Science of Nursing Care
Management of Medications and Adherence in People with Multiple Chronic Conditions
My research is patient-centered and aims to produce new knowledge to reduce the complexity of medication self-management and improve adherence in people managing multiple chronic conditions. Understanding the patient experience in understanding and managing medications is the hallmark of my research. In the first stage of this research, my team used Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data from adult patients discharged from 3420 hospitals across the US. HCAHPS data is one way to engage patients in providing feedback on the quality of care received in the hospital. We found that nurse and physician communication were associated with patients perceptions of communication about new medications. I then formed a team and partnered with a rural community hospital to analyze their HCAHPS data (N=154). We used these data to build a logistic regression model and identified four correlates of patients’ perceived understanding of their medications (nurses always communicates well, physician always communicates well, new prescriptions during hospital stay, and generally good self-perceived mental health) that classified 72.6% of cases. The nurse always communicating (OR = 3.10, 95%CI: 1.25, 7.66) and generally good patient self-perceived mental health (OR = 2.17, 95%CI:1.02, 4.64) were significantly correlated with patients strongly agreeing that they understood discharge medications. We then disseminated these results to the hospital’s patient and public advisory board to gain a patient-centered perspective of the data and to develop next steps for intervention development. I have an ongoing partnership with this community hospital (Schneck Medical Center) and we are currently designing interventions to improve care delivery in the hospital to prepare patients for hospital discharge and self-management of medications at home, emphasizing the importance of nurse communication based on my research findings. Patients in the advisory board identified a need to improve discharge instructions and assess for medication management capabilities early in the hospital stay in order to prepare for hospital discharge. We will be incorporating my transdisciplinary research findings from other research studies (on my CV), such as use of an electronic pillbox as a possible strategy, along with enhancing communication between patients and care providers. This work is based on evidence generated through my research and is cross disciplinary, patient centered and engages patients in improving care delivery. The overarching aim of my program of research is to improve how people manage their medications to improve their overall quality of life.