• Implementation of Text Messaging and Brief Phone Counseling to Improve Medication Adherence

      Akolo, Omolola; Davis, Allison D. (2021-05)
      Problem & Purpose: Among persons infected with human immunodeficiency virus (HIV), suboptimal adherence to antiretroviral therapy (ART) decreased treatment efficacy, increased hospital admissions, delayed viral suppression, and increased subsequent onward transmission. As of March 2020, of the approximately 350 HIV-positive patients receiving continuity HIV care at an urban public sexual health and wellness clinic, 41 (13.1%) were not virally suppressed. The purpose of this Quality Improvement (QI) project was to implement and evaluate the effectiveness of weekly medication reminder text messaging and brief phone-based counseling on adherence to ART among HIV-positive adults seen at this clinic. Methods: Implementation, led by Registered Nurse Case Managers (RN-CMs) trained on project procedures, was conducted among a sample of new and existing HIV-positive patients aged 18 years or older who were newly initiating treatment, had sub-optimal medication adherence, had an unsuppressed viral load, had a functioning cell phone, and who agreed to participate. Following ethical approval, the intervention was conducted over 14 weeks (August 31, 2020-December 4, 2020). Data were collected and tracked weekly using a specially designed audit sheet, projected into run charts, and analyzed using Microsoft Excel. Results: Twenty-two (n=22) HIV-positive patients, including four new and 18 existing patients, participated in this project. All 22 (100%) patients received weekly medication reminder text messages, but only seven of the 22 (31.8%) patients agreed to also receive weekly phone-based adherence counseling sessions. Adherence was measured through phone-based unannounced pill counts at weeks four, eight, and 12. The proportion of the total participants who completed pill count with an adherence level of >95% was 71.4% (n=10 of the 14 patients) at four weeks, 86.7% (n=13 of the 15 patients) at eight weeks, and 85.7% (n=12 of the 14 patients) at 12 weeks. Conclusion: Reminder text messages and phone-based adherence counseling were feasible and potentially effective interventions to improve ART adherence. Pill count adherence completion was highly dependent on participants’ availability. However, weekly phone-based counseling sessions were less acceptable to participants.
    • Implementing Mobile Text-messaging to Improve Attendance at Well Visits in Primary Care Pediatrics

      Osuagwu, Ngozi E.; Connolly, Mary Ellen (2019-05)
      Background: Missed appointments are a long-standing problem encountered both in the United States and abroad with rates ranging anywhere from 5% to 55%. It is a major cause of inefficiency in the medical system and consequences include poor health outcomes, wasted health care dollars, waste of provider time and adverse effect on patient -provider relationship. Local Problem: No-shows are a significant problem in primary care especially in underserved populations. The implementation site for this quality improvement project provides care to an underserved population with a no-show rate of 35%. The purpose of the DNP quality improvement project was to implement and evaluate the use of mobile text messaging to reduce the non-attendance rate to routine well visits in a primary care pediatric clinic in inner city Baltimore. There is evidence to support the use of text message reminders to improve both medication adherence and attendance rates when compared to other available appointment reminder systems. Intervention: The project was implemented in a sample of patients by nurses, front office staff and providers. The intervention involved sending text message appointment reminders to patients. The attendance rate was later analyzed and compared to the attendance rate prior to the implementation period. Inclusion criteria for the patient population was patients aged 18 years and older or the legal parent or guardian of a patient who was under the age of 18 years. Staff attended a 4-hour training session, which was led by the project leader and I.T. personnel. A preimplementation survey was conducted to determine patients’ and parents’ perception of the planned mobile text-messaging system. The questionnaire was quantified, averaged and the result was favorable. During the implementation period, data was collected that reflected the rate of attendance during the project. This information was aggregated and stored by the EHR system. Data was retrieved from the EHR and Run charts were used for data analysis. Results: The attendance data from the intervention showed that there was no significant increase in attendance to well visits for October, November and December compared to the preceding months of July, August, and September 2019. Conclusions: Though the result of the intervention did not reflect the expected impact, several lessons were learned. There were some positive unexpected findings, including an increase in portal registration, improvement in the update of patient phone numbers in the EHR database, and greater rapport among staff due to teamwork.