Russell proposed a clinical nurse specialist-led intervention to improve medication adherence in chronically ill adults using renal transplant recipients. Meta-analyses and systematic reviews of chronically ill and transplant patients indicate that patient-specific characteristics are not only poor and inconsistent predictors for medication nonadherence, but are also not amenable to intervention. Adherence has not meaningfully improved, as noted by meta-analyses and systematic narrative reviews of randomized controlled trials (RCTs) dealing with medication nonadherence in acutely and chronically ill persons and RCTs dealing with transplant patients. Interventions with a superior potential to enhance medication adherence must be developed. Russell suggested use of a clinical nurse specialist-led continuous self-improvement intervention with adult renal transplant recipients. Continuous self-improvement focuses on improving personal systems thinking and behavior using the plan-do-check-act process. Electronic medication monitoring reports, one of several objective measures of medication adherence, are used by the clinician to provide patient feedback during the check process on medication-taking patterns.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Russell concluded that continuous self-improvement as an intervention holds promise in supporting patient self-management and diminishing the blame that clinicians place on patients for medication nonadherence. Using an objective measure of medication adherence such as an electronic monitoring report fosters collaborative patient-clinician discussions of daily medication-taking patterns. Through collaboration, ideas for improving medication taking can be explored. Changes can be followed and evaluated for effectiveness through the continuous self-improvement process.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The article likely means little to you as no data were presented to suggest the proposals would work. However, a number of ideas were offered which warrant research.

CL Russell. A Clinical Nurse Specialist-Led Intervention to Enhance Medication Adherence Using the Plan-Do-Check-Act Cycle for Continuous Self-improvement. Clinical Nurse Specialist, 2010;24:69-75.