UMASS Medical School, Graduate School of Nursing, Worcester, Massachusetts.
Wright & Associates Family Health Care, Amherst, New Hampshire and Concord, New Hampshire.
J Am Assoc Nurse Pract. 2020 May 6;33(7):553-562. doi: 10.1097/JXX.0000000000000414.
The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes.
A prior study at two nurse practitioner (NP)-owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker.
Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers.
Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes.
Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change.
This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.
世界卫生组织将药物依从性确定为改善与慢性病相关结果的最大机会。达到 80%或更高的依从率，或至少 80%的时间按规定服用药物，可以对健康结果产生积极影响。
新罕布什尔州两家由执业护士（NP）拥有的家庭诊所进行的先前研究表明，成年 2 型糖尿病（DM）患者的药物依从率为 77%，并在 4 年内呈下降趋势。尽管之前曾采取措施改善这一生物标志物，但患者的血红蛋白 A1c 水平仍停滞不前。
执业护士接受了有关提供者驱动策略的教育，以提高 DM、高血压和高血脂老年患者的药物依从性。在研讨会之前和之后的 52 周内对患者的医疗记录进行了审查，以捕捉药物依从率和临床生物标志物。
分析研讨会前后的数据，以确定研讨会是否导致依从性和临床结果的改善。
每个条件的课前药物依从率均超过 80%的循证标准。在患有高血压的 DM 患者中，课后观察到药物依从率显著提高。尽管这种变化没有统计学意义，但高血脂患者的依从性恶化了。临床生物标志物几乎没有变化。
这项质量改进项目发现，教育执业护士改善药物依从性的策略可以提高 DM 和高血压患者的依从性。鼓励继续教育和测量依从性和临床生物标志物，以捕捉更多的课后就诊。该项目增加了关于由执业护士管理的患者和执业护士拥有的实践的知识体系。
