DPI Project – Proposal Defense PowerPoint and Call Presentation

73

Improving Medication Adherence among Type II Home Healthcare Diabetic Patients
Submitted by
Bola Odusola-Stephen

Direct Practice Improvement Project Proposal
Doctor of Practice

Grand Canyon University
Phoenix, Arizona

May 12, 2021

GRAND CANYON UNIVERSITY

Improving Medication Adherence among Type II Home Healthcare Diabetic Patients

by
Bola Odusola-Stephen

Proposed

May 12, 2021

DPI PROJECT COMMITTEE:
Maria Thomas, DNP, Manuscript Chair
Bamidele Jokodola, DNP, Committee Member

Abstract

Home healthcare programs are often effective since these programs offer techniques for improving health outcomes among diabetes patients. At the project site, although staff consistently assesses for patient medication adherence (MA), there is no standardized process for identifying and addressing MA. Medication Adherence Project (MAP) resources have been utilized in chronic disease management to improve MA. The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of Medication Adherence Project (MAP) resources, which include (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List, will 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 theoretical frameworks that will guide this direct practice improvement (DPI) project include the social cognitive theory and the attachment theory. MA rates will be abstracted from the project site’s EHR, based on documentation provided by home health personnel, and will be compared to baseline MA rates.

Keywords: home-based care, MAP resources, quantitative approach, medication adherence, diabetes mellitus type II

Table of Contents

Chapter 1: Introduction to the Project 8
Background of the Project 9
Problem Statement 10
Purpose of the Project 14
Clinical Question 15
Advancing Scientific Knowledge 16
Significance of the Project 18
Rationale for Methodology 19
Nature of the Project Design 20
Definition of Terms 22
Assumptions, Limitations, Delimitations 23
Summary and Organization of the Remainder of the Project 25
Chapter 2: Review 27
Theoretical Foundations 28
Review of the 33
Strengthening the Relationships with Patients 35
Importance of Adhering to Medication Regimen 36
Tools/Support Strategies for Improving Self-Efficacy and Medication Adherence 39
Diabetes Care Concepts 40
Patient-Centeredness 40
Diabetes Across the Life Span 41
Advocacy for Individuals with Diabetes. 42
Summary 42
Chapter 3: Methodology 45
Statement of the Problem 46
Clinical Question 47
Project Methodology 49
Project Design 50
Population and Sample Selection 51
Sources of Data 53
Validity 55
Reliability 56
Data Collection Procedures 56
Data Analysis Procedures 58
Potential Bias and Mitigation 59
Ethical Considerations 60
Limitations 61
Summary 62
References 64
Appendix A 73
Appendix B 80

5

Chapter 1: Introduction to the Project

According to the Centers for Disease Control and Prevention (2020), diabetes impacts one in ten Americans. Furthermore, the prevalence of diabetes continues to rise and is projected to increase by 0.3% per year until 2030 (Lin et al., 2018). Two types of diabetes plague a large proportion of Americans: Type I diabetes and Type II diabetes. Type I diabetes is dependent on insulin, whereby the pancreas produces minimal amounts of insulin (Bellouet al., 2018). Type II diabetes is an impairment related to the body’s ability to regulate glucose (Bellou et al., 2018). There are ways to curtail the onset of Type II diabetes; however, once individuals are diagnosed with diabetes, there is no cure (Kvarnström et al., 2017).
Among individuals with Type II diabetes, proper and effective medication adherence is critical (Kvarnström et al., 2017). According to the World Health Organization (WHO, 2003), “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvements in specific medication treatment” (Brown & Bussell, 2011, para. 1). Furthermore, Kvarnström et al. (2017) stated that more than half of the population does not adhere to prescribed medication regimens, resulting in various health-related challenges. Health-related challenges associated with poor medication adherence include limited knowledge of health-related benefits, lack of proper technique for providing dosage, lack of patient self-management, and lifestyle constraints (Kvarnström et al., 2017). For individuals with Type II diabetes, lacking medication adherence can mean the difference between life and death (Rathish et al., 2019).
Various researchers have denoted the critical role that home healthcare providers play in promoting enhanced medication adherence (Bussell et al., 2017). Furthermore, the WHO, as cited by Brown and Bussell (2011), explained that five factors impact medication adherence, which include: (1) patient-related factors, (2) socioeconomic factors, (3) therapy-related factors, (4) condition-related factors, and (5) the health system/health care team-related factors. For this project’s purpose, the primary investigator (PI) will examine the impact/role that healthcare team members play in addressing patient-related factors that affect medication adherence among home healthcare diabetic patients. The health system/health care team-related factors.
The project was conducted to improve the patient’s adherence to medication to increase their overall health and wellbeing as it relates to diabetes mellitus. The primary investigator (PI) will also examine the impact/role that healthcare team members play in addressing patient-related factors that affect medication adherence among home healthcare diabetic patients. When diabetic patients do not adhere to their prescribed medication regime, they tend to have poor outcomes (Kvarnström et al., 2017).

Background of the Project Comment by Author: This heading is tagged with APA Style Level 2 heading.
Home-based healthcare has existed since 1909 (Choi et al., 2019). Since its inception, home-based healthcare has been perceived as a more costly method of patient care than expenses associated with hospitalization (Singletary, 2019). In the early 20th century, home-based healthcare was mainly practiced due to financial disparities, specifically since many individuals could not afford hospitalized care. Furthermore, home-based healthcare was also practiced due to medical inaccessibility, which often existed in African American communities due to limited access to resources (Choi et al., 2019).

Present-day, home-based healthcare is often selected due to an individual’s personal preferences. There are some situations in which individuals prefer the comforts of their own home compared to that of a hospital or group home (Bryant, 2018). As older generations continue to age, they often prefer to remain in their home for as long as possible. Given the needs of older generations and the impact of advances in healthcare and technology, the prevalence of home-based healthcare has exponentially grown (Wong et al., 2020). 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. Patients who have diabetes or hypertension are often recipients of home-based healthcare (Wong et al., 2020).
Home healthcare providers often visit patients and assess their blood pressure, cognitive functioning, and adherence to treatment proposals. During patient visits, home healthcare providers are responsible for biological assessments of patients (Wong et al., 2020). One of the vital functions of home healthcare providers is to ensure that patients are adhering to their medication regimen (Wong et al., 2020). According to Wong et al. (2020), medication adherence is predicated on medication understanding and education, which home healthcare providers should convey.
Adhering to diabetes medication regimen requirements can be complex. In fact, in a study by Raoufi et al. (2018), the researchers noted that 10% of diabetic patients did not correctly monitor their glucose levels, nor did they adhere to medication requirements. Dr. Goldbach, who is the Chief Medical Officer for Health Dialogue, stated, “There are programs that can be based on things like texting people, but what we’re highlighting is the fact that – especially for people with chronic illness that are facing challenges like depression, or transportation, or complexity of medication regimens – that these interpersonal, trusted interactions with a nurse tend to be very effective” (Heath, 2018, para. 8). Patients with diabetes often express difficulties in adhering to medication regimens, thereby reinforcing the critical role of receiving education from home healthcare providers (Wong et al., 2020). Comment by Author: Paraphrase please, there should only be on quote per chapter
In a study by Wong et al. (2020), home healthcare patients expressed that they did not have sufficient knowledge about the requirements associated with diabetes treatment. Often, diabetic home healthcare patients fail to practice medication adherence, thereby resulting in health complications due to unmanaged health conditions. Comment by Author: Need another sentence to equal a paragraph

Problem Statement

It is not known if or to what degree the implementation of the Medication Adherence Project (MAP) resources, which include (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List, will 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. At the selected project site, a home healthcare organization located in urban Texas, the stakeholders have cited that medication adherence among diabetic patients is lacking. In fact, according to data obtained from the site’s electronic health record (EHR), home healthcare providers have documented that 10% of diabetic home healthcare patients are not adhering to their medication regimen. Although this percentage is under 10 percent lower than other percentages cited in the literature for medication non-adherence, in terms of chronic disease management, various researchers have noted the implications associated with lacking adherence to medication regimens (Brown & Bussell, 2011; Camacho et al., 2020; Hamrahian, 2020; Misquitta, 2020; Wood, 2012). Lacking medication adherence is especially troubling among diabetic patients. It can be due to inadequate drug-related knowledge, medication costs, poor understanding of medication regimen, etc., thereby reinforcing the need for this direct practice improvement (DPI) project (Heath, 2019; Sharma et al., 2020).
Kvarnström et al. (2017) emphasized healthcare providers play a critical role in ensuring medication adherence. While there are many reasons for lacking adherence among patients, for this project, the WHO’s (2019) focus on the role of healthcare team members in enhancing medication adherence will be addressed. To promote medication adherence among patients of a home healthcare facility, the primary investigator will use MAP resources.
As previously noted, among diabetic patients at the project site, medication non-adherence is 10%. While this level of medication non-adherence seems exceptionally low, it is essential to note that false reporting among patients may occur (Tedla & Bautista, 2017). Tedla and Bautista (2017) explained that “self-reported medication adherence is known to overestimate true adherence.” Choo et al. (2001) demonstrated that 21% of patients expressed non-adherence when in fact, after measuring adherence with electronic cap bottles, non-adherence rates were 42%. In-home healthcare settings, lacking adherence to diabetic regimens is 14% (Ong et al., 2018). It is important to note that the project site’s non-adherence rates might be similar to that of the national average; however, often, patients are wary about disclosing true non-adherence due to embarrassment, forgetfulness, and lacking knowledge about the importance of medication adherence. Comment by Author: Divide into two sentences for clarity

44 words, a sentence has 24 to 30 words
To improve patient-related outcomes and reduce preventable issues, home healthcare nursing staff members will utilize MAP tools, which were created by Starr and Sacks (2010). The tools utilized in this study, which are from 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. Before implementing these tools, the PI will provide a 30-minute information session on this project’s purpose and significance and provide detailed information about utilizing the MAP resources.
During the onset of this project, once home healthcare nursing staff members have attended the educational training session, the project will be implemented. staff members will first provide patients with the Questions to Ask Poster. The purpose of offering this poster to patients is to address the six questions about medication, thereby improving patients’ knowledge regarding their medication regimen and reasons for the regimen prescribed.
After addressing the six critical questions on the Questions to Ask Poster, patients will be provided with the Adherence Assessment Pad. The purpose of the Adherence Assessment Pad is to explore barriers that impact one’s adherence to the prescribed medication regimen. There are several factors, listed on the pad, that affect one’s medication adherence (e.g., [1] Makes me feel sick, [2] I cannot remember, [3] Too many pills, [4] Costs, [5] Nothing, and [6] Other). To further understand what might be preventing patients from adhering to their medication regimen, this resource is necessary to utilize.
Once barriers associated with medication adherence are identified, the nursing staff member will provide patients with the My Medications List. This list is essential to give the patients, as it allows providers and patients to converse about a schedule for taking one’s medication and details, in a sheet, when medication must be taken. According to Starr and Sacks (2010), “Filling out the Medication List may seem time-consuming. However, your initial investment will pay off, as patients better understand their regimens and adherence increases” (p. 17). In addition to the time-consuming nature of filling out the My Medications List, nursing staff members and patients might feel overwhelmed during this first session. However, it is important to note that subsequent nurse-patient home healthcare meetings will seem less intense after the first session because the My Medications List is the only MAP resource that will be consistently reviewed over the four weeks.
To evaluate the impact of the intervention, the PI will compare pre-project implementation medication non-adherence rates to post-project implementation medication non-adherence rates after implementing the MAP resources. Project participants will include Type II diabetes patients, ages 35-64, who are receiving home health services at the project site. Medication adherence data will be available through the project site’s EHR. This project will take place over four weeks. 

Purpose of the Project

The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of the MAP resources, which will be delivered by home healthcare nursing staff members, will impact medication adherence when compared to current practice among type II diabetic patients, ages 35 to 64 of a home healthcare setting in urban Texas. Medication adherence is the dependent variable explored in this project and 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. Comment by Author: Spell out 1st time using
Each month, the selected project site, which is located in urban Texas, serves an average of 100 patients. Of the total number of patients, approximately 30 patients have Type II diabetes. Patients with Type II diabetes, who are between the ages of 35 and 64 and are without cognitive or language deficits, will be the target population for this project. Exclusion criteria consists of age, gender, race, ethnicity, type of disease, treatment history, and other medical conditions. The project is significant since home-based healthcare services can enhance treatment initiative outcomes. Wong et al. (2020) stated that physicians visit patients to ensure proper status of patient’s blood pressure, cognitive functioning, and adherence to treatment proposals. Comment by Author: Complete this please
Starr and Sacks (2010) explained that engagement with healthcare providers is imperative, as these encounters can enhance patient-related health outcomes. Physical and cognitive assessments are conducted to ensure that patient-related home-based treatment approaches are effectively implemented. The project is vital as it may enhance positive healthcare outcomes, through improving medication adherence among Type II diabetic patients, using the MAP resources.

Clinical Question

The problem described above was used to create a clinical question. The problem was it was unknown if or to what degree the implementation of the MAP resources, which will be delivered by home healthcare nursing staff members, will impact medication adherence when compared to current practice among type II diabetic patients, ages 35 to 64 of a home healthcare setting in urban Texas. The clinical question results will be determined using data collected on the diabetic patient self-reported documentation on their adherence to medication administration as prescribed by their clinician. A clinical question should be relevant to the problem being investigated and formed to facilitate an answer (Leedy & Ormrod, 2013).
A well-developed clinical question must be related and relevant to patient care. This helps the primary investigator search for evidence-based answers. The clinical question that will direct this quality improvement project is: 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?

This project’s independent variable was implementing the 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. The dependent variable was the Medication adherence attained through the project site’s EHR. Medication adherence has the potential to decrease the likelihood of complications related to diabetes. The adherence to medication attained via the EHR will be counted and the use of the MAP resource will be documented.

Chapter 2: Review
Diabetes is a medical condition that is characterized by high blood sugar levels, and is managed with drugs and insulin. Blood sugar serves as the major producer of energy in the body, therefore conditions/factors interfering with blood sugar levels and mechanisms disrupt normal body activities. Optimal diabetes control requires patient engagement in various types of self-care activities, including adhering to the identified medication regimens, adjusting to various lifestyle changes, and monitoring blood glucose levels (Jajarmi, Ghanbari, & Baleanu, 2019).
Diabetes is a lifestyle disease, which can be prevented or avoided by making lifestyle changes. Disease management can also occur through adhering to one’s prescribed medication regimen(s). Medication adherence is important since it can help to reduce the likelihood of diabetes-related challenges and complications.
One of the most problematic issues associated with home care for diabetes patients is adherence to medications. According to Bonney (2016), patients take their medication as prescribed only 50% of the time. Furthermore, patients are often reluctant to share medication compliance details, thereby resulting in health-related complications. This project hopes to enhance medication adherence, at the project site, which offers home-based care to diabetes patients. This project will also analyze the role of educating patients on medication adherence in improving their medication adherence.
Chapter 2 provides a theoretical framework and an empirical framework. Medication taking behaviors among home-based healthcare diabetes patients is investigated. The chapter is divided into theoretical and empirical sections. The theoretical section reviews the two theories that will guide this project, which include the attachment theory and social cognitive behavior theory. In the empirical section, literature from peer-reviewed studies and projects is explored. Furthermore, literature gaps are identified.
The primary investigator (PI) utilized various databases to conduct a thorough review of the literature. Specifically, the PI systematically searched for reviews that reported various aspects associated with medication adherence among diabetic patients. Eighteen systematic reviews, scoping reviews, and narratives were analyzed and are included in this chapter. Overall, the literature review revealed six main sub-themes and other sub-themes that promote the importance of this direct practice improvement (DPI) project. Each of the key sub-themes is comprehensively discussed and details about the importance of these sub-themes, in terms of the project’s focus, are explored.

Theoretical Foundations
According to Liu and Butler (2016), medication adherence is considered to be the largest challenge that healthcare workers and patients encounter. Medication adherence is a critical issue that requires more attention. Two key theories are explored during this project, which attempts to explain the relationship between medical non-adherence among patients and how medication adherence can be enhanced among diabetic patients through improved interventions.

Attachment theory. The first theory that will guide this project is the attachment theory. Bowlby (1958) proposed that attachment is adaptive as it improves the infant’s chance of survival. The attachment theory is defined as being a psychological, evolutionary, and ethological associated theory concerning the aspects of relationships between individuals. The attachment theory is famous and has been used in healthcare practices for many years. The most vital tenet of the attachment theory is that young children usually need to develop a relationship with, at minimum, a single primary caregiver. The child’s caregiver assists in offering social and emotional support. Within this theory, the term “attachment” is usually utilized to refer to an affection bond or tie that is between a person and their attachment figure, who in this case is considered to be the child’s caregiver (Liu & Butler, 2016). In this project, the attachment figure is the patient’s home healthcare provider, as providers can assist in creating the best interventions for enhancing medication adherence among diabetic patients.
The biological purpose for the use of attachment theory is the facilitation of survival, while the psychological purpose of the theory is to offer security, thus making it a suitable theory to use. Attachment theory does not provide an exhaustive description of human relationships. Furthermore, this theory is not synonymous with feelings of love or affection. In child-adult relationships, the child is usually referred to as the attachment while the caregiver is usually defined as being the reciprocal equivalent, who in this case is called to provide the caregiving bond (Hunter & Maunder, 2016). 
The modern attachment theory focuses on bonding, which is an intrinsic human need that can assist in regulating emotions, such as fear, which can result in improve vitality and can promote development. Common attachment behaviors and emotions are usually displayed in most social primates, including humans, and are considered to be adaptive. The long-term evolution of social primates has aided in identifying social behaviors that enable people and groups to survive. The commonly observed types of attachment behavior in toddlers, such as staying near familiar individuals, are based on safety advantages. According to Bretherton (1992), Bowlby and Ainsworth perceived the environment associated with early adaptation as similar to hunter-gatherer communities. There is a survival advantage in the capacity to effectively sense dangerous conditions, like the issue of unfamiliarity, loneliness, and rapid approach, through guidance and support.
The advancement of attachment is considered to be a transactional process. Particular attachment behaviors start as predictable innate behaviors in the infancy stage of life. The behaviors are altered with age in various ways that are determined partly by experience, as well as the various sit-upon elements. As the various attachments are altered throughout life, they are shaped by relationships.
According to 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.
Clinicians can help people who have attachment anxiety and avoidance to find the best alternative way to meet their various needs. Most of the individuals who seek help want to learn how they can employ different strategies for coping with the dysfunction in their daily lives. Furthermore, individuals often express the desire to modify their dysfunctional and/or inappropriate coping techniques. The desire to change/modify techniques is an essential aspect needed to encourage medication adherence. Before delivering appropriate and patient-specific advice and interventions, to diabetic patients of the selected project site, individuals may express that they would like to adhere to their medication regimens. It is important to note that for effective outcomes to be realized, it is critical to ensure that all of a patient’s basic needs are effectively met. Therefore, through understanding barriers and challenges associated with medication adherence, strategies can be created, which can result in effective patient-related outcomes (Hunter & Maunder, 2016). 

Social cognitive theory (SCT). The social cognitive theory (SCT) is a critical theory that will be utilized during this DPI project. The SCT is utilized to explain how 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.
According to Bosworth (2015), the SCT bases its focus on the concept of behavioral capability, which states that before any individual acting in a certain situation, the individual needs to have knowledge on what they need to do and the manner in which they need to do it. Bandura’s (1986) conceptual model regarding reciprocal determinism is often utilized in addressing all the personal determinants associated with health. Bandura (1986) postulated people often engage in cognitive, vicarious, self-reflective, and self-regulatory processes in hopes of attaining a given goal. Individuals can often change by identifying their actions and proactively engaging in their change-related behaviors. When people exercise individual control over their behaviors, thoughts, procedures, and motivations, enhanced outcomes can be achieved (Bosworth, 2015).
Bandura (1986) asserted without having any kind of aspirations, individuals usually course through life unmotivated and uncertain regarding their specific capabilities. Nonetheless, Bandura also stated that people who take part in health-promoting behavior have self-belief, which enables them to fully take control over their thoughts, feelings, and actions (Badura, 1986). Bosworth (2015) explained that self-control should get promoted since it improves the ability of individuals to adopt healthy habits. According to Bandura (1986), although the SCT acknowledges that patients must understand health-associated risks and the benefits of treatment to effectively perform health-associated behaviors, understanding, …

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
$26
The price is based on these factors:
Academic level
Number of pages
Urgency
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
Open chat
1
You can contact our live agent via WhatsApp! Via + 1 929 473-0077

Feel free to ask questions, clarifications, or discounts available when placing an order.

Order your essay today and save 20% with the discount code GURUH