Capstone Project Change Proposal Plan

Atinuke Domingo

Grand Canyon University

NRS-493- Professional Capstone & Practicum

Dr. Stacey Hannah

May 20, 2023.

Medication Non-adherence among Older Adults in Home Health Agency Settings

Non-adherence to medication orders is a significant concern among older adults in the home healthcare setting. Treatment non-adherence includes not beginning, starting inadequately, or ending too soon. (Walsh et al., 2019). Patient non-adherence can lead to adverse outcomes such as medication errors, hospitalization, and mortality (Walsh et al., 2019). Increasing medication adherence in older persons receiving home treatment is essential to enhance health outcomes and save healthcare expenditures. The intervention's goal is to successfully address the problem of medication non-adherence via individualized education programs, family engagement, medication reminder tools, coordination with healthcare practitioners, and affordable medications. Moreover, promoting autonomy and social justice may improve medication adherence and the quality of life for senior citizens from various demographics.

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Brief Overview

Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes

Common Causes of Patients Nonadherence.

Fear of potential side effects

Cost of the medicine prescribed to the patient

Misunderstanding

Too many medications

Lack of symptoms

Depression

(Marcum, Hanlon & Murray, 2017).

Social factor to medication Non-adherence.

The cultural assessment was conducted among older adults in the home healthcare setting to understand the factors contributing to non-adherence to medication orders. According to Yap et al. (2016), most older adults have limited health literacy and do not understand medication adherence's importance. Also, older adults face several barriers to medication adherence, such as cost, the complexity of medication regimens, and physical and cognitive limitations that limit their medication adherence (Yap et al., 2016). To enhance drug adherence among older persons in the context of home healthcare, it is crucial to consider cultural variables.

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Cultural assessment

Include poverty

Illiteracy or low level of education

Lack of effective social support networks,

unstable living conditions,

high cost of medication costs

Cost of access to delivery or transportation

The Intervention

Medication nonadherence is a problem among older patients

There needs to be a change to improve the situation

Older patients need to take medication as prescribed

The intervention needs multi-facet approach

Family members need to come in

Without adhering to medication, it is not possible to recover from illnesses and diseases. It is important for patients to strictly take medication as prescribed. If this does not happen, there should be intervention to improve the situation.

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The Intervention

The recommended intervention is family engagement

The older patient’s family should help them to adhere to medication

This will improve adherence

Older patients should be assisted by their family members to adhere to medication (Centers for Medicare & Medicaid Services, 2016). In some cases, they just forget to take their medicine or cannot follow the prescription. With the help of their family member, older patients will stick to the prescription and the medicine will be more effective.

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Evidence-Based Literature

Centers for Medicare & Medicaid Services. (2016). Medicare home health comparison. Retrieved from https://www.medicare.gov/homehealthcompare/

Christopher, M. L., Dowling, J. A., & Clegg, A. (2022). A systematic review and meta-analysis of medication adherence interventions among older adults. International Journal of Geriatric Psychiatry, 37(1), 3-13.

Marcum, Z. A., Hanlon, J. T., & Murray, M. D. (2017). Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs & aging, 34(3), 191–201. https://doi.org/10.1007/s40266-016-0433-7

The literature above confirms that when older patients are assisted, they will adhere to medication. The literature includes previous research relevant to the current topic. It highlights the problem as well as several intervention measures that can be implemented to solve the problem.

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Objectives

The objective of the change is to improve adherence to medication

The change will also improve the health of older patients

Older adults should take their medicine as prescribed

The problem is the lack of adherence to medication by older patients. Therefore, the objective of the change is to solve the problem. This implies that older patients should be able to take medication strictly and this will improve their health situations.

The proposed intervention aims to improve medication adherence among older adults in the home healthcare setting. The following objectives will guide the intervention:

1.Improve patient understanding of the value of medication adherence by giving them specialized instruction on their medication schedule.

Rationale: Older persons may forget or misuse medication, leading to negative results. Education is necessary to help older individuals and their carers understand the importance of medication adherence, promote health literacy, and provide tailored training on the drug regimen (Gentizon et al., 2022). That enhances the administration of self-education.

2.Involve family members in medication administration by providing them with educational resources on medication safety and proper administration techniques.

Rationale: The assistance of the family in procuring and administering drugs arranging and monitoring prescriptions, accumulating data, and selecting a course of therapy can help older adults remember to take their medicines and reduce the risk of adverse events such as medication errors (Gentizon et al., 2022). Including older persons in medical decisions may enhance their comprehension and adherence.

3.Implement medication reminder tools, such as pillboxes or medication reminder apps, to assist with medication adherence.

Rationale: A medication monitoring system can help identify non-adherence and allow timely interventions to improve medication adherence. Technology can aid in medication adherence by assisting older adults in remembering to take their medications.

4.Collaborate with healthcare providers to simplify medication regimens and reduce the cost and number of medications prescribed to older adults.

Rationale: Simplifying medication regimens can reduce the complexity of medication administration and improve medication adherence among older adults (Gentizon et al., 2022). That can help older adults afford and manage their medications more effectively.

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Resources Needed

For any change to be implemented, resources are needed

In this case, the first resources are human resources

These are the family members of the older patient

They are an important resource because the success of the change depends on them

The family members of the older patients play an important role in ensuring that the older patient adheres to medication. In most cases, they will be practically giving the medicine to the patient (Christopher, Dowling, & Clegg, 2022). If necessary, they need to be trained so that they have proper knowledge to help.

The goals of the proposed initiative support individual freedom and social justice for a range of varied communities by empowering older adults to make informed decisions about their medication regimens. The medication education program and involving older adults in the medication decision-making process aim to improve health literacy and understanding of the importance of medication adherence, enabling older adults to make informed decisions about their medication regimens. Additionally, providing access to affordable medication aims to address the cost-related barriers to medication adherence, which can disproportionately affect low-income individuals and communities of color. The proposed intervention aims to promote autonomy and social justice by providing older adults with the resources and support they need to adhere to their medication orders.

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The Intervention

Help patient form habit with organizing medications (i.e. pillbox)

Encourage patient to store all medications together and safely

Set timing of taking the medication to an existing habit

With breakfast

With Lunch

With Oral care or brushing teeth (AM and PM)

Before bedtime

Resources Needed

Timers and reminders are also needed

They will sound an alarm to indicate it is time to take medication

They need to be properly set so that they are accurate

Smartphones and smartwatches can be used as reminders. They should be set with details about the specific medication that should be taken as well as the quantities. This will ensure there is a strict and accurate adherence to medication. Technology is an important resource in solving this problem.

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Anticipated Measurable Outcomes

One of the effects of lack of adherence to medication is the failure to complete the dose. Patients who do not complete the dosage assigned to them are likely to make their situations worse (Christopher, Dowling, & Clegg, 2022). Doses should be completed within the prescribed time. The intervention will make this happen.

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The first outcome is completion of the dose

Completing the dose of medication is crucial in healthcare

The intervention will ensure adherence to medication

Patient will complete their dose with the expected time

This will improve their recovery

Anticipated Measurable Outcomes

It is also anticipated that older patients will recover from their ailments

Sticking to prescription improves the efficiency of the drugs

This improves the health of the patients

When medications are taken according to instructions, patients are likely to recover (Centers for Medicare & Medicaid Services, 2016). This makes the medicines more efficient and effective. There will be a general increase in the health conditions of older patients and they will live a disease-free life.

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Evaluation of the Intervention

Caregivers will be interviewed about their role in adhering to medication

They will be asked if they helped older patients in their homes

The family members are important resources and will help in evaluation

Family members are critical in this intervention. Their role in assisting older patients is important because it determines the effectiveness of the intervention. They will interviewed to provide information of their involvement. This will help in gauging the effectiveness of the intervention.

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Evaluation of the Intervention

Interventions are meant to solve problems and improve conditions. In this case, the intervention will be evaluated by checking the difference in the health conditions of the older patients. If they will be healthier than before, then the intervention would be successful.

For older persons receiving home healthcare, increasing drug adherence is essential to improving health outcomes and lowering costs. The suggested strategy tackles that problem with specialized education programs, family engagement, medication reminder devices, coordination with healthcare professionals, and cost-effective drugs. That intervention may increase medication adherence and improve the quality of life for older individuals by supporting autonomy and social justice.

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The response of the patients will be analyzed

Their conditions before and after the intervention will be compared

This will determine whether or not the intervention was effective

Changes need to create improved results

References

Centers for Medicare & Medicaid Services. (2016). Medicare home health comparison. Retrieved from

Christopher, M. L., Dowling, J. A., & Clegg, A. (2022). A systematic review and meta-analysis of medication adherence interventions among older adults. International Journal of Geriatric Psychiatry, 37(1), 3-13.

Gentizon, J., Bovet, E., Rapp, E., & Mabire, C. (2022). Medication Literacy in Hospitalized Older Adults: Concept Development. HLRP: Health Literacy Research and Practice, 6(2). https://doi.org/10.3928/24748307-20220309-02

Reference

Hargis, M. B., & Castel, A. D. (2018). Improving Medication Understanding and Adherence Using Principles of Memory and Metacognition. Policy Insights from the Behavioral and Brain Sciences, 5(2), 147–154. https://doi.org/10.1177/2372732218781643

Marcum, Z. A., Hanlon, J. T., & Murray, M. D. (2017). Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs & aging, 34(3), 191–201.

Walsh, C. A., Cahir, C., Tecklenborg, S., Byrne, C., Culbertson, M. A., & Bennett, K. E. (2019). The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis. British Journal of Clinical Pharmacology, 85(11), 2464–2478.

Yap, A. F., Thirumoorthy, T., & Kwan, Y. H. (2016). Medication adherence in the elderly. Journal of Clinical Gerontology and Geriatrics, 7(2), 64–67. https://doi.org/10.1016/j.jcgg.2015.05.001

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