NRS 465 PICOT Question Development

Sample Answer

PICO(T) Question In elderly patients suffering from chronic diseases (population), how do medication reminder apps (intervention), compared to traditional reminder methods like alarms or written schedules (Comparison), affect medication adherence (Outcome) within three months (Time, Optional)?

PICO(T) Question Template

P Population Elderly patients with chronic diseases

I Intervention Medication reminder apps

C Comparison Traditional reminder methods like alarms and the written schedule

O Outcome Improving rates of medication adherence by 30%

T Timeline Three months

PICOT Question

In elderly patients with chronic diseases (P), how do medication reminder apps (I) compared to traditional reminder methods like alarms and written schedules (C) improve rates of medication adherence by 30% (O) within three months (T)?

Problem Statement

The problem statement is a scholarly statement that justifies or rationalizes that this is a problem. A problem statement must include literature for support and justification. In 150 words or less, provide a problem statement for your PICOT question.

Medication adherence is important for patients to attain quality outcomes based on prescribed medications. However, non-adherence to medications is a rising concern, especially among elderly patients with chronic diseases who have multiple medications to take for their different conditions.

Non-adherence to medications increases the cost of care and length of stay in facilities. Elderly patients with chronic conditions suffer from various health conditions associated with aging and old age leading to cognitive impairment that affects adherence to medications.

Studies show that close to 50% of elderly patients do not adhere to medications, which exacerbates their efforts to improve health outcomes. Providers like nurses should integrate evidence-based practice interventions to increase the rates of adherence to medications for elderly patients and improve outcomes.

In their study, Stewart et al. (2022) focus on the health impact, prevalence, correlates, and interventions to deal with medication non-adherence. Further, the American Medical Association (AMA) (2023) is categorical that medication non-adherence happens due to several reasons that include poly-pharmacy, forgetfulness, lack of symptoms, and misunderstanding among other factors.

Population

The population target helps narrow the scope of the project. In 150 words or less, describe the population of interest including its functional and problem-solving capabilities.

The population of interest is elderly patients suffering from one or more chronic conditions like diabetes, hypertension, dementia, and other mental health conditions. This population is susceptible to comorbidities as a result of age-related conditions like dementia, Alzheimer’s disease, and schizophrenia among others.

Due to possible comorbidities, these individuals are exposed to and require medications, which may include poly-pharmacy where they have to take multiple medications for the various conditions that one may be having. Consequently, they forget and may misunderstand taking medications at the right time and in the right dosage.

Elderly patients suffering from these chronic conditions require effective interventions to reduce non-adherence that emanates from different factors. Liu et al. (2023) assert that multi-morbidity and poly-pharmacy are some of the critical risk factors that lead to medication non-adherence among elderly patients.

Further, Alhabib et al. (2022) observe that patients require an effective understanding of their conditions and strong beliefs about the prescribed medications to improve adherence.

Nursing Intervention

A nursing intervention is used to address the problem. In 150 words or less, describe the nursing intervention. The proposed nurse intervention is integrating technology through medication reminder apps. Existing evidence from studies demonstrates that mobile apps or applications as reminders can improve medication adherence among elderly patients.

For instance, the study by Poorcheraghi et al. (2023) demonstrates the efficacy of mobile applications based on older patient specifications in improving drug adherence and reducing adverse events. Further, Blinker Jr. et al. (2022) note that smartphone medication reminder applications can support efforts to reduce non-adherence to medications among elderly patients.

Cao et al. (2024) also demonstrate the significance of mobile apps to improve medication adherence among older adults who have survived from stroke. The implication is that the proposed intervention is based on existing evidence about its efficacy in reducing medication non-adherence rates among elderly patients with chronic conditions.

Comparison

In 150 words or less, compare the nursing intervention to what is currently in place at your practicum site/selected setting. Currently, many facilities and providers use traditional reminders like bed alarms and schedules. These interventions work well for patients.

However, the increasing rates of non-adherence emanating from forgetfulness and poly-pharmacy make traditional methods like alarm reminders ineffective. The reminders may be effective in reducing non-adherence but not to satisfactory levels.

In their paper, Saha et al. (2022) demonstrate that alarms are effective with only 16% of patients being sure of not missing their medications by using the intervention. This evidence demonstrates that traditional reminders do not guarantee enhanced compliance or adherence to medications, implying the need for more measures like integrating technology to improve outcomes.

Outcome

An outcome is the result expected from the implemented action. In 150 words or less, describe the expected outcome for the selected intervention.
The expected result from the proposed intervention is to reduce the rate of non-adherence to medications by 30% among patients with chronic conditions.

The proposed intervention of integrating mobile applications as reminders will enhance outcomes and chances of patients and providers not missing medications. Medication non-adherence leads to poor outcomes, increases the cost of care, and endangers patient safety.

Therefore, the proposed intervention is expected to address these issues and increase adherence in the selected population. For instance, through a systematic review and meta-analysis, Peng et al. (2020) demonstrate the effectiveness of using mobile applications to improve medication adherence in adults with chronic diseases. The study asserts that compared to the conventional approach, mobile apps help improve medication adherence.

Time Frame

Every project should have a specified time frame. In 150 words or less, describe the time frame for implementing the proposed intervention and evaluating the outcome. (Note The capstone project will not be implemented on the practicum site. This is only a proposal.)

The time frame for the implementation of the proposed project is three months. This implies that the facility will develop strategies to implement the intervention within three months and evaluate the effects on patient safety and care, especially where the patients do not miss medications.

References

• Alhabib, M. Y., Alhazmi, T. S., Alsaad, S. M., AlQahtani, A. S., & Alnafisah, A. A. (2022). Medication adherence among geriatric
  patients with chronic diseases in Riyadh, Saudi Arabia. Patient preference and adherence, 16 2021-2030.
  DOI 10.2147/PPA.S363082
  
• American Medical Association (AMA) (2023 February 22). 8 reasons patients don’t take their medications.
  https //www.ama-assn.org/delivering-care/physician-patient-relationship/8-reasons-patients-dont-take-their-medications
  Brinker Jr, D. L., Foley, K. A., Zhou, Y., Acevedo-Callejas, M., Li, Y., & Farrell, E. L. (2022). Use of a smartphone medication
  reminder application to support emerging adult adherence to non-antibiotic treatment for viral upper respiratory tract infection. Journal of primary care & community health, 13, 21501319221129732. DOI 10.1177/21501319221129732
  
• Cao, W., Wang, J., Wang, Y., Hassan, I. I., & Kadir, A. A. (2024). mHealth App to improve medication adherence among older adult
  stroke survivors Development and usability study. Digital health, 10, 20552076241236291. https //doi.org/10.1177/20552076241236291
  
• Liu, J., Yu, Y., Yan, S., Zeng, Y., Su, S., He, T., … & Yue, X. (2023). Risk factors for self-reported medication adherence in
  community-dwelling older patients with multi-morbidity and poly-pharmacy a multicenter cross-sectional study. BMC geriatrics, 23(1) 75. DOI https //doi.org/10.1186/s12877-023-03768-7
  
• Peng, Yihang, et al. “Effectiveness of mobile applications on medication adherence in adults with chronic diseases a systematic
  review and meta-analysis.” Journal of managed care & specialty pharmacy, 26.4 (2020) 550-561.
  DOI 10.18553/jmcp.2020.26.4.550
  
• Poorcheraghi, H., Negarandeh, R., Pashaeypoor, S., & Jorian, J. (2023). Effect of using a mobile drug management application on
  medication adherence and hospital readmission among elderly patients with polypharmacy a randomized controlled trial. BMC health services research, 23(1), 1192. DOI https //doi.org/10.1186/s12913-023-10177-4
  
• Saha, S. K., Adhikary, A., Jha, A., Saha, S., & Bora, B. (2022). Probability of Medication Adherence When Alarm Is Used as a
  Reminder. International Journal of Reliable and Quality E-Healthcare (IJRQEH), 11(1), 1-16. DOI 10.4018/IJRQEH.305221
  
• Stewart, S. J. F., Moon, Z., & Horne, R. (2023). Medication nonadherence health impact, prevalence, correlates, and interventions.
  Psychology & health, 38(6) 726-765. https //doi.org/10.1080/08870446.2022.2144923