Implementing the Morisky Medication Adherence Scale To Improve Medication Adherence in Patients With HIV and Mental Illness

PURPOSE The purpose of this scholarly project was to implement a standardized process for assessing patient medication adherence through the use of a high-quality self-report questionnaire. BACKGROUND The project was implemented at a federally funded outpatient HIV specialty clinic. METHODOLOGY Patients seen by the clinic’s psychiatric/mental health nurse practitioners completed the Morisky Medication Adherence Scale during the nurse triage encounter. Patients who scored poorly (below 6) were then referred to the clinic’s interprofessional team (e.g., social workers and pharmacists) to address barriers to medication adherence. Medication adherence was measured using data collected from the on-site pharmacy records in order to calculate percentage of days covered (PDC). Changes to the program were employed according to the Plan-Do-Study-Act quality improvement method. RESULTS Of the 286 patients who completed the questionnaire, 92 (32.2%) received medication guidance or case management from clinic’s interprofessional team. Paired t-test analysis of mean PDC showed a small but statistically significant improvement (p = 0.029, 95% CI, -9.81 to -0.59) in medication adherence for the patients who received additional interventions compared to those who only completed the questionnaire. IMPLICATIONS Nurse practitioners are instrumental in operationalizing a standardized process for assessment and coordinated interventions related to medication adherence.