Medication adherence has been a crucial component in chronic disease management, because poor medication adherence negatively affects patients’ health, increases healthcare utilization, and increases healthcare cost. However, only 50% of people with chronic diseases adhere to their prescribed medications, indicating the importance to improve medication adherence in this population. Traditionally, clinicians thought that individuals are not “compliant” with their prescription medication orders but the World Health Organization has changed the terminology from compliance to adherence, which shows the partnership between patients and healthcare providers in medication management. In Taiwan Long-term care 2.0, which responds to our aging society, increases the accessibility of healthcare and minimizes the unnecessary social-structure-related hospitalization, more older people and individuals with multiple chronic diseases will receive homecare services. However, little is known about medication adherence and associated barriers in homecare in Taiwan. Therefore, aims of this study are to: 1) Explore the knowledge about medication management in homecare including: physicians, nurses, pharmacists, and patient/family/aides experience and barriers of medication adherence in homecare; 2) Identify the characteristics of medication nonadherence in homecare; 3) Investigate the risk factors and types of nonadherence; 4) Develop electronic tools/forms for measuring medication adherence and medication regimen complexity; 5) Develop nurse-led integrated medication management program with the concept of shared decision-making; and 6) Evaluate the effectiveness of nurse-led integrated medication management in increasing medication adherence, and decreasing medication regimen complexity, hospital admissions and emergency room visits.The proposed study will be a three-stages study completed in three years. Stage one will be an exploratory study, physicians, nurses, and pharmacists, and patients/family/healthcare aides will be invited to investigate their experience and barriers of medication adherence at home. The 8-item Morisky Medication Adherence Scale-Chinese version and pill-counting will be used to assess medication adherence. George’s medication regimen complexity index will be used to calculate the medication regimen complexity. Descriptive statistics and multiple linear regression will be used to explore the occurrence, types of medication nonadherence, contributing factors of medication nonadherence, and characteristic of high-risk patients. Stage two is to develop the nurse-led integrated medication management program using concepts of shared decision-making. Electronic tools/forms to evaluate medication nonadherence and medication regimen complexity will be developed in this stage as well. Homecare physicians, nurses, and pharmacists will receive the medication-adherence training program and learn the use of those electronic tools. The integrated medication management model will be pilot tested. Stage three will be a quasi-experimental, pre- and post-test study. Fifty patients with their family will be enrolled in this study and evaluated the effectiveness of this nurse-led integrated mediation management in improving medication adherence and decreasing medication regimen complexity. The outcomes of this study are to develop an effective nurse-led integrated medication management program. From this study, we can expand our understanding of medication adherence and barriers in homecare from the perspectives of physicians, nurses, pharmacists, and patients/family/healthcare aides, and enhance the shared decision-making process across multiple disciplinarians and patients/family/healthcare aides. We hope this model could be applied to other homecare services nationally and internationally.
|Effective start/end date||8/1/18 → 7/1/19|
- medication adherence
- medication regimen complexity
- shared decision-making