Date of Award

Summer 5-15-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joe Burkard, DNSc, CRNA



Purpose of Project: The purpose of this evidence-based practice (EBP) project was to review research-based evidence systematically and to implement evidence-based change in practice in the clinical setting. The goal is to improve treatment adherence in patients with obesity, hypertension (HTN), type 2 diabetes mellitus (T2DM), and obstructive sleep apnea (OSA) by providing telephone follow-ups within 30 days post-perioperative discharge.

Background: Obesity, HTN, T2DM, and OSA continue to pose significant challenges to the United States healthcare system. Nonadherence to prescribed management of these chronic diseases is prevalent among patients presenting to the perioperative department of a regional academic hospital that serves the surrounding underserved communities. This project aims to enhance treatment adherence by engaging patients at multiple healthcare touchpoints–in this case, in the perioperative setting. Based on an initial population assessment of 403 patients obtained at UCSD Hillcrest Perioperative Services, obesity (n=146, 36.23%), diagnosed OSA (n=40, 9.93%), T2DM (n=84, 20.84%), and HTN (n=145, 35.98%) were top diagnoses in this patient population.

Methods: The IOWA Model and the 5 A’s (Ask, Advise, Assess, Assist, Arrange) framework were selected as guiding conceptual frameworks. Patients were enrolled in the preoperative area. Personalized interventions driven by motivational interviewing were conducted via telephone follow-up after 2 weeks post-procedure. Evaluation of these interventions was conducted after 4 weeks following the initial telephone follow-up.

Results: Twelve patients were enrolled in the study and 4 patients were lost to follow-up. Based on the self-reported medication adherence questionnaire, MMAS-8, there was an average increase of 0.71 points from the pre to post intervention. The results further showed that 7 out of 8 patients reported a reduction in intentional adherence, while 6 out of 8 patients reported a decrease in unintentional adherence. Based on the WHOQoL-BREF, there was an average of 4.75-point increase in the post-intervention period for Domain 1-Physical Health. An average of 2.37-point increase in the post-intervention period for Domain 4-Environment was also noted. Domain 2-Psychological and Domain 3-Social Relationships demonstrated a small decrease and remained the same in the post-intervention period, respectively.

Evaluation: The results of this study highlight the efficacy of implementing post-discharge telephone follow-ups within 30 days after perioperative care for patients with chronic diseases, leading to enhancements in medication adherence and quality of life. Patients reported notable improvements in dietary habits, physical activity levels, sleep hygiene, and overall quality of life following the interventions, indicating a greater engagement with their treatment regimen over time. Incorporating postoperative telephone follow-ups not only addresses the need to improve treatment adherence among patients with chronic conditions but also meets the best practice needs for patients.

Keywords: Medication Adherence, Quality of Life, Telehealth

Available for download on Sunday, May 04, 2025

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