10 STRATEGIC POINTS TABLE 2

Improving Medication Adherence in Diabetic Patients in Home Health Care

a. Background of the Problem/Gap:

· Medication adherence can be defined as how well patients in home-based care can correctly take the medication that has been prescribed by the doctors in the absence of health practitioners.

· Medication adherence incorporates total adherence and compliance with the medical instructions that the patients have been giving.

· Proper medication adherence can significantly minimize chronic illness and emergency visits to hospitals.

· The number of patients who have been diagnosed with diabetes in America alone cannot be hospitalized (Brown & Bussell, 2018). This is the reason why home base health care programs for these patients has been initiated.

b. Theoretical Foundations (models and theories to be the foundation for the project):

· Medication nutrition therapy: Its is commonly abbreviated with MNT. It is defined as an evidence-based approach in which the family members are tailored towards implementing an individual nutrition plan. Ideally, the plan is designed, ordered ad approved by qualified and registred health practitioner.This model is responsible for determining the types of foods that diabetic patients are supposed to be consuming at any given time and stage of their treatment efforts. No one size can fit all eating requirements for diabetic patients (Brown & Bussell, 2018). The model demands that diabetic patients be involved in at least one form of education and collaborative care. Educating the patients about nutrition will enable themselves to take care of while in homebased care.

· Ongoing care management: There is a need for diabetic patients to receive care from multiple integrated teams that comprise the expert. The team’s possible members include but are not limited to the nurses, physicians, nurses, and mental health professionals (Brown & Bussell, 2018). Although the team members might not physically meet the team, communication between them and the home care diabetic patients will be maintained remotely.

c. Review of Literature with Key Organizing Themes and Sub-themes (Identify at least two themes, with three sub-themes per theme)

Medication adherence:

· This refers to the art of taking medication in the right way as prescribed by healthcare practitioners. For home-based diabetic patients, they might be missing the opportunity to have a physical person monitoring their recovery process. However, their adherence and track of the body changes can play a significant role (Ahmed et al., 2018). Adherence incorporates factors like recalling the exact time to take medication, the right doses and keeping track of what ought to be done at any given time. The sub-themes under the medication adherence themes are diatery adherence, drug dherence and pharmacist-led drug therapy.

Dietary adherence

· This refers to the art of adhering to the preset diet obligation. In summary, this is the process by which the home-based diabetic patient sticks to the physician recommended by the physician (Brown & Bussell, 2018). This demands that the patients stick to healthy foods alone, which can positively boost growth.

Drug Adherence

· This is the art of sticking to the drug prescription as being presented by the doctors. There are many reasons why home care patients might fail to take drugs as prescribed. For instance, when there is no person to remind them of what is supposed to be taken and at what time (Brown & Bussell, 2018). Some patients go ahead of suffering conditions that make it difficult for them to progress in life.

Pharmacist- led drug therapy

· According to Campbell et al. this is a medication therapy which involves direct contact and communication between patients and health practitioners. (Campbell et al., 2018)

· This form of medication might not be an ideal one for home-based patients.

· It is not applicable in this case of medication because they are not always with the home care members.

· Family members can play a vital role in upholding the person’s health compared to medical practitioners because they tend to spend much time with the patient at home.

Strategies to improve diabetic care patients:

Patient-centered communication approach

· This approach will incorporate the interests and preferences of the patients. It will also serve to determine the possible barriers which people might be facing in this situation (Voortman et al., 2017)

Chronic Care Models

· Any form of care should be associated with chronic care models. Adopting the models will ensure that any form of care needed by the patients has been taken good care of.

Capitalize on Advocacy

· This involves the provision of active support to patients to positively boost their lives.

d. Summary

· Gap/Problem: Implementation of Medication nutrition therapy strategy that will support medication adherence in diabetic patients in-home health care.

· Prior studies: Prior studies reveals that medical adherence for home-based patients has not been a smooth process.

· Quantitative application: WHO reports with numerical data about medication adherence to home based patients.

· Significance: Increase the number of ways through which homecare medical adherence can be attained.

It was not known if or to what degree the implementation of Medication nutrition therapy strategy would impact diabetic patients under home care compared to pharmacist-led strategies adherence strategies among diabetic patients.

Literature holds that family members are closer to home-based patients with healthcare practitioners. Therefore, they can be of great importance to the patients as they can give ready support compared to doctors.

To what degree does the implementation of Medication nutrition therapy impact medication adherence(what) compared to pharmacist drug-led strategies among diabetic patients in home care in Texas over four weeks.

a. Location: Texas

b. Population 50 diabetic patients. These will be adults, aged 45 years and above. The population will comprise of mixed gender.

d. Inclusion Criteria

· Interested parties striving to increase an understanding of medication adherence among home care patients

e. Exclusion Criteria

· Patients less than 45 years and who are in he initiation stage of their diabetic treatment.

a. Intervention: Medication nutrition therapy.

b. Outcome: Enhanced mediction adherence to home based diabetic patient.

Quantitative with a quasi-experimental design. This is an ideal research methodlogy design because it will incorporate collection of the retrospective baseline and prospective intervention rates. This will increase the chances of the intervention group.

The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the implementation of Medication nutrition therapy would impact medication adherence when compared to pharmacist drug-led strategies among diabetic patients in-home care in Texas over four weeks.

Data collection will involve a pretest-posttest approach. Home-based patients will be given questionnaires to be filled with the patients under home-based care. the questionnaire will have precise questions aiming a collecting data from family members who have taken part in Medication nutrition therapy. Family members giving the patients direct support will be evaluated as well. Information gathered will be gathered and contrasted with theoretical information available. The pre-designed questionnaire will allow collection of the carer views and suggestions on how the process can be enhanced. The questionnares will be channeled to the care givers alone.

The data mentioned below will be collected and analyzed using SPSS. The software will further be used in establishing relationships between different aspects of the information. The software will further predict possible application/utilization of the information as it will be sorted appropriately. The analysis will be launched after a proper understanding of patients’ and caregivers’ nature and status. Anticipated analysis will involve the number of patients satisfied with the kind of services being offered at family level, the number of patient recoveries and the best performing family member strategies.

Brown, M., & Bussell, J. (2018). Medication Adherence: WHO Cares?. Mayo Clinic Proceedings, 86(4), 304-314. https://doi.org/10.4065/mcp.2010.0575

Campbell, A. M., Coley, K. C., Corbo, J. M., DeLellis, T. M., Joseph, M., Thorpe, C. T., … & Sakely, H. (2018). Pharmacist-led drug therapy problem management in an interprofessional geriatric care continuum: a subset of the PIVOTS group. American health & drug benefits, 11(9), 469. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6322592/

Voortman, T., Kiefte-de Jong, J., Ikram, M., Stricker, B., van Rooij, F., & Lahousse, L. et al. (2017). Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study. European Journal Of Epidemiology, 32(11), 993-1005. https://doi.org/10.1007/s10654-017-0295-2