A single-session, nurse-led clinic staff education program on improving medication adherence led to increases in knowledge, self-confidence, and self-reported practice behavior change among staff at an urban federally qualified health center (FQHC), according to a quality-improvement pilot study presented at the Gerontological Advanced Practice Nurses Association (GAPNA) Annual Hybrid Conference held September 30 to October 2, 2021.
Medication nonadherence is associated with approximately 125,000 deaths annually in the US, 10% of hospitalizations, and nearly $300 billion annually in costs to the US health system, explained Valerie Gruss, PhD, GNP-BC, FAAN, who is a clinical professor at the University of Illinois at Chicago, director of Interprofessional Education at the College of Nursing, and director of Enhancement of Geriatric Care for All-Illinois (ENGAGE-IL). Rates of nonadherence are reportedly higher among minority, low-income, and urban communities.
“Primary care providers, working directly with their patients are in a key position to reduce poor outcomes associated with medication nonadherence and to improve communication to understand patients’ needs and concerns,” explained Dr Gruss. The researchers reviewed the literature and identified 8 randomized controlled trials involving nurse-led interventions that lead to significant improvements in medication adherence with minimal training required.
Educational Workshop Design
Based on this research, Dr Gruss and colleagues developed and implemented a single educational workshop designed to enhance staff knowledge, confidence, and commitment to practice change at the Mile Square Health Center in Engelwood, an FQHC serving a primarily Black population (91%) in Chicago in which 42% of patients are below the poverty line. Participants attended a single 30-minute workshop virtually (n = 6) or via prerecorded video (n = 2) in which they were trained on the following tools:
- Modified Medication Adherence Rating Scale (MARS)
- Barriers and Interventions Checklist (BIC)
- Motivational interviewing
After the interventions, participants were sent weekly email reminders to engage patients in conversations about medication adherence by using tools learned in the workshop and surveys were sent to participants at 4 weeks after the workshop concluded.
Intervention Led to Practice Change
A comparison of pre- and post-test intervention surveys showed a 29% increase in staff knowledge, 44% increase in staff confidence in initiating conversations, and 77% increase in the self-reported number of discussions with patients about medication adherence. On a 10 point scale, the participants rated their commitment to practice change as 8.5 and their ability to successfully apply what was learned in the workshop as 8.4.
“Training staff at a federally qualified health center in an at-risk population using a single educational workshop with supportive follow-up made a substantial impact on clinic staff knowledge and significantly improved self-confidence and increased the frequency of conversations with patients about medication adherence,” Dr Gruss noted.
The educational program will continue at this clinic and expand to other sites with modifications based on lessons learned during this pilot program, Dr Gruss said. The researchers recommended adding the modified MARS and BIC to the intake workflow on electronic health records, delegate process steps by staff position, and establish standard methods of staff communication to ensure adequate patient follow-up.
“Assessing medication adherence should be a standard of practice in primary care,” Dr Gruss concluded.
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Ebeywa E, Gruss V, Koronkowski M. Enhancing primary care clinic staff’s skills to promote a shared medication adherence practice. Poster presented at: Gerontological Advanced Practice Nurses Association (GAPNA) Annual Hybrid Conference; September 30 October 2, 2021; San Diego, CA: P12.