A behavioral feedback-based intervention to improve medication adherence in older adults with hypertension

Includes bibliographical references.Dissertations, Academic -- University of Missouri--Columbia -- nursing."May 2009"Vita.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Thesis (Ph. D.) University of Missouri-Columbia 2009.Medication adherence among older adults is far below the levels needed for clinical effectiveness from many medications. Control of hypertension prevents the development of further chronic disease and limits morbidity and mortality. This exploratory RCT tests an 8-week behavioral feedback-based intervention to improve medication adherence and blood pressure control among older adults with hypertension. Fifteen adults aged 60 years and older were randomized to intervention or control groups. At 12 weeks post-randomization, outcomes were improved in the intervention group versus control group for medication adherence (Cohen's d = 1.35), systolic blood pressure (d = 0.99), and diastolic blood pressure (d = 1.12). The intervention was wellreceived by study participants, and outcomes show promise for improving adherence and blood pressure outcomes.Includes bibliographical reference

Longevity perceptions in patients who have had their kidney transplant for 25 years or longer [abstract]

Survival of a renal transplant beyond 25 years is a relatively rare event with median length of graft survival 11 years. Numerous outcomes, but no studies have described longevity perceptions of individuals who have had their kidneys for 25 years or longer. The purpose of this qualitative study was to examine longevity perceptions of 19 renal transplant recipients who had their transplants for 25 years or longer. The question asked of the subjects was "To what do you attribute keeping your kidney for such a long time?" Appropriate institutional approval and human subjects during the study. The sample was obtained from an informal support group which includes only those who have had their kidney transplant for 25 years or longer. A semi interview was audio-taped and transcribed. Data sample consisted of 19 participants (7 male, 12 female) ranging in age from 43 to 67 years, with a mean age of 52.8 years (S.D. = 6.82). Transplants were performed between 26 and 36 years ago, with a mean of 30.7 years (S.D. = 3.2). Themes emerged included competence, autonomy, relatedness, faith, normalcy, and luck. The participants voiced statements of competence in the care of their kidney, autonomy in health decisions, and relatedness to support group member transplant games, and/or to the donor's family. Striving for a sense of normalcy, faith, and luck were also shared by the participants Michelle Matteson (Doctoral Candidate) RN, PhD (Postdoctoral Fellow) (Cynthia Russell RN, PhD) Sinclair School of Nursing Numerous studies have described predictors of poor renal transplant ceptions protection was followed semi-structured phone were examined using thematic analyses. The 7 participants

The Medication Adherence Context and Outcomes Framework Image

Background: Adherence interventions have been largely ineffective, with most taking a "one-size-fits-all” approach without consideration of reasons for nonadherence. While the ABC Taxonomy clarified terminology and identified various outcomes measured along the process continuum, intervention design requires understanding the environments and contexts that contribute to nonadherence. A framework that combines the understanding of environment contextual influences, processes, and outcomes is needed to move forward with approaches to intervention design. Methods: Developed based on theory, practice, and research, the Medication-management and Adherence Contexts and Outcomes (MACO) framework describes the environmental contexts, the processes that occur within the contexts, and how these processes contribute to adherence outcomes. The MACO framework differentiates the processes, defined as medication management, within and across contexts that affect adherence outcomes. Results: Three distinct yet interrelated contexts identified in the MACO framework include 1.) clinic, 2.) pharmacy, and 3.) home. Conclusions: The MACO framework is a useful heuristic to understand at which point people experience problems with managing medications in the medication management continuum. This information can then be used for designing and delivering context-specific interventions and selecting appropriate outcome measures of adherence based on the contexts

A core curriculum for the continuing professional development of nurses: Developed by the Education Committee on behalf of the Council on Cardiovascular Nursing and Allied Professions of the ESC

Background: The European Society of Cardiology and the Council on Cardiovascular Nursing and Allied Professions share a vision; to decrease the burden of cardiovascular disease in Europe. Nurses represent the largest sector of the health professional workforce and have a significant contribution to make, which has not yet been fully realised. Recent evidence highlights an association between the level of nurse education and inpatient mortality making this an important topic, particularly as the provision of nurse education in Europe is variable. Aim: To develop a core curriculum to inform the education of nurses following initial qualification for work in cardiovascular settings. Method: A syllabus was developed using published literature, policy documents and existing curricula with expert input from service users, specialist nurses, cardiologists, educationalists and academics. The syllabus formed the framework for the development of the core curriculum. Results: Eight key themes characterise the core curriculum which are presented together with an account of the development process. While the curriculum is not intended to cover all aspects of the highly complex role of the cardiovascular nurse, the themes do exemplify the science and art of nursing and are transferable across different levels of clinical practice and settings. The curriculum functions both as a ‘map’, which identifies key themes to include in nurse education, and as a ‘tool’ to inform educational provision that bridges’ the gap between initial nurse education and advanced specialist practice. Content can be adapted for use to fit the national context and reflects the specific needs, health priorities, legislative and regulatory standards that govern safe nursing practice across different countries. Conclusion: The core curriculum can be used as a learning framework to guide nurse education, in particular the continuing professional education of post-qualifying nurses working in cardiovascular settings. This represents a significant step towards streamlining cardiovascular nurse education in Europ

Medication beliefs and antihypertensive adherence among older adults: a pilot study

Older adults with hypertension are dependent on medication to control blood pressure and reduce risk for cardiovascular disease and renal impairment. Unfortunately, adherence to antihypertensive regimens remains low. This pilot study examines the relation among medication beliefs, demographic variables, and antihypertensive medication adherence in a sample of older adults (median age = 74 years). Medication beliefs were measured using the Beliefs About Medicines Questionnaire (BMQ), and medication adherence was measured by electronic monitoring. Among study participants (n = 33), concerns about medications were found to be related to poorer antihypertensive adherence. In particular, older adults with lower medication adherence were concerned about dependency and long-term effects from their medications. When controlling for other factors that may influence antihypertensive adherence, beliefs about medication necessity were related to adherence (odds ratio: 2.027, 95% confidence interval: 1.10-3.75)

Systematic Review of Clinical Practice Guidelines for the Improvement of Medication Adherence

Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and existing practice guidelines are unclear.; This review evaluated clinical practice guidelines designed to help health care providers address patients' medication adherence.; Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation.; We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (n = 20 guidelines); educational strategies (n = 18); behavioral strategies (n = 17); therapeutic relationship, communication, and provider factors (n = 19); and addressing outside influences/co-morbidities (n = 10).; Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes

Systematic review of clinical practice guidelines for the improvement of medication adherence

Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and existing practice guidelines are unclear.; This review evaluated clinical practice guidelines designed to help health care providers address patients' medication adherence.; Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation.; We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (n = 20 guidelines); educational strategies (n = 18); behavioral strategies (n = 17); therapeutic relationship, communication, and provider factors (n = 19); and addressing outside influences/co-morbidities (n = 10).; Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes

A core curriculum for the continuing professional development of nurses: Developed by the Education Committee on behalf of the Council on Cardiovascular Nursing and Allied Professions of the ESC

Background: The European Society of Cardiology and the Council on Cardiovascular Nursing and Allied Professions share a vision; to decrease the burden of cardiovascular disease in Europe. Nurses represent the largest sector of the health professional workforce and have a significant contribution to make, which has not yet been fully realised. Recent evidence highlights an association between the level of nurse education and inpatient mortality making this an important topic, particularly as the provision of nurse education in Europe is variable. Aim: To develop a core curriculum to inform the education of nurses following initial qualification for work in cardiovascular settings. Method: A syllabus was developed using published literature, policy documents and existing curricula with expert input from service users, specialist nurses, cardiologists, educationalists and academics. The syllabus formed the framework for the development of the core curriculum. Results: Eight key themes characterise the core curriculum which are presented together with an account of the development process. While the curriculum is not intended to cover all aspects of the highly complex role of the cardiovascular nurse, the themes do exemplify the science and art of nursing and are transferable across different levels of clinical practice and settings. The curriculum functions both as a ‘map’, which identifies key themes to include in nurse education, and as a ‘tool’ to inform educational provision that bridges’ the gap between initial nurse education and advanced specialist practice. Content can be adapted for use to fit the national context and reflects the specific needs, health priorities, legislative and regulatory standards that govern safe nursing practice across different countries. Conclusion: The core curriculum can be used as a learning framework to guide nurse education, in particular the continuing professional education of post-qualifying nurses working in cardiovascular settings. This represents a significant step towards streamlining cardiovascular nurse education in Europ