Matching Items (2)
Description
The treatment of individuals with multiple chronic conditions represents the single largest driver of Medicare costs. The use of prescription drugs is a major component in the treatment/management of chronic disease in the United States. Medication nonadherence, however, is a common problem among older adults and leads to significant morbidity and mortality. Whereas, the problem of medication nonadherence has been a primary focus of research for the last thirty years, much is still unknown about which older adults are most at risk for medication nonadherence, as well as what are effective theory-based interventions to improve a person's medication self-management.
The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research.
The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research.
ContributorsO'Brien, Anne Marie (Author) / Marek, Karen D. (Thesis advisor) / Coon, David W. (Committee member) / Evans, Bronwynne C. (Committee member) / Arizona State University (Publisher)
Created2014
Description
Understanding how adherence affects outcomes is crucial when developing and assigning interventions. However, interventions are often evaluated by conducting randomized experiments and estimating intent-to-treat effects, which ignore actual treatment received. Dose-response effects can supplement intent-to-treat effects when participants are offered the full dose but many only receive a partial dose due to nonadherence. Using these data, we can estimate the magnitude of the treatment effect at different levels of adherence, which serve as a proxy for different levels of treatment. In this dissertation, I conducted Monte Carlo simulations to evaluate when linear dose-response effects can be accurately and precisely estimated in randomized experiments comparing a no-treatment control condition to a treatment condition with partial adherence. Specifically, I evaluated the performance of confounder adjustment and instrumental variable methods when their assumptions were met (Study 1) and when their assumptions were violated (Study 2). In Study 1, the confounder adjustment and instrumental variable methods provided unbiased estimates of the dose-response effect across sample sizes (200, 500, 2,000) and adherence distributions (uniform, right skewed, left skewed). The adherence distribution affected power for the instrumental variable method. In Study 2, the confounder adjustment method provided unbiased or minimally biased estimates of the dose-response effect under no or weak (but not moderate or strong) unobserved confounding. The instrumental variable method provided extremely biased estimates of the dose-response effect under violations of the exclusion restriction (no direct effect of treatment assignment on the outcome), though less severe violations of the exclusion restriction should be investigated.
ContributorsMazza, Gina L (Author) / Grimm, Kevin J. (Thesis advisor) / West, Stephen G. (Thesis advisor) / Mackinnon, David P (Committee member) / Tein, Jenn-Yun (Committee member) / Arizona State University (Publisher)
Created2018