Improving Medication Adherence In Patients With Multiple Chronic Conditions : Evaluation Of A Pilot Intervention In A Rural Primary Care Clinic

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Laura M. Daniels (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: Background: More than 25% of primary care patients are managing multiple chronic conditions (MCC) and 50% of their medications are not taken as prescribed. Self-efficacy is the foundation of many successful medication adherence and chronic disease self-management (CDSM) interventions for specific chronic conditions. Interventions designed within a self-efficacy framework and tailored for the primary care setting could improve health outcomes for patients with MCC. Primary Aims: 1) Describe demographic and psychosocial characteristics of patients with MCC, 2) Examine the relationships between number of chronic conditions, primary (medication adherence) and secondary (health literacy, self-efficacy, problem-solving, and QOL) variables, 3) Evaluate the preliminary efficacy of a medication adherence intervention for patients with MCC on improving outcomes. Methods: Adult patients presenting for care in the Family Medicine department at a rural Federally Qualified Health Center were recruited to complete a survey on CDSM and participate in the intervention. The intervention involved 4 group sessions and 2 follow-up telephone sessions. Data collection occurred at baseline and post-treatment. Results: Pilot study results indicated that MCC was prevalent in 62% of the sample (N = 53), patients and providers generally had similar perceptions of CDSM needs, and better medication adherence was among the most frequently endorsed need. The intervention study participants (N = 20) were managing on average 5 chronic conditions and 40% had less than adequate health literacy levels. Health literacy and MCC were significantly positively associated (p = 0.036). Outcomes analyses indicated that scores significantly improved on measures of Effective Problem-solving (p = .028, d = .67), Positive Transfer Problem-solving (p = .010, d = .67), Self-efficacy for managing chronic disease in general (p = .005, d = .66), and Self-efficacy for engaging in social/recreational activities (p = .005, d = .42). Self-reported medication adherence improvements fell short of significance. Conclusions: Participants reported significant improvements on factors theoretically and empirically linked to adherence and health outcomes. Research with larger samples and longer follow-up is needed in order to evaluate the efficacy of this treatment and mechanisms for change. Collaborating with patients and providers during program development could facilitate acceptability and sustainability of CDSM programs.

Additional Information

Publication

Dissertation

Language: English

Date: 2023

Subjects

Clinical psychology;Health care management;Behavioral psychology;Health literacy;Medication adherence;Primary care;Self-efficacy;Self-management

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