Browsing by Author "Ruppar, Todd M."

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    Managing Medications and Medication Adherence Among US Adults During the Early Phase of the COVID-19 Pandemic
    (Dove Press, 2023-02-11) Bartlett Ellis, Rebecca J.; Andrews, Angela; Elomba, Charles D.; Remy, Laura M.; Ruggeri, Sunny Yoo; Russell, Cynthia L.; Ruppar, Todd M.; School of Nursing
    Purpose: Before the COVID-19 pandemic and the disruptions it brought, medication adherence was already a challenging and complex health behavior. The purpose of this study was to describe patients' interactions in clinic, pharmacy, and home contexts and associated medication management and adherence during the early phase of the COVID-19 pandemic. Patients and methods: A survey questionnaire was developed using the Medication Adherence Context and Outcomes framework and distributed via social media between May and July 2020 targeting adults taking a daily prescribed medication. Survey questions assessed sociodemographics, interactions with healthcare providers, clinics, pharmacies, medication management experiences, habit strength, and life chaos perceptions during the pandemic. Medication adherence was assessed by the self-report BAASIS© scale to measure implementation, discontinuation, and overall nonadherence. Results: A total of 134 adults from the United States, mean age 50.0 (SD 16.1) years were included in this analysis. Respondents took a median of 3.50 (interquartile range 4) daily medications. Delays in seeing a provider were reported by 47 (35.1%). Pharmacy encounters were impacted; 25 (18.7%) indicated their method for obtaining medication changed. Medication nonadherence was reported among 62 (46.3%) and was significantly greater among those who delayed prescription refills (p=0.032), pillbox users (p=0.047), and those who experienced greater life chaos (p=0.040) and lower habit strength (p<0.001) in the early phase of the pandemic. Conclusion: Although the early phase of the pandemic affected access to care for nearly one-third of the sample, distance-accessible care options and strategies to obtain needed services without being in-person supported respondents medication management. Helpful strategies included provider accessibility, telehealth, home delivery/mail-order, drive-thru's, 90-day supplies, and online/automatic refills. Methods to develop and reestablish habits are critical. Care providers in clinic and pharmacy settings can educate and remind patients about services like distance-accessible technologies and online ordering of medications and establishing routines to support medication adherence.
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    The Medication Adherence Context and Outcomes Framework Image
    (2018-10-04) Bartlett Ellis, Rebecca J.; Ruppar, Todd M.
    Background: Adherence interventions have been largely ineffective, with most taking a "one-size-fits-all” approach without consideration of reasons for nonadherence. While the ABC Taxonomy clarified terminology and identified various outcomes measured along the process continuum, intervention design requires understanding the environments and contexts that contribute to nonadherence. A framework that combines the understanding of environment contextual influences, processes, and outcomes is needed to move forward with approaches to intervention design. Methods: Developed based on theory, practice, and research, the Medication-management and Adherence Contexts and Outcomes (MACO) framework describes the environmental contexts, the processes that occur within the contexts, and how these processes contribute to adherence outcomes. The MACO framework differentiates the processes, defined as medication management, within and across contexts that affect adherence outcomes. Results: Three distinct yet interrelated contexts identified in the MACO framework include 1.) clinic, 2.) pharmacy, and 3.) home. Conclusions: The MACO framework is a useful heuristic to understand at which point people experience problems with managing medications in the medication management continuum. This information can then be used for designing and delivering context-specific interventions and selecting appropriate outcome measures of adherence based on the contexts.
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    Understanding Processes, Outcomes, and Contexts in Medication Adherence: The Medication Adherence Context and Outcomes (MACO) Framework
    (Dove Press, 2023-01-24) Bartlett Ellis, Rebecca J.; Haase, Joan E.; Ruppar, Todd M.; School of Nursing
    Poor medication adherence is a significant problem, yet interventions to improve it have been largely ineffective. Existing ecological models indicate that adherence is multi-dimensional; however, they do not reflect understanding of context-specific processes and how they lead to adherence outcomes. A framework that reflects context-specific processes is important because it could be used to inform context-specific intervention delivery and measure associated adherence outcomes. The purpose of this paper is to describe the Medication Adherence Context and Outcomes (MACO) framework, which includes contexts (ie, clinics, pharmacies, and home) and context-specific processes (ie, shared decision-making, prescription filling strategies, home medication management) that lead to adherence outcomes (initiation, implementation, discontinuation, and persistence). The Medication and Adherence Contexts and Outcomes (MACO) framework was iteratively developed between 2015 and 2018 based on theory, practice, and research and combining patient experience journey mapping to chronologically describe the environmental contexts and actions (processes) that occur within the contexts and how they contribute to medication adherence as outcome. The three distinct yet interrelated contexts described in the MACO framework are 1) clinical encounters, 2) pharmacy encounters, and 3) day-to-day home management. Within these contexts are specific medication management actions that occur (processes) in order to produce adherence-related outcomes (initiation, implementation, and discontinuation/persistence). The MACO framework distinguishes context-specific processes and outcomes. The MACO framework may be useful to understand at which point(s) along the continuum people experience problems with managing medications. This understanding is potentially useful for developing and delivering context-specific interventions that are based on processes that underlie nonadherence and selecting adherence measures appropriate for the contexts.