Benchmark - Evidence-Based Practice Proposal Final Paper

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Implementation Plan

Student's Name

Institutional Affiliation

Date

Implementation Plan

Purpose

The primary purpose of the interventions created to improve health outcomes associated with Type 2 Diabetes patients in Lowndes County, Valdosta was to improve adherence to Type 2 Diabetes (T2D) Medication. Adherence to T2D medication has been recommended in various settings as the appropriate measure of enhancing health outcomes associated with people from a middle or low socio-economic status in the USA's rural areas (Alfian et al., 2016). Unfortunately, however, there are inadequate studies focusing on the impact of adherence to medication on improving life outcomes for Diabetes Mellitus patients (Alsayed Hassan et al., 2020). The purpose of this research will be to identify whether adherence to Diabetes Mellitus medication is an effective way of improving Diabetes Mellitus outcomes, especially for people in rural areas.

Setting

The setting of Lowndes County is majorly rural. Subjects will be contacted through phone calls or emails, and in some cases, if they cannot access these systems, they will be contacted in person by the doctors who have volunteered for the project. All patients will sign a consent form before participating in the study. The signing of consent forms will be possible by every participant because the minimum age for participation in the study is 18. Participants wil also sign the consent form after they've been fully educated about the study's objective and purpose.

Time

The cross-sectional survey will be conducted within three months. In these three months, data will be collected from Diabetes mellitus patients in Lowndes County who are receiving medication from Secondary Healthcare facilities. Since the study's purpose is to encourage home visitations by doctors and other healthcare givers, Diabetes mellitus patients who agree to have doctors and nurses visit them at home will have an easy time filling out the questionnaires at home.

Sample

To increase the findings' certainty at a 90% confidence level about the effectiveness of adhering to prescribed medication, the least sample size expected is 80 individuals residing within Lowndes County. The participants of the consecutive sampling exercise were expected to fulfill the inclusion criteria of: Taking prescribed diabetes medication, having their T2D diagnosis confirmed for more than four months, over 18 years of age, not taking insulin injection therapy, and be receiving medical care and attention from healthcare facilities in Lowndes County.

Resources required

All the healthcare participants, who are approximately 80, will be expected to conduct this cross-sectional survey with strict observance of the ethical standards stated in Georgia's Healthcare Ethics Consortium and the national research committee. Implementing this initiative will also require costs associated with the personnel such as transport and welfare expenses, consumable supplies, T2D equipment, computers to collect email questionnaires and conduct the analysis of the data collected and research by diverse medical personnel on effective T2D interventions, and materials for developing the presentation of the results of the study.

Training

Basic training will be done to train the caregivers who choose to participate in the study on the effective ways of delivering T2D medication for patients at home. Doctors will also be trained on how to handle patients who have reservations about participating in this initiative. Training will also be offered on how to handle the different medications patients have. For instance, the common T2D medication are diet, exercise, foot examinations, dilated eye examinations, HbAIc tests, and blood glucose monitoring, which is commonly done at home (Chavan et al., 2020). The doctors will need to know to administer the right dosages for patients to avoid adverse interruptions of other healthcare givers' prescriptions.

Data collection

Adherence will be measured through the eight-item Morisky-Medication-Adherence Scale (MMAS). The MMAS scale is utilized to measure the impact of adherence to medication for diabetes and other chronic illnesses because it has good predictive validity and good reliability (Moon et al., 2017). All questions in the questionnaires will be in English, and appropriate translations will be done where necessary. The impact of adherence on a patient's quality of life (QOL) will be measured using the D-39 assessment tool. The D-39 assessment tool was chosen for this study because it is not specific to ethnic groups, health status, educational level, age, gender, or age, making it effective for Diabetes Mellitus studies (Mbuagbaw et al., 2017). The self-administered D-39 will allow patients to specify how the impact of adhering to the medication has improved five dimensions in their lives, which are: worry (6 questions), diabetes control (10) questions, energy and mobility (ten questions), sexual behavior (5) questions, and social impact (four questions) (Thapa et al., 2019). Domain responses will be calculated by summating responses from all participants and applying linear transformation using a 0-100 scale.

Data Analysis

Low scores will be an indication of better life outcomes as a result of medication adherence. The consistency of the results will be measured using a Cronbach alpha of 0.916. Descriptive statistics will be utilized in analyzing the distribution of variables among T2D patients. Continuous variables will be represented using interquartile ranges, medians, standard deviations, medians, and mean, while categorical variables will be assessed using percentages and counts. The relationship between better QOL and adherence will be measured using the Kruskall-Wallis test of significance. This test is significant in comparing data on different strata (Hajji & Leyrat, 2018).

Challenges

One of the common challenges to Diabetes Mellitus intervention is the discouragement physicians encounter after prescribing medications to patients. The failure of patients to adhere to clinical advice is a huge discouragement for many physicians. To address this issue, physicians involved in the program will be educated on efficient emotional-coping skills (Garcia-Molina et al., 2020). Another expected challenge is insufficient time in researching the best techniques for delivering efficient T2D care (Rushforth et al., 2016). To address this issue, the research department will be expected to conduct as much research as possible before the implementation of the plan. They will also be required to present their findings monthly to the hospital's management team.

Budget Plan

The feasibility of allocating the project's finances will be done based on the prioritization of the most urgent tasks. The physicians will also be required to present the recepits of any purchases made during the project to the management team. The estimated costs for each part of the plan are stated below

Type

Amount

Rationale

Personnel-Salaries

7,200,000

80 [email protected],000 for 3 months

Consumable supplies

500,000

Physicians will require a well-established meal plan to facilitate their feeding during the 3 months

Equipment

100,000

Includes equipment such as insulin pen, syringes, insulin pump, and blood glucose meters

Computer-related costs

50,000

Rigorous research will be expected from the research department to ensure that the initiative of the project is effective

Other costs

300,000

Include presentation development and transport

Total

8,150,000

Fig 1: Proposed Budget Plan

If the research shows that adherence to medication is an effective T2D intervention, the project will be carried out with the primary purpose being to encourage patients' adherence to T2D prescribed medication. If adherence is not effective, alternative intervention methods will be identified. Proposed alternatives include Intensive Dietary Management and therapeutic fasting. Therapeutic fasting is used to maintain blood sugar levels through reversing insulin resistance (Furmli et al., 2018). The director of this initiative will ensure that the most appropriate intervention method is identified to improve the health outcomes of T2D patients in Lowndes County, Valdosta.

References

Alfian, S. D., Sukandar, H., Lestari, K., & Abdulah, R. (2016). Medication adherence contributes to an improved quality of life in type 2 diabetes mellitus patients: A cross-sectional study. Diabetes Therapy7(4), 755-764.

Alsayed Hassan, D., Curtis, A., Kerver, J., & Vangsnes, E. (2020). Diabetes Self-Management Education and Support: Referral and Attendance at a Patient-Centered Medical Home. Journal of Primary Care & Community Health11, 2150132720967232.

Chavan, P., Karale, P., Thaware, P., & Misar, P. (2020). Complementary and Alternative Medicine in Association with Type 2 Diabetes Mellitus. Int J Cur Res Rev| Vol12(17), 156.

Furmli, S., Elmasry, R., Ramos, M., & Fung, J. (2018). Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. Case Reports2018, bcr-2017.

Garcia-Molina, L., Lewis-Mikhael, A. M., Riquelme-Gallego, B., Cano-Ibanez, N., Oliveras-Lopez, M. J., & Bueno-Cavanillas, A. (2020). Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. European journal of nutrition59(4), 1313-1328.

HAJJI, Y., & LEYRAT, C. (2018). ANOVA, Welch correction, Satterthwaite correction and Kruskal-Wallis test: comparison of type I error rate and power.

Mbuagbaw, L., Aronson, R., Walker, A., Brown, R. E., & Orzech, N. (2017). The LMC Skills, Confidence & Preparedness Index (SCPI): development and evaluation of a novel tool for assessing self-management in patients with diabetes. Health and quality of life outcomes15(1), 27.

Moon, S. J., Lee, W. Y., Hwang, J. S., Hong, Y. P., & Morisky, D. E. (2017). Accuracy of a screening tool for medication adherence: a systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PLoS One12(11), e0187139.

Rushforth, B., McCrorie, C., Glidewell, L., Midgley, E., & Foy, R. (2016). Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review. British Journal of General Practice66(643), e114-e127.

Thapa, S., Pyakurel, P., Baral, D. D., & Jha, N. (2019). Health-related quality of life among people living with type 2 diabetes: a community based cross-sectional study in rural Nepal. BMC public health19(1), 1171.