NURS FPX 9000 Assessment 4 Topic Report: Secondary Review

Student name

Capella University

NURS-FPX9000

Professor Name

Submission Date

Topic Report: Secondary Review

The topic presents the doctoral project that can be used to discuss the problem of medication non-adherence in patients with anxiety disorders. The problem of the project, suggested evidence-based interventions, and anticipated outcomes are also described in the report. Multicomponent adherence interventions (delivered by trained nursing staff in the form of organized interventions) are very effective in preventing better medication-taking practices and clinical outcomes among psychiatric patients (Leon et al., 2022). The whole research training requirements in terms of ethics have been met in the institutional training initiative program. Compliance strategy: CITI training transcript is in the appendix that portrays compliance with human subject’s protection standards.

Project Problem and Relevant Evidence

The issue of non-pharmacological compliance is a serious hindrance to the optimal psychiatric outcomes of patients with anxiety disorders. In the US, nearly 57 percent of those who receive antidepressant therapy to treat anxiety display drug non-adherence (Dibato et al., 2022). The mental health outpatient clinic in Chicago, Illinois is the target of the study and covers about 150 patients in a month with anxiety-related diagnoses. Available baseline data indicate that 55 percent of the patients have poor medication adherence at the project location, which translates to 45 percent of the patients being having good medication adherence.  The estimates of the World Health Organization show that the global situation with regard to the adherence to medication in the treatment of chronic diseases is about 50 percent (National Council for Mental Wellbeing, 2020).

Centers of Medicare and Medicaid Services defined 80 percent adherence as the threshold of quality of medication adherence in chronic disease management and recent data show that optimum thresholds to reduce hospitalization, and health care expenditures are about 90 percent (Parikh et al., 2025).  The 45 percent adherence rate of the project site is a shortfall of 35 percent points against the set quality standard and a 45 percentage point difference against the available optimum adherence levels. It was proved that medication nonadherence results in more severe symptoms, relapses, and high costs of healthcare estimated at $100-300 billion per year, which should be systematically intervened (Religioni et al., 2025; Reid, 2023).

The existing standard measures in the project location rely solely on limited verbal training on the topic of medication and do not consider the assessment of adherence and a regular treatment program. The extensive examination of the initial measures will ensure appropriate measurement of the intervention outcome and possible future measurements improvement. The current activities at the site include prescription refill rates that are tracked with the help of electronic health records and self-assessed adherence rates of patients.

Medication possession ratio calculation provides objective information about the compliance, and a percentage higher than 80 indicated adequate medication-taking practices. Despite the fact that self-report measures are a helpful tool that gives insights into the patients, the method is also too optimistic about adherence by approximately 20 percent compared to the objective measures. Adherence rating Scale is to be adopted and will standardize the assessment of adherence and enhance the measurement validity (National Council for Mental Wellbeing, 2020). The concatenation of systematic process and outcome measure will optimize the quality improvement processes and maintenance of the practice change.

Evaluation of Metrics and Areas for Improvement

The current indicators of the site include prescription refill rates and are monitored on the basis of electronic health records and self-assessed adherence measures by the patients. Medication possession ratio calculation provides objective information about the compliance, and a percentage higher than 80 indicated adequate medication-taking practices. The introduction of the adherence rating brief will standardize the assessment of adherence and enhance validity measurement (National Council for Mental Wellbeing, 2020). The concatenation of systematic process and outcome measure will optimize the quality improvement processes and maintenance of the practice change.

The Project Site

The place of the proposed project is a community based outpatient mental health clinic that will provide various patients with psychiatric ailment. According to the evidence provided by organizational leadership and the preceptor, medication non-adherence can be designated as a severe issue that requires an evidence-based approach and is highly supportive of the project implementation within the suggested time frame. It is a small, privately owned clinic that has one board-certified psychiatric mental health nurse practitioner. Adjunctive psychotherapy is offered by licensed therapists as part of the entire behavioral health care service delivery to complex needs patients. Primary psychiatric services offered in the practice environment include diagnostic assessment, medication administration, and on-going treatment response.

The clinic is located in a large metropolitan community in the Middle West in an urban community where different demographic exists. Weekdays 8:00 AM -6:00 PM and Saturday are working hours, but to some extent (10:00 AM-2:00 PM). It was determined that multicomponent adherence interventions can be applied in the community-based mental health settings, which are the most appropriate (Sedeno et al., 2024). Both face-to-face and telehealth services are offered to make sure the accessibility to patients with transportation or scheduling restricts is maximum. The clinic deals with about 150 patients a month and anxiety disorders constitute a great percentage of the patients.

Project Support at the Project Site

Strong working relationships between stakeholders and the project leaders on quality improvement implementation and sustainability of the site need to have strong collaborative working relations. The project preceptor has 22 years of clinical experience as a board-certified psychiatric mental health nurse practitioner. The weekly meetings with the preceptor aid the project in the continued planning of the project, the revision of the interventions, and the specification of the potential barriers to implementation. The preceptor provided access to patient data, electronic health records systems, and clinic workflow organization necessary to provide interventions. The stakeholder interviews were conducted on a regular basis (one every two weeks) to the clinical staff members in order to receive feedback on the implementation of interventions.

It was also shown that the participation of preceptors and the encouragement of the organization are also critical factors that determine the success of quality improvement projects (Sedeno et al., 2024). The feedback of stakeholders showed the need of short, practical interventions that can be easily integrated into the existing clinical processes and do not disrupt care. Workload and time limitations and competing priorities were mentioned as potential barriers that require to be solved by the clinical staff as an implementation plan. It was proven that medical practitioners recognize a lack of patient education and absence of systematic follow-up to be the key barriers to medication adherence (Kohn et al., 2022).

Thus, the multicomponent toolkit intervention was chosen due to the structured adherence evaluation, motivational interviewing, and psychoeducation (National Council for Mental Wellbeing, 2020). The preceptor proposed the adoption of motivational interviewing practices that would be in line with the philosophy of patient-centered care and the practice adopted by the clinic.

Areas for Preparation Enhancement

The gaps are the gaps in the knowledge and areas of preparation that require more focus as it will allow implementing the project in an efficient manner and exclude potential barriers. The skills in the tools of the National Council Toolkit (such as motivational interviewing, psychoeducation, and systematic adherence assessment) would strengthen the ability of the nursing personnel to mitigate patient ambivalence and knowledge gaps related to medication adherence. Additional details on cultural beliefs regarding medication-taking habits would be useful in improving individualization of interventions to a range of populations of patients that are served.

As per the policy, cultural competence training has the potential to positively contribute to the efficacy of professionals in the healthcare sector regarding the sphere of medication adherence challenges (National Council for Mental Wellbeing, 2020). Additional information on insurance reimbursement plan on long-term sessions of counseling would encourage the sustainability of practice operations towards application. Further training in the change management strategies would enable effective manoeuvring through organizational resistance and change in the working process in the implementation.

Proposed Interventions

One of the most important ways of improving medication adherence among patients with a psychiatric diagnosis is to base interventions on competencies associated with healthcare providers. The primary intervention will be the establishment of the national council on mental wellbeing organizational toolkit on medication adherence among the nursing personnel. The intervention is an intervention based on a multicomponent approach, which is coupled with systematic adherence measurement through the use of brief adherence rating scale, motivational interviewing, and systematic psychoeducation. In a randomized controlled trial, it was shown that nurse-delivered adherence interventions enhanced medication-taking behavior at the endpoint that ranged between 43.9 and 70.7 (Peterson, 2025).

It was shown that multicomponent interventions based on transfer of knowledge in the form of psych education, motivational interviewing, and BARS assessment, positively influence medication adherence at the 6-month follow-ups in a psychiatric population (Sedeno et al., 2024). An extensive meta-analysis of 46 randomized controlled trials (n=24,324) found that interventions that included psych education, behavioral approaches, and shared decision-making, which are the primary-level interventions of the National Council toolkit, resulted in a high medication adherence (Leon et al., 2022).

The qualitative information established that mental health nurses successively use psych education, cognitive-behavioral, and motivational methods to enhance adherence (Lin et al., 2022). Nurses introduced structured medication adherence programs that increased the levels of adherence and enhanced the outcome of the treatment considerably (Wen et al., 2025). It was proposed based on the meta-analytic findings that interventions with multicomponent incorporating psych education and behavioral interventions offer an odds ratio of 1.33 to improve adherence (Leon et al., 2022).

Among those studies, one was a cluster randomized controlled trial in which knowledge transfer and behavior modification were found to be effective in the promotion of medication adherence among depressive disorders (Sedeno et al., 2024). This perception of the medical workers has indicated that the absence of post-discharge care and resource insufficiency are the primary contributors to medical non-adhesion in the severe mental diseases (Deng et al., 2022). The study established that nurse-led telephonic medication adherence programs are useful in adherence promotion and the required emotional support after discharge (Peterson, 2025).

The results of the conducted study showed that it is an effective intervention that nurses can use to increase medication adherence among psychiatric patients in any clinical setting (Dellafiore et al., 2023). Motivational interviewing interventions implementable by nurses demonstrate significant alterations in self-care practices and compliance with treatment within different groups of people having chronic conditions (Dellafiore et al., 2023). A systematized adherence intervention involving trained nursing staffs is a long term remedy to the problem of psychiatric medication outcomes.

Educational Interventions

The educational intervention prepares the nursing personnel with the processes of an evidence-based toolkit, approaches in respect of systematic training in motivational interviewing, and joint decision-making. Nursing staff can be considered as the target audience of the mandatory learning element that occurs prior to the start of the project implementation. Providers can enhance the rates of treatment engagement and adherence outcome in the psychiatric population through motivational interviewing training (Herrera et al., 2024). The study has determined that mental health workers should be comprehensively trained about the obstacles to compliance and available evidence-based intervention methods (Kohn et al., 2022).

Motivational interviewing training has proved to be effective in enhancing the use of healthcare services and adherence to treatment in vulnerable groups (Reinauer et al., 2021). Mental health nurses were observed to apply the tacit knowledge gained through clinical experience and the formal training process in qualitative studies in order to utilize adherence strategies (Lin et al., 2022). Motivational interviewing resembles a medical field with the trained specialists that show excellent communication with a positive influence on patients taking medication and adherence to the treatment (Herrera et al., 2024).

Intervention programs that are based on the consideration of adherence barriers through the lens of healthcare workers are found to increase adherence to interventions and clinical outcomes in mental health (Kohn et al., 2022). The evidence has proved that the training of motivational interviewing enables health professionals to effectively address the issue of patient ambivalence and enhance intrinsic motivation to change (Reinauer et al., 2021). The competencies of nurses who are trained as a part of comprehensive education programs are high regarding the use of patient-centered adherence intervention on a diverse population of individuals under clinical care (Deng et al., 2022). The educational intervention will offer a background of knowledge against which the nursing personnel can implement the elements of the toolkit with fidelity in the implementation process.

Additional Information

The sophisticated intervention strategies would guarantee the nursing staff to deliver exemplarily in addressing the multifaceted adherence barriers among the various patients. The enhancement of the training time in comparison to the conventional workshop categories may complement the motivation, development of the interviewing skills, and the increase in the intervention fidelity of the implementation process (Kohn et al., 2022). The other publications on cultural competence in medication counseling would assist in providing interventions to patients with a different ethnicity in an individualized way. Another idea that would be exceptional in the implementation process is sustained mentoring and training of the skills under the guidance of experienced motivational interviewing experts.

Comparisons

Quality improvement projects should be clear on how the existing patterns of practice can be contrasted with the evidence-based desired situation to assess desired results of meaningful changes. The scenario present in the project site consists of the standard verbal medication education which is done on short clinical visits. The present nursing staff adheres to general medication education, the systematic psychoeducation is not systematically evaluated, as well as the evidence-based behavioral intervention strategies. The baseline statistics indicate that a very small proportion of patients with anxiety disorders (45 percent) can achieve satisfactory medication adherence in the current practice.

There are no standardized measuring tools such as the brief adherence rating scale currently being used to measure the adherence barriers in a systematic way in the project site. The difference between the performance and the evidence-based standard of 80 percent adherence is 35-percentage-point (National Council for Mental Wellbeing, 2020). Current records are not systematically tested on compliance and specific intervention programs to mitigate the aforementioned barriers to the medicine-taking behaviors.

The first option is the systematic implementation of the components of the national council for mental wellbeing organizational toolkit by the trained nursing staff. The approach will be to have the nursing staff conduct systematic adherence evaluation by the use of the brief adherence rating scale at every medication management visit. Evidence-based motivational interviewing and shared decision-making approaches will be used in all medication counseling sessions with patients. The national level of indicators of the best psychiatric treatment results is target adherence rates (more than 80 percent) (Neiman et al., 2017).

The study demonstrated a significant positive influence of interventions that comprise multiple components that encompass systematic assessment, psychoeducation, and behavioral techniques when compared to normal care (Leon et al., 2022). The desired condition refers to the evidence-based practice modification of the unstructured and variable medication education to the structured and toolkit-based adherence interventions.

Desirable Outcomes

Evident and observable outcomes make it possible to systematically analyze quality improvement programs and achieve the practice change in healthcare facilities on the evidence basis. The main outcome will be better rates of patient adherence to medication, and the objective progress will be to grow the current 45 percent baseline rate to 70 percent of medication adherence post-implementation through medication possession ratio calculated on the basis of pharmacy refill data. Increased patient medication adherence rate is a key project objective which will aim at increasing the current 45% of baseline to a minimum of 70% after the implementation.

The quality of medication adherence will be assessed with the help of medication possession ratio (MPR) which is defined as the number of days of the supply of prescribed drugs which is received divided by the number of days of the measurement period, and the value values [?]80% will denote a sufficient amount of adherence (Moreira et al., 2023). The knowledge improvement of nursing staff is the secondary outcomes that are measured through the means of pre-test and post-test measurement before and after educational training (Dellafiore et al., 2023).

The confidence of the staff of using brief adherence rating scales, motivational interviewing, and shared decision-making techniques will be measured by validated surveys. The findings revealed that the skills of providing interventions are immensely improved, and the involvement of patients in mental health settings is advanced by training healthcare providers (Reinauer et al., 2021). The successful implementation of the evidence-based guidelines to produce sustainable clinical practice improvements would be viewed through the successful attainment of the measurable outcomes that are staff-based.

Potential Impact

The successful realization of the project can transform the effectiveness of the nursing staff and develop a long-term evidence-based model of medication management practices. Nursing staff who has competencies of systematic adherence assessment would be more effective in their ability to identify the barrier and patient-specific intervention. Communication strategies training of medical workers is based on evidence and improves treatment engagement outcomes and therapeutic relationships (Herrera et al., 2024). The long-term outcomes include more job satisfaction among the nursing staff, adherence of the organization to the standards of national best practices, and professional development.

Learner’s Role for the Project

A successful execution of the doctoral project would involve well-defined leadership roles with the appropriate mentorship provision that can ensure the successful change of the evidence-based practice. The learner will be the central project leader in regards to the planning, implementation, and evaluation of all factors of interventions in the initiative. The leadership functions involve the general training of the entire personnel on the national council toolkit strategies, motivational interviewing techniques, and the brief adherence rating scale. Research also demonstrated that the success rates of high-quality improvement were high in the case of the application of the project leadership with stakeholder involvement and implementation planning (Sedeeno et al., 2024).

The preceptor will also serve as a clinical mentor, providing guidance and site and consultation access regarding the barriers in the organization. The efficient application of systematic project management techniques combined with the successful clarification of functions favors the transformation of the sustainable practice in the health care settings (Leon et al., 2022). The overall leadership in the process of planning, implementation, and evaluation will put the learner in a scenario of actualizing the significant transformations in the medication adherence rates.

Project Question

Among nursing staff treating patients with anxiety disorders (P), the application of the National Council for Mental Wellbeing organizational toolkit in medication adherence (I) in comparison with the current standard practice (C) regarding patient medication adherence levels (O) in 12 weeks (T)?

The PICOT question is a systematic approach to evidence-based quality improvement projects and sets the proper parameters to measure the outcomes. The population (P) includes the nursing staff working directly with adult patients with the diagnosis of anxiety disorders, but in an outpatient environment. The intervention (I) is the systematic use of the organizational toolkit on medication adherence proposed by the National Council of Mental Wellbeing by training the staff and implementing the practices. The toolkit will cover various evidence-based elements that the nursing personnel will present to patients.

In the case of the project, systematic adherence assessment with the help of the brief adherence rating scale will be considered, which is consistent with the component of the toolkit, motivational interviewing techniques, shared decision-making to promote patient autonomy, psychoeducation according to the ninth component, and practical adherence supports (National Council for Mental Wellbeing, 2020). The comparison (C) involves existing standard practices that involve short oral medication education and do not involve systematic adherence evaluation or evidence-based behavioral interventions.

The outcome (O) is the enhancement of patient medication adherence rates in the population of anxiety disorder receiving the services of trained nursing staff, and the planned increase in the patient medication adherence rate is 45 percent (baseline level) to at minimum 70 percent. (Measured using Medication Possession Ratio (MPR) calculated using pharmacy refill data acquired via electronic health records (Moreira et al., 2023). The period (T) includes the time frame composed of 12 weeks, which will include eight weeks of the implementation time when the nursing personnel will be actively engaged in providing the components of the toolkit to the patients.

Conclusion

The proposed quality improvement initiative will be evidence-based and will address the current gap between the current medication practices and the national standards of adherence. The voluntary implementation of the National Council of Mental Wellbeing’s organizational toolkit will equip the nursing personnel with the proven measures that will enhance compliance. The 12-week implementation period will entrench a permanent infrastructure in the management of psychiatric medication in the outpatient mental facilities in an evidence-based way. Good translation of the research evidence into the successful completion of the project will be demonstrated by the capacity to translate the evidence into clinical practice change that will be advantageous to patients with anxiety disorders.