An organizational or patient issue for which a collaborativeinterdisciplinary team approach

Improving Medication Adherence in Patients with Chronic Diseases: An Interdisciplinary Approach

Part 1: Organizational or Patient Issue

• What is the issue that you are trying to solve or improve?
  • Poor medication adherence among patients with chronic diseases (e.g., diabetes, hypertension) is a significant and persistent problem.
• Why should the audience care about solving it?
  • For Patients: Poor adherence can lead to:
    • Worsening of chronic conditions
    • Increased risk of complications (e.g., heart attacks, strokes)
    • Hospitalizations
    • Reduced quality of life
  • For the Healthcare System:
    • Increased healthcare costs due to preventable hospitalizations and complications.
    • Wasted resources on medications that are not taken as prescribed.
  • For the Organization:
    • Increased risk of readmissions, impacting reimbursement rates and patient satisfaction.
    • Potential for negative impact on the organization's reputation.

Part 2: Relevance of an Interdisciplinary Team Approach

• Why is using an interdisciplinary team relevant, or the best approach, to addressing the issue?

  • Medication adherence is a complex issue influenced by various factors, including:
    • Patient-related factors: Health literacy, cognitive function, social support, and cultural beliefs.
    • Medication-related factors: Complexity of medication regimens, side effects, and cost.
    • System-related factors: Access to care, communication barriers, and lack of coordination among healthcare providers.
  • An interdisciplinary team approach allows for a holistic and comprehensive assessment of these factors and the development of tailored interventions.

• How will it help to achieve improved outcomes or reach a goal?

  • Enhanced Communication: Improved communication and coordination among healthcare providers (physicians, nurses, pharmacists, dieticians) ensure consistent messaging and a shared understanding of the patient's care plan.
  • Comprehensive Assessment: Each discipline brings unique expertise to assess patient needs and identify potential barriers to adherence.
  • Tailored Interventions: An interdisciplinary team can develop and implement individualized interventions that address the specific needs and challenges of each patient.
  • Improved Patient Outcomes: By addressing multiple factors influencing adherence, an interdisciplinary approach can lead to improved medication adherence, better health outcomes, and reduced healthcare costs.

Part 3: Interdisciplinary Plan

• Team Composition:
  • Physicians
  • Nurses
  • Pharmacists
  • Registered Dietitians
  • Social Workers
  • Case Managers
• Key Interventions:
  • Medication Therapy Management (MTM) services: Provided by pharmacists to optimize medication regimens.
  • Patient education programs: Delivered by nurses and dieticians to improve health literacy and self-management skills.
  • Regular follow-up appointments: Scheduled by case managers to monitor adherence, address barriers, and provide ongoing support.
  • Social work interventions: To address social determinants of health that may impact adherence (e.g., housing instability, food insecurity).
  • Technology-based interventions: Utilize mobile health apps or telemedicine to improve communication and medication reminders.

Part 4: Implementation and Resource Management

• Implementation Strategy:
  • Develop clear protocols and workflows for interdisciplinary communication and collaboration.
  • Utilize electronic health records (EHR) to facilitate data sharing and communication among team members.
  • Conduct regular team meetings to review patient progress and adjust interventions as needed.
• Human Resources:
  • Ensure adequate staffing levels for each discipline involved in the program.
  • Provide training and education to team members on interdisciplinary collaboration and communication.
• Financial Resources:
  • Explore potential funding sources (e.g., grants, hospital budgets) to support the program.
  • Develop a budget to cover program costs, including staff time, training, technology, and supplies.

Sample Question