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Patient Education, Nurses Cut Medication Adherence Woes by A Third

Patient education and nurse feedback programs helped Johns Hopkins Medicine address lapses in medication adherence for acute care, post-op patients.

A group of researchers from Johns Hopkins Medicine may have cracked the code on medication adherence, outlining two viable options involving patient education and nurse feedback to increase the number of patients taking life-saving medications after surgery.

Particularly, the researchers found that both a patient education bundle and a nurse feedback program helped reduce the number of patients foregoing a low-dose blood thinner after an operation.

Medication adherence to post-operative medications can be a big problem for healthcare organizations working toward better clinical outcomes. In post-surgery care, adherence to a low-dose blood thinner can help prevent venous thromboembolism (VTE)—or deep vein thrombosis (DVT)—but all too often, patients skip the medication.

“According to the U.S. Centers for Disease Control and Prevention, VTE kills some 100,000 people each year, with approximately half developing their VTE associated with hospitalization,” study lead author Elliott Haut, MD, PhD, associate professor of surgery at the Johns Hopkins University School of Medicine, stated publicly. “We’ve shown that an effective intervention can help bring those numbers down for patients who are hospitalized.”

Non-adherence could be attributed to a lack of patient health literacy or simply limited patient-provider communication about the blood thinner’s importance.

The Hopkins researchers tested two strategies to support patients in medication adherence. The first strategy, sparked by electronic alerts indicating the patient had not taken a blood thinner, included a comprehensive patient education package.

The patient education package included one-on-one patient-provider communication, a two-page educational handout, and a 10-minute educational video reviewing the blood thinners that prevent VTE.

The second strategy focused on nurses, who are usually in charge of administering VTE prevention drugs to patients. On a monthly basis, unit nurse managers would get individualized “score cards” outlining the number of VTE prevention drugs each nurse prescribed, administered, or saw refused by a patient.

The researchers left it up to individual unit nurse managers whether they provided coaching in response to the scorecards.

The researchers deployed one of the strategies on one of 10 adult non-intensive care medical units and six surgical units at The Johns Hopkins Hospital, reaching a total of around 9,600 patients. And on the whole, they were successful.

These two strategies had a combined positive impact on medication adherence to blood thinners, reducing the rate of refused or missed VTE prevention drugs by around 36 percent.

In units where researchers used the patient education bundle, the number of missed doses for any reason dropped by 44 percent. The number of patients refusing doses went down by 54 percent.

“Our study provides clear evidence that supports the use of IT strategies [the alert-triggered intervention] with targeted patient-centered education to bolster best practices of VTE prophylactic medication administration,” Haut explained.

The nurse feedback intervention was also a success, albeit more modestly. In units where that intervention was rolled out, missed doses fell by 28 percent, and patient-refused doses dropped by 29 percent.

“While the nurse feedback intervention had a more modest improvement, it required fewer information technology [IT] resources and less frequent nurse engagement,” study senior author Brandyn Lau, MPH, assistant professor of radiology and radiological science at the Johns Hopkins University School of Medicine, said in the statement.

These findings are key for healthcare organizations working to improve medication adherence rates among acute care patients in the hospital. However, medication adherence in chronic disease management is a different beast.

Although patient education is always important in any care management plan, the most common barrier to medication adherence among chronically ill people is the high cost of drugs. Clinicians focusing on chronic disease populations should continue to look into cost-effective medication access for their patients.

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