Professional poster presentation

Medication non-adherence is a major barrier to effective chronic disease management and is associated with poor clinical outcomes, preventable hospitalizations, and increased healthcare costs. This evidence-based practice project implemented a structured nurse-led medication adherence program in a private primary care clinic using the Iowa Model of Evidence-Based Practice as the guiding framework. A total of 120 adult patients with chronic diseases participated in the six-week implementation. The intervention included medication reconciliation, individualized patient education delivered in each patient's preferred language, teach-back communication, motivational interviewing, written medication schedules, and follow-up telephone calls. Medication reconciliation was completed for 100% of participants. Baseline evaluation demonstrated that 92% of participants were -to their prescribed medication regimen. Following implementation, medication non-adherence decreased to 30%, demonstrating substantial improvement in medication adherence. These findings support the effectiveness of multifaceted nurse-led interventions in improving medication adherence, enhancing patient engagement, and promoting chronic disease self-management in the primary care setting. The project highlights the leadership role of advanced practice registered nurses in translating evidence into sustainable clinical practice.

Table of Contents Abstract 2 Introduction 3 Background of the Practice Problem 4 Clinical Setting 5 Problem Statement 6 Purpose Statement 6 PICOT Question 7 Literature Review 7 Medication Reconciliation and Follow-Up. 9 Implications for Advanced Practice Nursing 10 Literature Review Summary 10 Conceptual Framework: Iowa Model of Evidence-Based Practice 10 Evidence-Based Practice Intervention 11 Implementation Plan 12 Stakeholders and Project Team 12 Budget and Resources 13 Implementation Timeline 13 Evaluation Plan 13 Results 14 Interpretation of Results 15 Discussion 15 Actual Outcomes 16 Barriers and Facilitators 16 Ethical Considerations 17 Sustainability Plan 17 Implications for Advanced Nursing Practice 17 Conclusion 18 References 20

Chronic diseases are the leading cause of morbidity, mortality, and healthcare expenses in the United States, requiring consistent medication adherence to achieve optimal outcomes. Despite the availability of effective therapies, approximately half of adults with chronic conditions do not take medications as prescribed, resulting in poor disease control, preventable complications, increased healthcare utilization, and higher costs (Berardinelli et al., 2024; Conn et al., 2023). Medication adherence is influenced by multiple factors, including limited health literacy, complex medication regimens, financial barriers, inadequate patient education, and poor follow-up (Papus et al., 2022).

Advanced practice registered nurses (APRNs) play an essential role in improving adherence through patient education, medication reconciliation, care coordination, and evidence-based interventions. Strategies such as motivational interviewing, teach-back, individualized education, and structured follow-up have consistently improved adherence and chronic disease outcomes (Berardinelli et al., 2024; Kim et al., 2023). This evidence-based practice project recommended implementing a structured nurse-led medication adherence program in a private outpatient primary care clinic. Guided by the Iowa Model of Evidence-Based Practice, the intervention integrated medication reconciliation, individualized education, teach-back, written medication schedules, motivational interviewing, and follow-up telephone calls to improve medication adherence, optimize chronic disease management, enhance patient engagement, and strengthen evidence-based nursing practice.

Medication adherence is a crucial factor that determines successful chronic disease management and helps achieve the best clinical outcomes. However, medication adherence is determined by a combination of several factors both related to patients, their providers, and the healthcare system itself. Typical factors that impede medication adherence include low health literacy, inadequate knowledge of prescribed medications, financial limitations, complex medication regimens, side effects, and insufficient follow-up (Papus et al., 2022; Hartch et al., 2024). These factors can be seen in a great extent among those who suffer from various chronic diseases and take pharmacological drugs throughout their whole life.

Poor medication adherence has adverse impacts not only on health outcomes. Lack of adherence is related to the development of the disease, poor quality of life, visits to the emergency department, unnecessary hospital admissions, and increased healthcare expenses (Conn et al., 2023). In addition, health care organizations have to demonstrate high-quality standards regarding chronic disease management and can be evaluated according to certain measures (Hartch et al., 2024).

During clinical practice in a private outpatient primary care clinic, medication nonadherence was consistently identified as a contributing factor to uncontrolled hypertension, diabetes, and hyperlipidemia despite the availability of evidence-based pharmacologic treatments. Medication reconciliation frequently revealed missed doses, premature discontinuation of therapy, and misunderstandings regarding medication instructions. These observations suggest that improving adherence requires more than prescribing effective medications; it requires structured, patient-centered interventions that address the underlying barriers to treatment adherence.

Evidence-based Practice Project was conducted in a privately-owned outpatient primary care clinic located in Southwest Florida, which is an organization providing services to adult patients with acute and chronic diseases. The interdisciplinary team consists of the physician who is in charge of the practice, a nurse practitioner, registered nurses, medical assistants, administrative staff, and referral coordinators. This group works together providing patient-centered evidence-based healthcare.

There are a wide range of culturally diverse adult patients treated in the clinic; most of them are Hispanic patients preferring healthcare services to be delivered in Spanish. Chronic diseases, which are common for the patients in the clinic, include hypertension, type 2 diabetes mellitus, hyperlipidemia, obesity, chronic kidney disease, chronic obstructive pulmonary disease, asthma, anxiety, and depression. Despite access to evidence-based therapies, providers frequently encounter uncontrolled chronic conditions that are associated with inconsistent medication use and barriers to treatment adherence.

This evidence-based practice project's purpose was to implement and evaluated a medication adherence program structured in a nurse-led manner for adults diagnosed with chronic diseases in a private primary care clinic. In this project, medication reconciliation, personalized education, health literacy interventions, motivational interviewing, teach-back strategy, a schedule of medications in writing, and telephonic follow-up visits have been combined in clinical practice. This project seeks to achieve better medication adherence, increased patient engagement, optimal management of chronic diseases, and better evidence-based practice of nursing through translating the available research into clinical practice (Buckwalter et al., 2022).

Including adult patients with chronic diseases receiving care in a primary care clinic (P), does implementation of a structured nurse-led medication adherence program that includes medication reconciliation, individualized patient education, motivational interviewing, teach-back communication, written medication schedules, and follow-up telephone calls (I), compared with usual care (C), improve medication adherence, blood pressure control, hemoglobin A1c levels, lipid management, and reduce preventable emergency department visits and hospitalizations over six weeks (O/T)?

Medication -continues to undermine chronic disease management despite advances in evidence-based pharmacologic therapies. Adults with chronic conditions frequently require complex medication regimens, yet nearly half do not take medications as prescribed, contributing to poor disease control, preventable hospitalizations, increased healthcare costs, and reduced quality of life (Berardinelli et al., 2024; Conn et al., 2023). Because adherence is influenced by behavioral, educational, socioeconomic, and healthcare system factors, current evidence recommends comprehensive, patient-centered interventions rather than isolated educational strategies (Papus et al., 2022).

Medication adherence is influenced by several barriers, which include low health literacy, financial issues, complexity of the medication regimen, cultural beliefs, poor communication by providers, and lack of follow-up (Hartch et al., 2024; Papus et al., 2022). These barriers are even more pronounced among people with several chronic conditions, thus highlighting the importance of individualized interventions.

There is substantial evidence that suggests nurse-led interventions as a useful way to increase adherence rates. Several systematic reviews have shown that interventions involving the use of medication reconciliation, education, motivational interviewing, behavioral counseling, and follow-up were more effective than usual care (Berardinelli et al., 2024; Kim et al., 2023). Advanced practice registered nurses have the necessary knowledge and skills to implement these interventions due to their continuous interactions with patients.

Health literacy is another critical determinant of adherence. Patients with limited health literacy often struggle to understand medication instructions and treatment goals, increasing the risk of medication errors and treatment discontinuation. The Agency for Healthcare Research and Quality (AHRQ, 2024) recommends universal health literacy precautions, including plain-language communication and the teach-back method, to improve patient understanding and reinforce self-management. Studies have shown that individualized education combined with teach-back enhances medication knowledge, patient confidence, and adherence more effectively than traditional education alone (AHRQ, 2024; Kim et al., 2023).

Behavioral interventions such as motivational interviewing further strengthen adherence by addressing patients' beliefs, readiness for change, and perceived barriers to treatment. Motivational interviewing promotes collaborative decision-making and has been associated with sustained improvements in medication adherence across multiple chronic conditions (Papus et al., 2022). Additionally, implementation research suggests that motivational interviewing can be successfully incorporated into routine primary care when clinicians receive appropriate training and organizational support (Temedda et al., 2024).

Overall, the literature supports implementing a multifaceted, nurse-led medication adherence program that integrates medication reconciliation, individualized education, teach-back communication, motivational interviewing, and structured follow-up. Guided by the Iowa Model of Evidence-Based Practice, these strategies provide a strong evidence base for improving medication adherence, enhancing chronic disease outcomes, and advancing quality improvement in primary care (Buckwalter et al., 2022).

Advanced practice registered nurses (APRNs) play a vital role in improving medication adherence through patient education, chronic disease management, interdisciplinary collaboration, and quality improvement initiatives. Beyond prescribing medications, APRNs are uniquely positioned to identify adherence barriers, implement evidence-based interventions, evaluate patient outcomes, and lead practice changes that promote safe, patient-centered care (Melnyk & Fineout-Overholt, 2023). Their leadership is essential for translating current evidence into sustainable clinical practice and fostering organizational cultures that support continuous quality improvement (Buckwalter et al., 2022).

An interdisciplinary team consisting of the nurse practitioner project leader, supervising physician, registered nurses, medical assistants, administrative personnel, and information technology staff collaborated throughout implementation. Evidence supports interdisciplinary collaboration as an essential component of successful translation of research into sustainable clinical practice (Melnyk & Fineout-Overholt, 2023).

Teach-back communication was used during every educational encounter according to AHRQ recommendations (AHRQ, 2024). Motivational interviewing helped identify patient-specific barriers and strengthen self-management (Papus et al., 2022; Temedda et al., 2024). Written medication schedules and structured follow-up telephone calls reinforced adherence and addressed emerging concerns (Hartch et al., 2024).

During the six-week implementation period, 120 adults participated. Medication reconciliation was completed for every participant, education was delivered in the patient's preferred language, teach-back was documented, written medication schedules were distributed, and follow-up calls reinforced adherence.

The evidence-based practice project was implemented over a six-week period in a private primary care clinic. A total of 120 adult patients with chronic diseases participated in the intervention. Medication reconciliation was completed for 100% of participants before provider evaluation. Every patient received individualized education in his or her preferred language, teach-back communication, motivational interviewing, written medication schedules, and follow-up telephone calls. Baseline assessment demonstrated that 92% of participants were non-adherent to their prescribed medication regimen. Following implementation, medication non-adherence decreased to 30%, representing a substantial improvement in medication adherence. Overall medication adherence increased from 8% at baseline to 70% after implementation, demonstrating the effectiveness of the structured nurse-led intervention.

The intervention was associated with a clinically meaningful improvement in medication adherence. Providing education in each patient's preferred language, completing medication reconciliation before provider evaluation, and reinforcing learning through teach-back, motivational interviewing, and follow-up telephone calls likely improved patient understanding and engagement. The reduction in medication non-adherence from 92% to 30% supports the effectiveness of combining multiple evidence-based nursing interventions rather than relying on education alone.

The findings are consistent with the evidence summarized in the literature review. Previous studies demonstrated that multifaceted nurse-led interventions improve medication adherence among adults with chronic diseases (Berardinelli et al., 2024, Kim et al., 2023, Papus et al., 2022). Similar improvements were observed during implementation of this project. One notable strength was the provision of education in each patient's preferred language, which likely improved health literacy and patient engagement. Medication reconciliation identified discrepancies and barriers before provider evaluation, while teach-back confirmed patient understanding and follow-up calls reinforced adherence after the clinic visit.

Although adherence improved substantially, 30% of participants remained non-adherent at project completion. Persistent barriers such as financial limitations, transportation challenges, complex medication regimens, and competing life responsibilities likely contributed to ongoing non-adherence. Continued monitoring and reinforcement are recommended to sustain long-term improvements.

Challenges encountered during implementation included limited appointment time, financial barriers affecting medication access, complex medication regimens, and difficulty reaching some patients for follow-up (Papus et al., 2022). Key facilitators included strong nurse practitioner leadership, interdisciplinary collaboration, bilingual staff, established patient-provider relationships, organizational support for quality improvement, and an existing electronic health record system (Buckwalter et al., 2022; Melnyk & Fineout-Overholt, 2023). Addressed these factors enhanced implementation success and support long-term sustainability.

Based on the positive outcomes, the clinic plans to continue medication reconciliation, bilingual patient education, teach-back communication, and structured follow-up as part of routine chronic disease management. Periodic chart audits, ongoing staff education, and monitoring of medication adherence indicators will support long-term sustainability (Buckwalter et al., 2022; Hartch et al., 2024).

Medication non-adherence remains a significant barrier to effective chronic disease management despite the availability of evidence-based pharmacologic therapies. Poor adherence contributes to uncontrolled chronic conditions, preventable complications, increased healthcare utilization, and rising healthcare costs. This evidence-based practice project demonstrated that implementing a structured, multifaceted nurse-led medication adherence program can successfully address many of the barriers that contribute to poor medication adherence. The intervention integrated medication reconciliation, individualized patient education, teach-back communication, motivational interviewing, written medication schedules, and structured follow-up into routine primary care practice, consistent with current evidence supporting these strategies.

Guided by the Iowa Model of Evidence-Based Practice, this project successfully translated research evidence into clinical practice through interdisciplinary collaboration, patient-centered communication, and health literacy-focused interventions. Implementation of the program resulted in improved medication adherence, standardized patient education, and enhanced consistency in medication management across the clinic. Medication non-adherence decreased from 92% at baseline to 30% following implementation, demonstrating the effectiveness of the intervention in promoting adherence among adults with chronic diseases.

This project also highlights the leadership role of advanced practice registered nurses in implementing and sustaining evidence-based practice initiatives that improve patient outcomes and healthcare quality. By integrating evidence-based interventions into routine clinical workflows, APRNs can lead meaningful practice changes that promote patient engagement, optimize chronic disease management, and support continuous quality improvement. The findings support continued use of this standardized medication adherence program and provide a framework for implementing similar interventions in other primary care settings.

Agency for Healthcare Research and Quality. (2024). Health literacy universal precautions toolkit (3rd ed.). https://www.ahrq.gov/health-literacy/improve/precautions/index.html