G1d, and G1g Planned Intervention Intervention

Description of Intervention:

Medication adherence is one of the effective interventions for diabetes management. Adherence to medication is the extent patients take medications being prescribed for them by health care providers. In other words, a medication adherence refers to the extent patients have conformed to providers recommendations with regards to dosages, timing as well as frequency of medication taking by patients. Raising educational awareness about the importance of adherence to medication is very critical to reduce the rate of readmission. If there is an increase in the level of awareness among patients and educating them about how medications are very important for the management of diabetes, the rate of medication adherence will increase among patients.

The best intervention strategy for the medication adherence is to use SIMPLE model for patients. The SIMPLE model consists of:

S -- Simplify the medication regime

I -- Impart knowledge

M -- Modify patient behavior and beliefs

P -- Provide trust and communication

L -- Leave the bias

E -- Evaluate adherence

The CDC (2013) reveals that the medication adherence increases among patients within 3 months, however, decline after 6 months. Typically, about 40% of diabetes patients discontinue with medication after 6 months. In essence, high adherence to medication can reduce the LCD cholesterol and reduce the blood pressure. Patient education is one of the strategies for effective adherence. It is the responsibility of health care providers to educate patients about the negative effective of non-adherence and benefits of adherence to medication. In the United States, non-adherence to medication can increase the risks of mortality, which can consequently lead to death rate. Moreover, non-adherence can increase the cardiovascular risks by up to 40% and mortality by up to 80%. Thus, adherence to medications will reduce the rate of hospitalization of diabetes patients.

E3a. Measurement Methodology:

The study will use BMQ (Brief Medication Questionnaire) to assess the level of the adherence to the medication. Typically, the BMQ is very effective in determining the level of the use medication and under-use of medication. Moreover, the BMQ can be used to measure patients' medication beliefs. The BMQ consists of 11 items that include 5-point Likert scales to measure medication adaptation. More importantly, the BMQ will be used to measure patients' satisfaction to medication. The modified version of medication scale covers satisfaction received from doctors as well as from other medical practitioners. The paper will also use the MAQ (Medication Adherence Questionnaire) for the medication adherence. Major reason for using the MAQ is that it is the easiest to use and is the shortest scale. The MAQ consists of three main questions and some multiple sub-questions. Major benefit of MAQ is that it is the quickest and simplest scale to administer. Typically, a medication adherence is very critical for the medication management. The CDC (2013) reveals that only 33% of patients adheres to medication. Thus, medication adherence tools are the effective tool to detect non-adherence to medication. The use of the MAQ and BMQ will assist the medical practitioners to evaluate the level of medication adherence and implement effective decision to improve the medication adherence among diabetes patients.

E2b: Description of Intervention:

The promotion of a lifestyle behavioral change is one of the effective strategies for the diabetes intervention. A 7% weight loss due to physical activity is one of the effective methods for the lifestyle behavioral changes. Minimum of 2 hours 30 minutes of physical activity ranging from intensity to a brisk walking is advisable for diabetes patients, and the 7% weight loss should be maintained for the first 6 months. The lifestyle intervention of physical activity can assist people to achieve maximum weight loss of 7% within 24 weeks of physical activity.

The medical practitioners should teach patients method of adhering to behavioral lifestyle strategies to assist them realizing long-term changes in calorie and fat intakes for managing and preventing diabetes. The physical activities should be at least 700 kcal/week. The goal is to achieve150 minutes of moderate physical activity that ranges from intensity to a brisk walking. This behavioral change is beneficial because it will assist in preventing and reducing the diabetes complications.

More importantly, the physical exercise can improve cardiovascular health of diabetes patients as well as assisting in deceasing the fat abdominal fat accumulation, which is one of the causes of diabetes. More importantly, the 30 min daily moderate to intensity exercise weekly will assist patients to improve insulin sensitivity.

Additionally, the exercise can assist in achieving an along-term weight control. Typically, patients are required to indulge in high-volume of aerobic exercise of 700 kcal/day to assist in decreasing the accumulation of fat since obesity is associated to the type 2 diabetes. The intensity and aerobic exercise will reduce a significant among fat from the body. Additionally, vigorous exercise of minimum of 20 minutes per day can assist in enhancing a maximum heart rate, improve insulin sensitivity and control blood glucose.

E3b....

Measurement Methodology:
Different strategies will be applied for the measurement methodology. The medical record of patients will be used to measure whether the intervention strategy is working. The medical records are the effective method to ascertain whether diabetes conditions of patients are improving. The strategy is by instructing the patients to visit the hospital once in a month. Moreover, medical practitioners are required measure the weight of patients and carry out other medical check up to determine whether the patient adheres to behavioral modifications instructions. The medical record is cost effective measurement because it will assist in determine the level of readmission rates. Through the medical records, the medical practitioners will be able to determine the rates of readmission per 1000 patients. The medical record measurement will also assist whether the intervention is working.

Moreover, the appointment data will be used to measure the outcome of the intervention. The appointment data reveals the rate of patients appointment weekly or monthly. The appointment data can assist in determining whether the diabetes intervention is working for patient. After the intervention, if the appointment data are reduced by more than 30%, it is revealed that the intervention strategy is working moderately. The medical records are the effective tools of collect appointment data because all the appointment data are recorded in the medical records.

E2c. Description of Intervention

Diabetes education is an effective strategy to achieve patients' outcome. Many patients with diabetes do not understand that obesity is the primary cause of diabetes. Obese people have the risks of diabetes compared to non-obese people.In essence, patients' education is a critical strategy to reduce the mass body weight of diabetes patients. Typically, patients education can make patients to modify their behavioral lifestyle. A major strategy to modify patients' lifestyle is by educating patients that the physical exercise is the effective strategy to reduce the body weight. The medical practitioner can educate patient orally during their medical consultation. The contents of the education will include adherence to physical exercise, medication adherence and appropriate food regime.Other strategy to educate patients is to educate the patients by given them free medical pamphlet patients, which will consist of comprehensive information on the method patients should employ in adherence to medication and implement behavioral changes that will improve the medical condition of diabetes patients.

Medical practitioner should also educate patients to quit smoking and make them understand that smoking can damage their body, and consequently aggravate their diabetic condition. Moreover, the medical practitioner should suggest appropriate method that can assist patients to quick smoking. Apart from managing diabetes condition of patients by quitting smoking, medical practitioners should make patients to understand other benefits of quitting smoking. For example, quitting smoking will reduce the chances of patients having heart attacks, cancer, stroke, hear disease, and other diseases. Moreover, it is essential to make patients realizing that quitting smoking will make patients to be less likely to get sick. It will also make patients to cough less and breath easier. Moreover, quitting smoking will make patients' skin to look healthier and make them looking more youthful. Moreover, the fingernail and teeth will not be stained by quitting smoking.

E3c. Measurement Methodology

The paper suggests using the PROMIS assessment toolkit to assist clinicians to measure the level of smoking of adult individual. The tool kit composes of 6 items that include coping expectant, nicotine dependence, sensory expectancies, emotional expectancies, psychosocial expectancies, health expectancies, and social motivations. The Assessment PROMIS Smoking Toolkit is revealed in Table 1.

Item Bank Name

Number of Items

Brief Description

Example Item

Full Bank

Short Form

Nicotine Dependence

27

4 and 8

Assesses smoking temptations; tolerance, and compulsive use

"When I am out of cigarettes, I feel almost unbearable"

Coping Smoking Expectancies

15

4

Assesses smoking for coping with stress or negative affect

"I deal with stress by smoking"

Sensory Expectancies and Emotional Smoking

16

6

Assesses perceptions sensations, cognitive abilities, and pleasurable sensorimotor

"After smoking cigarettes I am OK"

Smoking Health Expectancies

19

6

Assesses long-term and current consequences of patients smoking on health

"Smoking has taken years off my life"

Smoking Psychosocial Expectancies

16

6

Assesses normative values, and feelings of social disapproval.

"People do not care about me when they view me smoking"

Smoking Social Motivations

12

4

Assesses expected social benefits that induce cigarette smoking.

"I feel better in a social gathering when smoke"

Source; Edelen, William Et al. (2014).

A. Plan Section Approval (This…