A Quality Improvement Project to Improve Medication Adherence Management in a Clinic to Increase Medication Adherence in a Medically Vulnerable Group

Abstract

This Quality Improvement Project (QIP) assessed the effect of a multi-component evidence-based (EB) Medication Adherence Intervention on adherence at a nurse-managed, student-run free clinic treating medically vulnerable adults aged >18 years who lacked health insurance and financial resources, had language barriers, low academic, health literacy, and understanding levels. The clinic staff lacked a process for screening, managing, and documenting non-adherence, estimated to be >50% by the stakeholders. Vulnerable patients, at risk for health disparities, known to need added time and attention (Viswanathan et al., 2012) did not receive adherence aid. Johnson’s (2002) Medication Adherence Model (MAM) describes the process patients go through to adhere, e.g., purposeful action, pattern behavior, and feedback. MAM’s concepts helped design, guide, and infer the intervention effects on adherence. The intervention involved: a) a designed online educational module to train staff on adherence and the QIP, b) a change to the clinic’s care process, and c) two 1-hr case management (CM) patient educational sessions, 4-weeks apart, on disease, medications, self-management, provider communication, and adhering-aiding tools. Adherence rates improved by 141% and blood pressure (B/P) and blood sugar finger sticks (BSFS) levels decreased in two months.