Designing an executable population-based change project

Full Answer Section

2. Proposed Solutions/Interventions (Based on Literature):

The literature suggests that multifaceted interventions are most effective. This project will implement a combination of:

• Pharmacist-led Medication Therapy Management (MTM): Collaborating with a local pharmacist to provide individualized medication reviews, address concerns about side effects, and simplify medication regimens where appropriate.
• Peer Support Groups: Establishing peer support groups facilitated by a community health worker or nurse, focusing on sharing experiences, problem-solving, and mutual encouragement.
• Culturally Tailored Educational Materials: Developing and disseminating culturally appropriate educational materials (e.g., brochures, videos) in [Languages spoken in the community] that address the importance of medication adherence, provide practical tips, and dispel common myths.
• Home Blood Pressure Monitoring (HBPM) with Telemonitoring: Providing training on HBPM and utilizing a telemonitoring system to track blood pressure readings and provide timely feedback and support.

3. Comparing Other Views:

Some argue that non-adherence is solely a patient issue, attributing it to forgetfulness or lack of motivation. However, the literature highlights the significant role of systemic factors, such as access to care, medication costs, and complex medication regimens. This project acknowledges the multi-faceted nature of non-adherence and addresses both individual and systemic barriers. Other interventions focus primarily on single strategies, such as medication reminders, while this project takes a more comprehensive approach.

4. APRN Role and Implications for Clinical Practice:

The APRN will play a crucial role in this project:

• Collaboration: Working closely with the community agency, pharmacist, and community health worker to implement the interventions.
• Assessment: Conducting comprehensive medication assessments and identifying barriers to adherence.
• Education: Developing and delivering culturally tailored educational materials and leading patient education sessions.
• Coordination: Coordinating care with primary care providers and other healthcare professionals.
• Evaluation: Monitoring the project's progress and evaluating its effectiveness.

Implications for clinical practice include:

• Improved Patient Outcomes: Increased medication adherence, leading to better blood pressure control and reduced risk of cardiovascular events.
• Enhanced Patient Engagement: Empowering patients to take an active role in their care.
• Strengthened Community Partnerships: Building collaborative relationships with community agencies to address population health needs.

5. Implications of the Change Project:

This project has the potential to:

• Improve medication adherence: The multifaceted intervention is designed to address multiple barriers to adherence.
• Reduce health disparities: By focusing on a specific community with identified needs, the project can contribute to reducing health disparities related to hypertension control.
• Generate evidence: The project will provide valuable data on the effectiveness of the intervention, which can be used to inform future programs and policies.

6. Connection to Research Problem, Data Collection, and Analysis:

The intervention directly addresses the research problem of low medication adherence among older adults with hypertension.

• Data Collection:

  • Pre- and Post-Intervention Surveys: Assess medication adherence using a validated scale (e.g., Morisky Medication Adherence Scale), patient satisfaction, and knowledge of hypertension management.
  • Blood Pressure Measurements: Track blood pressure readings at baseline, during the intervention, and at follow-up.
  • Qualitative Interviews: Conduct semi-structured interviews with a subset of participants to explore their experiences with the intervention and identify any remaining barriers to adherence.

• Data Analysis:

  • Quantitative Data: Use descriptive statistics to summarize participant characteristics and outcome measures. Conduct inferential statistics (e.g., t-tests, chi-square tests) to compare pre- and post-intervention data.
  • Qualitative Data: Use thematic analysis to identify key themes and patterns in the interview data.

7. Subject Selection, Sampling, and Limitations:

• Subject Selection: Older adults (65+) with a diagnosis of hypertension who are receiving care at [Name of Community Agency].

• Sampling: A convenience sample of [Number] eligible participants who meet the inclusion criteria and provide informed consent.

• Limitations: Potential limitations include:

  • Sample Representativeness: The sample may not be fully representative of all older adults with hypertension in the community.
  • Self-Reported Data: Reliance on self-reported medication adherence may introduce bias.
  • Attrition: Participants may drop out of the study, affecting the sample size and potentially biasing the results.

• Controlling Limitations: To mitigate these limitations, the project will:

  • Recruit a diverse sample of participants.
  • Use objective measures of blood pressure in addition to self-reported adherence.
  • Implement strategies to maintain participant engagement (e.g., regular communication, incentives).

8. Filling Gaps in Understanding:

This project will contribute to filling gaps in understanding by:

• Providing data on the effectiveness of a multi-faceted intervention to improve medication adherence in a specific community setting.
• Identifying specific barriers to adherence among older adults with hypertension.
• Generating evidence to inform the development of future interventions and policies aimed at improving medication adherence and hypertension control.

Sample Answer

Let's outline a population-based change project focused on improving medication adherence among older adults with hypertension in a community setting.

1. Clarify the Issue Under Study:

Hypertension is a prevalent chronic condition among older adults, significantly increasing their risk of cardiovascular events, stroke, and kidney disease. Medication adherence is crucial for effective blood pressure control, yet rates among this population are often suboptimal. This non-adherence leads to worsened health outcomes, increased healthcare costs, and decreased quality of life. This project addresses the practice-related problem of low medication adherence among older adults (65+) with hypertension within the [Name of Community/Region] served by [Name of Community Agency, e.g., Senior Center, Public Health Department].