Increasing Medication Adherence in a Primary Care Practice

Abstract

The focus of this Doctor of Nursing Practice project was to target medication adherence in a private, rural primary care office, designated as a Rural Health Clinic, in a Tier 1 county in central North Carolina. The project site identified that not enough patients with Medicare were demonstrating medication adherence to statins, oral antidiabetics, and renin-angiotensin system antagonists to achieve a 5-star rating for quality metrics. The purpose of the project was to develop and implement a standardized process to increase medication adherence for patients with Medicare and increase star ratings in a rural primary care office. The project included a four-part intervention to assess for medication adherence and address barriers, to use patient-friendly prescription practices, to increase scheduled follow-up visits, and to recapture patients who were identified as nonadherent. Findings from the project revealed a significant increase in the star rating for oral antidiabetics, the star rating remained stable for the renin-angiotensin system antagonists, and there was a slight decrease in the star rating for statins. There were positive results for four process measures, including improvement in prescribing prescriptions for 90 days or more, scheduling follow-up visits, including diagnosis or procedural codes in the chart, and sending prescriptions to a mail-order pharmacy. However, the trend decreased for the number of DOSE-Nonadherence measure forms completed during the project period. This project contributed to the creation of a quality committee and increased focus on quality measures, laid a foundation for improved medication adherence, and demonstrated the importance of nursing leadership in improving patient outcomes.