Publication Date

2019-08-08

Availability

Embargoed

Embargo Period

2021-08-07

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2019-06-26

First Committee Member

Brian E. McCabe

Second Committee Member

Sandra V. Chaparro

Third Committee Member

Johis Ortega

Fourth Committee Member

Martin M. Zdanowicz

Abstract

Heart failure is a chronic disease that increases mortality, reduces quality of life, and increases health care system costs. About 6.5 million people in the United States and 26 million worldwide have heart failure. Patients with heart failure often take multiple prescription medications. Medication adherence is crucial to improving health outcomes, but patients face multiple barriers to medication adherence. The World Health Organization (2003) describes these barriers as patient factors, therapy-related factors, condition-related factors, social/economic factors, and health care/system factors, and recommends medication adherence interventions address multiple barriers simultaneously. To date, there are no studies of medication possession interventions for heart failure patients at hospital discharge. This pilot randomized control trial enrolled 40 heart failure patients at a large public hospital who use the affiliated pharmacy. Participants in the control condition were assigned to receive usual care of electronic or paper prescription prior to discharge; those in intervention condition received the Meds to Beds intervention, i.e., had medications delivered to them before discharge. The study assessed feasibility and acceptability of the intervention. The study tested differences between conditions in medication adherence measured with pharmacy refill and self report, as well as readmission, death, and self-reported physical health, 30 days after discharge. It was hypothesized that intervention participants would have higher medication adherence and better health outcomes than controls, and that Meds to Beds will have high levels of feasibility and acceptability. However, no significant differences were found between the control group and the intervention group. Significant improvement was observed in self-reported health from baseline to follow-up in both groups. Study findings were limited by poor control of the independent variable; i.e., not all participants assigned to Meds to Beds received medication delivery before discharge. However, study outcomes overall provide a valuable source of data regarding an underserved segment of the population experiencing chronic disease, and to inform future nursing research and practice for patients with heart failure.

Keywords

Medication Adherence, Heart Failure, Patient Discharge, Patient Readmission, Pharmacy Refill

Available for download on Saturday, August 07, 2021

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