Medication adherence strategies in a nurse-managed clinic for indigent patients

¶ … Primary Care for Indigent Adult Patients in Texas

Treatment adherence is a common problem, especially among low-income patients. With nurse-managed clinics on the forefront of primary care for this patient demographic, treatment adherence is a relevant topic. Accordingly, a recent study examined the rates of treatment compliance at a nurse practitioner-managed clinic in Southeast Texas providing care to indigent patients (Alton, March, Mallary, & Fiandt, 2015). The population selected for the study provides some insight into the primary care being provided, which included Spanish- or English-speaking adults, 19-years of age or older. Pregnant women and children were not being treated at this clinic and were routinely referred elsewhere. The average age of study participants was somewhere between 40 and 59 years of age and the racial makeup of the group was almost evenly distributed between African-Americans, Hispanics, and non-Hispanic Whites, with most reporting a Hispanic identity. Nearly 70% were English-speaking and a similar number reported failing to complete high school. Half were unemployed. The most common chronic health conditions reported were hypertension (50.4%), diabetes (37%), hyperlipidemia (27.6%), and depression (26.8%).

The strengths of the clinic were revealed by the study findings. The treatment adherence rate was well above expected, between 90 and 100% (Alton et al., 2015). The mean, median, and mode for adherence rate for this patient demographic were 77, 90, and 100%, respectively. When compared to the adherence rates published by other researchers, between 50 and 75%, this clinic appears to be doing something right. Although health literacy was expected to be a significant barrier for this patient population, this was not the case. Instead, financial limitations and medication labels in English were the most common barriers reported by patients. The high adherence rate can be explained by clinic staff putting extra effort into making medication costs manageable for patients, by prescribing generic brands and giving away samples when possible. A clinic nurse also spent half of her day helping patients fill out application forms for prescription assistance programs (PAPs). Of course, the downside of this approach is that the nurse's salary costs cannot be reimbursed directly from the provision of primary care. Another possible strength of a nurse-managed clinic is the ability of nurses spending more time with patients explaining the importance of medication adherence and the expected side effects. Although the study participants may have overestimated medication adherence, the data fro two questions on the survey about the last missed dose and adherence barriers were consistent with the high adherence rate.