity and mortality rates, finances, hospital readmissions, and diminished quality of life (Polonsky & Henry, 2016). This quality improvement project was developed to address a standardized method for healthcare providers to assess their patients’ medication adherence. 21 Summary of the findings Two groups were compared comparative (n=XX) and implementation (n=XX). The number of medication adherence rates were evaluated four weeks pre-implementation and post-implementation of the project. The clinical question that was answered using the chi-square analysis showed a decrease in medication errors from the comparative group (n= XX%) to the implementation (n=XX%), X2 [1, N=XX] = X.XXX, p= X. XX. These results showed statistical significance increase in medication adherence rates after the MAP resource intervention compared to the comparative group. Two groups were compared comparative (n=XX) and implementation (n=XX). The number of medication adherence rates were evaluated four weeks pre-implementation and post-implementation of the project. The clinical question that was answered using the chi-square analysis and there was an increase or decrease in medication errors from the comparative group (n= XX%) to the implementation (n=XX%), X2 [1, N=XX] = X.XXX, p= X. XX. These results (showed or not showed) statistical significance increase in medication adherence rates after the MAP resource intervention compared to the comparative group. 22 Conclusion A chi-square test was conducted for a comparison of the medication adherence rates for the patients 30 days prior and 30 days post-implementation. A level of significance was set to .05, which indicated a p-value of less than.05 would reveal statistical or non-statistical significance. A convenience sampling was used to recruit N=15 participants for the comparative group and N=15 for the implementation group. The nurses (5) were educated regarding the use of the MAP resources. The chi-square test was utilized to determine the variations among the two groups for statistical difference. A chi-square test was conducted for a comparison of the medication adherence rates for the patients 30 days prior and 30 days post-implementation. A level of significance was set to .05, which indicated a p-value of less than.05 would reveal statistical or non-statistical significance. A convenience sampling was used to recruit N=15 participants for the comparative group (10 males and 5 females) and N=15 for the implementation group (8 males and 7 females). The nurses (5) were educated regarding the use of the MAP resources. A retrospective chart audit (n=XX) was done to evaluate the medication adherence rates before the project implementation. The chi-square test was utilized to determine the variations among the two groups for statistical difference. 23 Recommendations for future projects The first recommendation is for those projects to utilize a standardized assessment strategy to evaluate their patient’s medication adherence behaviors and practices. The first recommendation is for those projects to utilize a standardized assessment strategy to evaluate their patient’s medication adherence behaviors and practices. Inaccurate medical records and inadequate medication assessment result in poor healthcare outcomes and minimum patient engagement in the decision-making. Educating the diabetic patients regarding the need for medication adherence would help them remain compliant. The best determinant for medication adherence is for patients to demonstrate via their behavior the change. 24 References Choi, D., Choi, H., & Shon, D. (2019). Future changes to smart home based on AAL healthcare service. Journal of Asian Architecture and Building Engineering, 18(3), 190-199. https://doi.org/10.1080/13467581.2019.1617718 Creswell, J., & Creswell, J. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed). Sage Publications. D’Onofrio, G., Sancarlo, D., & Greco, A. (2018). Gerontology. InTech Open Limited. Hennessey, E., & Peters, G. (2019). Medication adherence in patients with type 2 diabetes. Power-Pak C.E. Continuing Education for Pharmacists & Pharmacy Technicians. https://journalce.powerpak.com/ce/medicationadherenceinpatientswithtype2diabetes Kang, H., Lobo, J., Kim, S., & Sohn, M. (2018). Cost-related medication non-adherence among U.S. adults with diabetes. Diabetes Research and Clinical Practice, 143, 24–33. https://doi.org/10.1016/j.diabres.2018.06.01 Lin, J., Thompson, T., Cheng, Y., Zhuo, X., Zhang, P., Gregg, E., &Rolka, D. (2018). Projection of the future diabetes burden in the United States through 2060. Population Health Metrics, 16(1). https://doi.org/10.1186/s12963-018-0166-4 Linni, G., Shaomin, W., &Donghua, T. (2015). Association of social support and medication adherence in Chinese patients with type 2 diabetes mellitus. International Journal of Environmental Research and Public Health, 14(12), 1522-1532. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750940/ References Mollaoglu, M. (2018). Caregiving and home care. InTech Open Limited. Nduaguba, S, Soremekun, R., Olugbake, O., &Barner, J. (2017). The relationship between patient-related factors and medication adherence among Nigerian patients taking highly active anti-retroviral therapy. African Health Sciences, 17(3), 738–745. https://doi.org/10.4314/ahs.v17i3.16 Orem, D. (1985). Nursing: Concepts of practice (5th ed). Mosby. Polonsky, W., & Henry, R. (2016). 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