Summarizing Quantitative Report, Research Paper Example

Majority of the research that have so far been conducted have led to the deductions that, medication non-adherence is one of the most challenging issues facing health professionals today.  The objective of this paper is to identify the health problem of medication non-adherence and the proposed solution of nurses by having a standardized approach in assessing, and evaluating patients’ knowledge, and their ability to obtain and take prescribed medications.

There are three main elements that are affected by non adherence. These are primarily: patients, the health care systems, and manufacturers of pharmaceuticals. Pharmaceutical manufacturers are reported to sacrifice potential earnings in billions of U.S dollars, particularly for medications that are used in chronic ailments. Patients are reported to have a diminished quality of life; life spans are now shorter and incur escalated long-term health expenses. The whole health care system bears the burden of escalated healthcare expenses, including high rates of hospitalization as well as physician consultation. The unfavorable outcomes in relation to medications non-adherence are well acknowledged by numerous studies. In the U.S, patient compliance with chronic medications is reported to average at 50%.  Estimates reveal that non-adherence to approved medications is the cause for approximately 125,000 deaths yearly. Non-adherence to medications accounts for 10% of hospital admissions whereas nursing-home admissions are rated at 23% percent. Approximately 30% of all prescribed medications are not filled, and over 50% of prescriptions filled are linked to erroneous administration. The gravity of this problem has impelled the National Council on Patient Information and Education (NCPIE) to regard non-adherence to medication as a drug problem in the U.S (Elliott  & Marriott, J  2009).

According to Elliott, & Marriott, (2009), non- adherence to medication means a patient’s non- compliance to the instructions of a mental health professional in regard to medication. There have been dismal efforts in research at developing and testing interventions to enhance compliance with prescribed medication despite the relationship between good adherence and results. The objective of educational intervention is to offer patients with relevant information in relation to their ailments and medication with the objective of developing more understanding as well as promoting adherence. It is interesting to note that, in a quantitative research carried out by Gary in 2000, a randomized controlled test of 44 patients with an aim to test the hypothesis that epigrammatic patient education is much more successful than regular care in improving insight as well as attitudes towards treatment in patients prescribed with clozapine (Elliott, & Marriott, (2009). The patients obtained three sessions of one-on-one instructive intervention inside a room in the hospice ward. Patients were evaluated as blind by a research assistant, who was not concerned in delivering of the intervention or their typical care pre-intervention, and also five weeks later, utilizing two reliable, valid and, standardized, self-report scales. The outcome of this research study revealed that the intervention did not improve adherence. This negative finding is attributed to the fact that clients on clozapine are usually disabled by their ailment (Elliott, & Marriott, (2009). It is rational from the findings of Gary’s study to conclude that while straightforward educational interventions is successful in enhancing patients’ knowledge regarding medication it is not universally effective in encouraging adherence to medication.

Elliott, & Marriott, (2009) carried out a qualitative research study by use of tentative design with a suitable sample size of 15 respondents hospitalized in a psychiatric hospice in Britain. The study intended to investigate the efficacy of medication groups on understanding regarding drug treatment and insight as well as drug adherence. Data collection was done through evaluating patients prior to and subsequent to attending educational groupings. This was done by the utilization of five measures which included: Understanding of Medication Questionnaire (UMQ), which is designed to evaluate understanding of anti-psychotic treatment; Expanded Schedule for Assessment of insight (SAIE), which has elements of treatment adherence, awareness of sickness as well as capability to re-label psychotic signs. Compliance Rating Scale, which is seven- point scale of rating filled by the patients main nurse;  Rating of Medication Influence (ROMI), a tool that is designed to evaluate patients’ subjective rationale for adherence, and non-adherence; Brief Psychiatric Rating Scale (BPRS), which is a semi-structured interview for the main psychiatric symptoms. This instrument’s validity was however, unmentioned in their research. The researchers stated that majority of psychiatric patients lack adequate knowledge in regard to their prescribed medications. The focus of the research was therefore to assess the benefit of patients’ education in relation to medication adherence.

Elliott  & Marriott, (2009) in a quantitative research study that used randomized controlled testing with 56 participants selected at random in a hospital in Ireland, had the intention of investigating the efficacy of the compliance therapy for enhancing compliance to prescribed medication in patients suffering from schizophrenia. A structured clinical interview was employed in data collection by evaluating the patients’ subjective response as well as attitudes to anti-psychotic medication. The general levels of functioning, symptoms, insight as well as quality of life were considered. The experimental group was subjected to five sessions of adherence therapy which lasted for 36 minutes (Elliott & Marriott, 2009). These sessions concentrated on the patient’s history of sickness, hesitance to treatment, understanding of sickness, maintenance medication as well as stigma. However the control patients obtained imprecise counseling devoid of any discussions in regard to their medications. The participants were re-evaluated one year subsequent to intervention by a researcher blind to the kind of intervention given. Evaluation entailed same variables evaluated at baseline but incorporated the patients’ psychiatric admittance one and two years subsequent to entering trial. The results of this research revealed that adherence therapy has no merits over non- specific treatment for patients suffering from schizophrenia in relation to adherence to treatment, patience, and attitudes towards medication, quality of life, symptom, insight, global societal functioning, or recurrent hospitalization. This outcome is consistent with Littrell & Schultz, 1994). quantitative research that used 300 respondents in a multi-centered randomized controlled testing. This research by Gary was conducted in regular general adult psychiatric hospices in Amsterdam, Germany, London and, Italy the aim being to examine the efficacy of compliance therapy in enhancing quality of life of persons suffering from schizophrenia. The participants obtained eight weekly sessions of compliance therapy or health instruction, each lasting for approximately 30 to 50 minutes. This study revealed that compliance therapy did not enhance compliance or any other variables that were tested in the study. The negative outcome of these studies would be attributed to the reality that the intervention period was brief and evaluation of adherence was unsophisticated. Since these two studies are quantitative research, they fall short of adequately explaining the intricacy of medication adherence behavior and are only capable of exploring a diminutive number of variables.

Johnson,  Littrell & Magill,  (1994) conducted a quantitative research and used randomized controlled test in a psychiatric unit in Thailand. The researchers used a sample size of 32 participants who were selected randomly to be in an experimental group or a control group. The experimental group obtained eight sessions of compliance therapy that lasted eight weeks. Each session lasted for 15 to 60 minutes. On the other hand the control group received therapy is normally for the same period of time (Johnson,  Littrell & Magill,  1994)  The rationale behind this study was inclined to the evaluation of the efficacy of compliance therapy on persons with schizophrenia. The finding of the study found out that compliance therapy had positive influence on satisfaction with as well as attitudes in regard to medication, and psychotic symptoms. It was revealed in the same study that adherence therapy did not enhance general functioning. Generalization of the study may be limited, attributable to the diminutive sample population that also had to some extent lower symptoms and higher general functionalities in comparison to the participants in the study carried out by Littrell, Peabody & Littrell, (1996). and Johnson, Littrell,  & Magill,  (1994). In the two studies participants were drawn from psychiatric intensive care unit. Furthermore, one therapist was utilized for the entire sample of 32 participants and the level of compliance of the patients prior to entering the trials was unknown (Littrell, Peabody & Littrell, (1996). and Johnson, Littrell,  & Magill,  (1994).

From the problems identification, the rate of hospitalization at Golden Heart Home Health’s (GHHH) hospitalization has been higher due to the escalating number of patients who failed to adhere to the prescribed medications.  Recommendation such as the once made by the Quality Assurance Department on implementation of a standardized approach to monitor any sort of non-compliance by the patients’ to their prescribed medications is praise worthy. However, it is also advisable that for the recommendations to be successfully implemented, patients and caregivers must also take into consideration factors such as the possible adverse effects of under medication or overmedication.

A point of appreciation remains the fact that, a challenging issue of great significance relates to medication non-adherence. The importance of proper channels to identify health problems allied to medication non-adherence remains the crux of the matter for the majority of the researchers. Any research conducted in this field should aim at identifying the amicable solutions for the nurses who adopt standardized approach in assessing, and evaluating patients’ knowledge, and their ability to obtain and take prescribed medications.

GlaxoSmithKline have done a lot of research work in this field that led to the identification of reliable estimates top the effect that medication non-adherence leads to 33% to 69% medication-related hospital admissions, 23% of all nursing home admissions, $100 billion in direct and indirect medical costs, and increased use of expensive and specialized medical resources (GlaxoSmithKline, 2011).

Further research indicates that The World Health Organization estimates that 40% to 75% of elderly suffering from chronic conditions is not compliant with their medications (Doggrell, 2010). The negative consequences of medication non-adherence in the elderly include progression of the disease, increased hospital and nursing home admissions, and increased cost to the society.  It is therefore important to consider the fact that implementing a standardized tool to assess patients’ non-adherence to prescribed medications will effectively determine presence and underlying causes of non-compliance and guide nurses regarding specific strategies to address the problem.

Consequently, majority of the leading health care organizations have decided to come up with influential policies that are likely to facilitate for the assessment of the non-adherence to medications and implemented strategies by the patients in an attempt to address these issues to prevent avoidable hospitalizations. In addition to a standardized and an interdisciplinary approach in medication management, the success of improving medication management would be educating the patient and caregivers regarding the importance of medication compliance and assisting with overcoming any barriers (GlaxoSmithKline, 2011).

Important to Resolve

The World Health Organization estimates that 40% to 75% of elderly suffering from chronic conditions is not compliant with their medications (Doggrell, 2010).  The negative consequences of medication non-adherence in the elderly include progression of the disease, increased hospital and nursing home admissions, and increased cost to the society.

By August 2011, visiting nurses at GHHH will receive education regarding the use and implementation of a standardized approach to assess presence and underlying causes of medication non-adherence to reduce hospitalization rates by 90% as reflected in Medicare Home Health Compare Data.

Implementing a standardized tool to assess patients’ non-adherence to prescribed medications will effectively determine presence and underlying causes of non-compliance and guide nurses regarding specific strategies to address the problem.    All visiting nurses of GHHH will be in-serviced in the office regarding the use of Medication Management Instrument for Deficiencies in the Elderly on August 2011.  This standardized tool will be a part of the beginning of the care in addition to the resumption of the care assessments to identify presence and causes of medication non-adherence (Elliott & Marriott, 2009).

Current research estimates that medication non-adherence leads to 33% to 69% medication-related hospital admissions, 23% of all nursing home admissions, $100 billion in direct and indirect medical costs, and increased use of expensive and specialized medical resources (GlaxoSmithKline, 2011). All visiting nurses are expected to comply 100% with using the standardized medication management tool after the in-service on August 2011.  The management will incorporate this tool as part of the comprehensive assessment during the start of care and resumption of care to assess accurately and evaluate patients’ non-adherence to medications, thus, improving patients’ outcomes.

Consistency with the Community

Health care organizations must establish policies to assess the level of non adherence of their patients to prescribed medications to and if possible implement proper strategies aimed at addressing such issues and avoid unnecessary hospitalization of patients who shows signs of adherence to prescription (GlaxoSmithKline, 2011).

Caregivers should be educated on the importance of compliance to the indicated doses as is prescribed by doctors. Patients should also be advised properly on such issues to prevent avoidable hospitalizations that lead to high hospitalization bills on the part of the sponsors and relatives of the patients.

In addition to a standardized and an interdisciplinary approach in medication management, the success of improving medication management would be educating the patient and caregivers regarding the importance of medication compliance and assisting with overcoming any barriers.

References

Doggrell, S.A., (2010). “Adherence to Medicines in the Older-Aged with Chronic Conditions”. Journal of General Internal Medicine, 27(3), 239-254.

Elliott, R.A., & Marriott, J.L. (2009). “Standardised assessment of capacity of the patients to manage medications: a systematic review of published instruments”. PubMed Central, 9 (27).

GlaxoSmithKline, (2011). Impact of Non-adherence. Retrieved from http://www.takingmeds.com/hcp/learn-more.html

Johnson, G., Littrell, H., & Magill, H. (1994). “Starting Patients on Clozapine in Partial Hospitalization Program”. Hospital and Community Psychiatry 45. (3), 264-268.

Littrell, K., Peabody, C. & Littrell, S. (1996). “Olanzepine: A New Atypical Antipsychotic”. Journal of Psychosocial Nursing. 34 (8), 41-46.

Littrell, K. & Schultz, R. E. (1994). “Resperidone: Clinical Issues in Treatment”. Journal of Psychosocial Nursing 32. (5), 47-49.