Doctor of Nursing Practice , Case Western Reserve University, 2020, School of Nursing

Patient medication administration is one of the major responsibilities of the professional nurse. Pre-licensure nursing students and new nursing graduates often lack competency to safely administer medications. Nursing educators teach and evaluate safe medication administration by undergraduate bachelor of science nursing (BSN) students during sophomore year. These students are expected to demonstrate safe medication competence through senior year and post-licensure. The purpose of this study was to determine the medication safety competence of undergraduate junior and senior BSN students. A descriptive comparison design of undergraduate BSN students from two cohorts was used to collect data at an urban, public university in Northeast Ohio. The convenience sample included 188 BSN students who agreed to participate in the simulation study, comprised of 98 juniors and 90 seniors. Data was collected over two weeks via observation and focused on the six rights of medication administration using the Medication Administration Safety Assessment Tool (MASAT). Analyses included descriptive statistics and independent samples t-tests to compare the medication competency of juniors and seniors. Results revealed 29.6% of juniors and 14.4% of seniors demonstrated competence on all eight medication checklist items on the MASAT. The difference between the medication safety competence of juniors and seniors on total MASAT scores did not show statistical significance (p > .05). On individual MASAT scores, there was no statistical significance (p > .05) between juniors and seniors on checklist items one through seven corresponding to right patient, right drug, right dose, right route, and right time. Results showed statistical significance (p < .01) on checklist item eight, indicating juniors performed right documentation more frequently than seniors. Two additional analyses revealed (1) no statistical significance (p > .05) between juniors and seniors asking about medication (open full item for complete abstract)

Committee: Celeste Alfes DNP (Committee Chair); Elizabeth Zimmermann DNP (Committee Member); Amy Weaver PhD (Committee Member) Subjects: Nursing

Bachelor of Arts, Wittenberg University, 2022, Psychology

The current study analyzed how the developmental components of emerging adulthood in first-year college students are related to medication adherence/nonadherence. It was hypothesized that the newly discovered autonomy during the transition to college would encourage an exploration in identity and provide an opportunity for the “reinvention” of the self that might impact medication taking. Participants were 124 undergraduate first-year students enrolled at a small university in the Midwest. Participants completed an online survey that asked about their medication habits and the potential barriers to their medication adherence. Participants then answered questions regarding their perceived self-esteem, autonomy, identity, and stigma. The results showed that the most common barriers for medication adherence in first-year students were “feeling better” and “forgetfulness.” Additionally, the results revealed that the first-year students who were currently taking mental health medications (MH) demonstrated higher levels of agreement with feelings of perceived stigma and lower levels of agreement with feelings of autonomy and perceived self-esteem than the students taking physical health (PH) medications or no medication (p < .05). These results highlight the importance of how transitional developmental components may have an impact on medication adherence in first-year college students.

Committee: Mary Jo Zembar (Advisor); Katie Warber (Committee Member); Stephanie Little (Committee Member) Subjects: Health; Health Care; Health Sciences; Mental Health; Psychology

PhD, University of Cincinnati, 2023, Nursing: Nursing - Doctoral Program

Background: Medication errors are the most common type of error affecting patient safety and the most preventable cause of adverse medical events globally. Medication errors occur most frequently (33.3%) during the administration phase. New graduate nurses are especially vulnerable to these errors due to reported insufficient educational preparedness and inexperience. There is limited literature examining the nurse's educational preparedness and perceptions of the importance of the medication competencies to its relationship with their confidence in medication administration. Studies show that the performance of success in a given task is based on a person's mindset and view of importance of the task. In addition, many nurses feel that the curriculum did not properly prepare them for practice and left them vulnerable to errors suggestive that current nursing curricula may be insufficiently preparing students to perform this task. Purpose: The purpose of this dissertation study was to determine the relationship between educational preparedness and perceived importance of the medication administration competencies for Ohio new graduate Registered Nurses' to their confidence in clinical medication administration. Design: A descriptive, correlational, cross-sectional design was employed. Methods: Ohio new graduate nurses were surveyed using a research team-created survey. The Likert-style questions asked the participants their opinion on their educational preparedness, perceived importance, and confidence in the nine medication competencies identified. Descriptive and inferential statistical analysis were used with T-tests, ANOVAs, Spearman's Rho correlations, and logistical regressions to identify relationships between the variables, as well as differences between the demographics. Results: A total of 201 Ohio new graduate nurses completed the study. A significant, positive relationship was found between both educational preparedness and (open full item for complete abstract)

Committee: Kimberly Johnson PH.D. C.E.N. (Committee Chair); Carolyn Smith Ph.D. (Committee Member); Benjamin Kelcey Ph.D. (Committee Member) Subjects: Nursing

Bachelor of Science in Nursing, Wittenberg University, 2021, Nursing

Lack of sufficient and effective medication education has resulted in low patient satisfaction scores on the Joint and Spine (JS2) unit at Miami Valley Hospital South. Improvements in the medication education process at all levels, from pre-operative to after discharge, could significantly improve overall patient satisfaction. Review of literature concerning medication education best practices indicates a need for evaluation and improvement of current practices. Recommendations for improvement based on best practices research can be implemented with commitment at all staff levels in an effort to improve patient outcomes and satisfaction.

Committee: Cherie Rebar (Advisor); Marie Bashaw (Committee Member); Margaret Goodman (Committee Member) Subjects: Medicine; Nursing

DNP, Otterbein University, 2019, Nursing

The purpose of this project is to decrease the footprint of the opioid epidemic by increasing awareness of proper disposal of unwanted, leftover, and expired household medications. The opioid epidemic is negatively affecting many U.S. communities, One way to combat the epidemic is to increase proper disposal of unwanted household medications. Increasing awareness and participation of proper disposal of household medications, including opioids, will not only help to decrease the footprint left by the opioid epidemic, but will potentially decrease the amount of accidental overdoses in household, decrease the impact of improperly disposed medications on the local environment, and decrease the amount of medication involved crime in the community.

Committee: John Chovan (Advisor); Brian Garrett (Committee Member); Cindy Zellefrow (Committee Member) Subjects: Health; Health Sciences; Medicine; Nursing

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2017, Nursing

Abstract Aims and Objectives: This performance improvement project was designed to increase patient's knowledge of their medication purposes and side effects. Background: A majority of older adults take anywhere from five to ten medications per day. With one in nine visits to the emergency department a direct result of drug related adverse events (ADEs), patients do not clearly understand their medications and side effects. Despite the increased focus on prevention of adverse medication events no one intervention has been successful in preventing ADEs. Design: Institute for Healthcare Improvement's (IHI) Performance Improvement Method as an intervention to prevent adverse medication events. Methods: Nursing and pharmacy staff created a medication “time out” where medications were reviewed with patients on a medical-surgical unit in Hospital A, during the hospitalized patient's stay in specific manner. When the patient was discharged home, random patients were contacted by phone to validate their knowledge of their medications and the effectiveness of the medication “time out” intervention. Results: Implementation of medication “time outs” enabled patients to verify their medication's purposes, special instructions, and taking their medication as prescribed. Results from the telephone interviews along with scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys regarding if the patients specifically recalled if hospital staff told them what their medication was for and described its side effects were used to evaluate the intervention.

Committee: Elizabeth Bragg PhD, RN (Committee Chair); Cynthia Sublett PhD, RN (Committee Member); Susan Allen PhD, RN (Committee Member) Subjects: Nursing

Master of Science (MS), University of Toledo, 2015, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)

Background: Individual pharmacy-based interventions have improved outcomes, but have not solved the $290 billion problem of medication non-adherence. Combinations of interventions have a potential to more heavily impact medication adherence, and associated healthcare costs. Objectives: To 1) Describe the implementation, and initial experiences, of a hybrid model of pharmacy care for patients with metabolic syndrome, 2) Study the impact of a hybrid model of pharmacy care on economic outcomes when compared to other community pharmacy models of care in patients with metabolic syndrome. 3) To study the impact of a hybrid model of pharmacy care on adherence to medications targeted by the CMS Five-Star Quality Rating System in patients with metabolic syndrome. Methods: This is an exploratory pilot of a large, prospective, randomized control study. The hybrid model utilizes an appointment based model to provide adherence blister packaging, Medication Therapy Management (MTM) and refill synchronization. A second group receives adherence packaging and refill synchronization, a third group MTM alone, and a control group receives none of the aforementioned services. Contact between the researcher and participant occurs every three months, alternating between face-to-face and telephonic. All four groups are compared for healthcare cost and utilization, as well as adherence to medications identified by the Centers for Medicare and Medicaid Services (CMS) STAR measures. Participants were recruited from a local endocrinology practice within an Integrated Delivery Network (IDN), and included adults within a certain health plan selected from a Diabetes Center. Patients were required to have; diabetes, hypertension and hyperlipidemia, and at least one medication for each disease state. Cost data was obtained via medical and prescription claims. Medication adherence was calculated from the claims data as the proportion of days covered (PDC). Baseline consists of data for (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Advisor); Robert Bechtol (Committee Member); Aliaksandr Amialchuk PhD (Committee Member) Subjects: Economics; Health Care; Health Care Management; Health Sciences; Pharmacy Sciences

PHD, Kent State University, 2015, College of Arts and Sciences / Department of Psychological Sciences

Many individuals with heart failure (HF) experience depression, which is associated with poorer outcomes. Medication nonadherence may help explain outcomes, and more complex regimens may be more challenging to manage, especially for depressed patients. The aim is to assess whether the complexity of the medical regimen moderates the relationship between depressive symptoms and medication adherence. This is part of a larger observational study of 305 HF patients recruited from two hospitals in Ohio. Depression was assessed with the PHQ-9 (a brief depression screener), medication adherence was assessed over 21 days using an electronic pillbox, and regimens were rated using the Medication Regimen Complexity Index. The majority of participants were male (60.7%), Caucasian (n = 73.1%), 68.36 years of age (SD = 9.59), and married (60.3%). The mean PHQ-9 score was 4.15 (SD = 4.46), and 29.9% of the sample reported experiencing at least mild symptoms (PHQ-9 = 5). Medication adherence scores ranged from 10.30-100%, and the mean was 81.03 (SD = 20.46). Depressive symptoms predicted medication adherence (¿R2 = .03, F (1, 303) = 9.04, ß = -.170, p = .003; ƒ2 = .03, corresponding to a small effect size). The complexity of the participant's medication regimen moderated the relationship between depressive symptoms and medication adherence (t (285) = -2.713, ß = -.161 p = .01; ƒ2 = .03, corresponding to a small effect size). For more depressed individuals, having a more complex medication regimen lowered medication adherence by 5.90%. Adding the moderator to the model accounted for 2.4% of the additional variance (¿R2 = .02, F (1,2) = 7.358, p = .007; ƒ2 = .03, corresponding to a small effect size). Healthcare providers should aim to simplify medication regimen complexity whenever possible, particularly for HF patients demonstrating depressive symptoms with complex regimens because they may be especially susceptible to poor adherence.

Committee: Joel Hughes Dr. (Advisor); John Gunstad Dr. (Committee Member); John Updegraff Dr. (Committee Member); Melissa Zullo Dr. (Committee Member); John McDaniel Dr. (Committee Member) Subjects: Aging; Behavioral Sciences; Clinical Psychology; Health; Medicine; Psychology

B.S. in Pharmaceutical Sciences, University of Toledo, 2011, Pharmaceutics

OBJECTIVES: The study objectives are to (1) evaluate the impact of expanding access to care on, and (2) examine the trends between, medication adherence and other patient outcomes for a safety net patient population participating in an urban Medication Therapy Management program. METHODS: Patients with diabetes, hypertension, and/or hyperlipidemia were enrolled in a pharmacist led MTM program through CareNet, a Toledo, OH safety net organization. This one year prospective pre-post funded study provided patients with access to health care providers, educational material, covered prescription drugs and testing supplies for the study period. Clinical and humanistic outcomes were measured at staggered intervals and analyzed to evaluate the impact of MTM care. The Morisky scale was used to measure patients' adherence to medications. The change in adherence was correlated with treatment outcomes to determine the significance of adherence in safety net patients. RESULTS: A significant decrease was reported in diastolic blood pressure (p < .016) and in systolic and diastolic blood pressure in patients with BP > 140/90 mmHg (p < .038, .043, respectively) as well as in hypoglycemic events (p < .018) at 12 months. There was also a significant increase in patient satisfaction for the pharmacist (p < .017) over the course of enrollment. Of the 72 diabetic patients enrolled at baseline, only 16 remained in the program at the end of the one-year time period. Thirty-four patients had substantial data to analyze the impact of adherence on treatment outcomes. The average baseline adherence per patience was 1.88 and improved by 0.118 on the Morisky scale (1 = good and 5 = poor). There were no significant correlations between collective adherence and the other outcome measures. However, patients who reported improved adherence were significantly correlated to a decreasing systolic blood pressure (p < .003), while patients showing no improvement were significantly correlated to an impro (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Advisor) Subjects: Pharmacy Sciences

Doctor of Philosophy, University of Toledo, 2010, Health Education

The purpose of this study was to explore the relationship between nurse characteristics and medication errors. The study examined nurses' perceptions of factors which contribute to medication errors; barriers to reporting and factors that increase the reporting of medication errors; whether medication errors should be reported to the patient, family or an outside agency; and, medication administration technology for reducing medication errors. A survey was mailed to a random sample of 800 registered nurses (RN) from across the United States who were members of the American Nurses Association. A response rate of 49% was achieved using a three-wave mailing. The primary causes of medication errors identified were interruptions during medication pass, short RN staffing, nurses caring for high acuity patients, nurses working more than 12 hours in one shift, and nurses' knowledge of medications dispensed. Approximately one-fourth of nurses reported they had made at least one error that had resulted in some type of harm to a patient in the past 12 months, while approximately 60% of nurses reported making one or more medication errors that did not cause harm to a patient. Rank ordering identified three major barriers to reporting medication errors: fear of consequences that may result if a medication error is reported, fear of blame if something happens to the patient due to a medication error, and fear of a reprimand if they reported a medication error had been made. Nurses perceived that medication administration technologies would decrease medication errors in their hospital. The majority of nurses overwhelmingly agreed that medication errors should be communicated to patients or families, as well as hospitals being responsible for communicating their error rates to the public. Results of this study have serious implications for individual staff nurses, nurse administrators, as well as hospital administration and hospital systems in terms of error reduction and patient s (open full item for complete abstract)

Committee: James H. Price PhD (Committee Chair); Joseph A. Dake PhD (Committee Member); Timothy R. Jordan PhD (Committee Member); Jane Ransom PhD (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2010, Pharmacy

Background: Diabetes (DM), a costly, increasingly prevalent chronic disease represents one of the leading causes of death and disability in the US. Declining macroeconomic conditions, unemployment, or work force non-participation may affect relationships between cost constraints, medication use, and health services utilization. Few studies assess associations between being without work and medication adherence or health services utilization for diabetics residing in the US. The objective of this preliminary, investigational research was to assess associations between joblessness and US adult working age diabetic oral anti-diabetic (OAD) medication adherence and health services utilization after controlling for demographic characteristics and clinical factors. Methods: A population based retrospective longitudinal fixed effects panel design using pooled MEPS data for the years 2001-2007 were used to estimate associations between joblessness and OAD medication adherence, as well as health services utilization. Adherence was measured using the proportion of days covered (PDC). Individuals with PDC > = 0.80 were classified as adherent. Utilization outcomes assessed associations between joblessness and the likelihood and number of all cause, DM disease specific and diabetic complication related emergency department, in-patient hospitalization, out-patient, and office based visits. Individuals age 24-59 with an ICD-9-CM code for DM, were included in the study. Pregnancy, seasonal job status, and individuals prescribed long term insulin were excluded from the study. Covariates included age, family size, gender, educational attainment, ethnicity, race, marital status, household income as a fraction of the poverty line, employment status, insurance status and geographical region, metropolitan statistical area, the Enhanced Charlson Co-morbidity Index, body mass index, and smoking status. DM related complications were classified as eye, neurological, renal, macrovascular and (open full item for complete abstract)

Committee: Milap Nahata PhD (Committee Co-Chair); Rajesh Balkrishnan PhD (Committee Co-Chair); James McAuley PhD (Committee Member); Eric Seiber PhD (Committee Member) Subjects: Health Care; Pharmaceuticals

Doctor of Philosophy, The Ohio State University, 2009, Pharmacy

Background: Vaginal atrophy, or atrophic vaginitis, is a symptom of menopause experienced by up to 40% to 50% of postmenopausal women. Symptoms include vaginal dryness, itching, and irritation; dyspareunia; successive urinary tract infections; and urinary incontinence. The most effective therapy for atrophic vaginitis is vaginal estrogen, available in cream and tablet forms. Not all forms have received equal acceptance, potentially resulting in sub-optimal medication adherence and persistence. The objective of this study was to understand the medication-taking behavior of vaginal estrogen users in clinical practice and measure associated healthcare utilization and cost outcomes.Methods: Retrospective claims of women enrolled in the North Carolina Medicaid program between January 2003 and December 2007 were analyzed. Inclusion criteria were occurrence of at least one prescription claim for vaginal estrogen and continuous health plan enrollment for 12 months prior to and 12 months following vaginal estrogen initiation. Multivariate regression analyses were used to estimate the effect of form of vaginal estrogen on medication adherence, medication persistence, and health services utilization and cost outcomes. Adherence was measured using the medication possession ratio (MPR); persistence was measured using treatment duration. Additional outcomes explored included prescribing provider specialty, proportion of initial prescriptions refilled, and switching to the other form of vaginal estrogen. Covariates included age, race, Charlson Comorbidity Index, mammography, prior and current use of systemic estrogen, and the number of outpatient office visits in the year prior to vaginal estrogen initiation. Results: 1,505 women (30% black, age 40 - 64 years, mean age 53.2 years) met all inclusion criteria. 89.6% of women used vaginal cream products; 10.4% used vaginal tablets. An estimated 23.3% of vaginal estrogen prescriptions were prescribed by obstetrician/gynecologists. Me (open full item for complete abstract)

Committee: Rajesh Balkrishnan PhD (Advisor); Deborah Levine MD, MPH (Committee Member); Milap Nahata MS, PharmD (Committee Member); Sharon Schweikhart PhD (Committee Member) Subjects: Health; Health Care; Pharmaceuticals

Doctor of Philosophy, The Ohio State University, 2008, Pharmacy

Nurses are responsible for the safety of their patients. Nursing factors such as long work hours and fatigue are concerns as they may affect patient safety. One area of patient safety to consider is medication use, specifically medication administration errors. Quantitative data in the form of observational studies are needed to assess the impact of nurses' work hours and fatigue on medication administration errors. This non-blinded, observation-based study took place at an academic medical center in Columbus, OH. The medication administration process was observed in volunteer nurses at three points in time over a single 12-hour shift: 0-2 hours (7am-9am), 6-8 hours (1pm-3pm), and 10-12 hours (5pm-7pm). In addition to the data collected through observation, each nurse completed three questionnaires: demographic and work-related, acute fatigue, and chronic fatigue. A pilot study was conducted in both the ED and medical intensive care unit (MICU) in order to decide which setting was more feasible for this study design. Eligible nurses for the study worked in either the MICU or ED (depending on pilot results), were registered nurses, and did not work straight night shifts. Using SPSS 16.0, linear regression, repeated measures ANOVA, and frequencies were used to analyze the medication administration and nursing data. A total of 548 medication administrations were observed among the 30 MICU nurses who volunteered for this study. Within order-based errors, dose errors were the most common (6%). Administration technique errors (10.7%) were the most common within the preparation/administration-based errors, followed by administration time errors (5.7%). Within errors of process variation, not checking the patient's armband (79.6%), not double checking the MAR (16.6%), and not washing hands (12.5%) were the most common. Error rates for administration time, not washing hands, not checking armbands, and pre-charting differed significantly across the three time periods of obser (open full item for complete abstract)

Committee: Craig Pedersen (Advisor); James McAuley (Committee Member); Pamela Salsberry (Committee Member) Subjects: Nursing; Pharmaceuticals

Master of Science, The Ohio State University, 2002, Pharmacy

Compliance with prescribed drug regimens can reduce health care spending while improving patient outcomes. Managed care organizations have begun requiring members to pay a higher proportion of costs for non-preferred brand drugs, a plan known as an incented formulary or tiered cost sharing. This study has two goals, to evaluate whether an incented formulary is associated with a change in patient compliance, and to discover whether patients switch to lower-cost medications after a cost-share increase for non-preferred brands. A retrospective database analysis of the prescription drug claims for a health plan that implemented an incented formulary was performed. Four cardiovascular drug classes were analyzed, Angiotensin Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers, and HMG CoA Reductase Inhibitors. Multivariate linear regression was used to explain the relationship between implementation of the incented formulary and difference in compliance measured using the Medication Possession Ratio (MPR) while controlling for covariates. No difference was found in changes in medication compliance between users of non-preferred brand drugs and users of preferred brand or generic drugs. Users of mail order pharmacy were more compliant than users of retail pharmacy. Analysis of switching among drug products using the Mantel-Haenszel chi square test of association estimated the effectiveness of the incented formulary implementation. Almost half of all subjects taking a non-preferred brand drug switched to a generic or preferred brand drug. Furthermore, efforts by the health plan to inform members of the change were not as effective as the cost share increase in encouraging members to switch to a lower-cost medication. Subjects were most likely to switch immediately after the cost-share increase. Subjects who used mail order at least once were three times more likely to switch drugs as those who used retail pharmacy exclusively. This thesis d (open full item for complete abstract)

Committee: Craig Pedersen (Advisor) Subjects:

Master of Science (MS), Ohio University, 2009, Psychology (Arts and Sciences)

Study Objectives: To examine predictors of medication non-adherence in a racially diverse sample of patients receiving specialty treatment for headache disorders. Methods: Using a longitudinal naturalistic study design, data from 33 African American and 79 Caucasian headache patients were collected to characterize patterns and predictors of non-adherence to daily headache preventive medication. Patients completed 30-day headache diaries that assessed daily preventive medication use, headache frequency, and headache severity during the 30-days following their six month follow-up medical visit with their physician at headache specialty clinics in four major cities in Ohio. At pre-treatment and 6-month follow-up, patients provided data on headache-specific quality of life and headache disability. Results: African Americans (73%) and Caucasians (83%) were equally adherent to their preventive headache medication. A within-group examination of predictors of non-adherence to preventive medication revealed that greater headache severity and poorer quality of life at baseline predicted lower levels of non-adherence at 6-month follow-up for African Americans. Among Caucasians, the presence of a comorbid psychiatric disorder at baseline predicted greater non-adherence at 6-month follow-up. Conclusions: Adherence to preventive medications in headache patients in specialty care clinics appears to be good. Poorer quality of life and greater headache severity predicted non-adherence in African Americans while psychiatric comorbidity predicted non-adherence in Caucasians. Racial differences in predictors of adherence suggest that adherence-improvement interventions in this clinical population should consider racial- and culturally-specific factors.

Committee: Bernadette D. Heckman PhD (Committee Chair); Kenneth Holroyd PhD (Committee Member); Timothy Heckman PhD (Committee Member) Subjects: Health

Doctor of Philosophy, University of Akron, 2009, Nursing

Medication errors represent a significant concern in healthcare. The process of preventing medication errors is complex and involves several disciplines. Nurses play a vital role in identifying and preventing these errors using clinical judgment and astute decision-making skills. The purpose of this research was to identify the patient factors, workplace factors and nurse characteristics that influenced the conflict involved in questioning a medication order, the judgments made in administering the medication and contacting the prescriber to question the order. The Conflict Theory of Decision-making was the model that guided this study; simply stated the level of conflict that a decision-maker experiences directly affects the final choice that is made and the action that is taken. The factorial survey method was used in this study. The strength of the method lies in the ability to examine the effect of each independent variable on the dependent variable. A convenience sample of medical/surgical and intensive care nurses employed in three acute care facilities in Northwest Ohio completed a three-part survey. Part One of the survey asked the nurse to describe the last time a medication order was questioned. Part Two contained vignettes that portray ‘real-life' decision-making situations that nurses responded to using a Likert Scale. Part Three asked for specific information about the nurses' personal and professional characteristics. Results of the analysis of the data from 115 nurses' responses found the single most important influence in the experience of conflict, decision to administer the medication and contacting the prescriber was the dose and the route of the medication. In addition, nurses with a baccalaureate or higher degree were found to have a significantly different level of conflict to question a medication order than nurses with Associate Degrees or diplomas. These findings give impetus for developing educational strategies to support management of c (open full item for complete abstract)

Committee: Ruth Ludwick PhD (Advisor) Subjects: Nursing

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The problem associated with Medication Assisted Treatment (MAT) programs is the high rate of broken appointments for patients enrolled in and receiving treatment. Broken appointments have continued to be an issue in MAT programs which can impact the overall effectiveness of programs. Improving a patient's treatment appointment compliance in treatment (MAT) programs has been an ongoing investigation phenomenon. Introducing interventions with pre-appointment reminders has been the focus of many researchers, however investigating the impact of a re-engagement intervention for those patients that have already missed an appointment has not been completed. This research study presented an alternative approach to addressing the issue of treatment compliance through post-broken-appointment re-engagement efforts. More specifically, this investigation compared the impact of an already established retention strategy to a new re-engagement strategy across two groups of patients in terms of impact on overall treatment compliance and satisfaction with communication specific to scheduling. The purpose of this quantitative study was to determine whether a new re-engagement strategy (vs. the old retention strategy) influenced the rate of compliance for attended appointments for 114 patients receiving the same MAT appointment frequency, relative to a standard retention strategy. Furthermore, the current study examined the relationship between patient satisfaction and communication specific to scheduling/arranging appointments.

Committee: Crissie Jameson (Committee Chair); Jesse Florang (Committee Member); David Meckstroth (Committee Member) Subjects: Health Care

Master of Science, The Ohio State University, 2007, Graduate School

Committee: Not Provided (Other) Subjects:

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

As of the end of the twentieth century, biological drug therapies were at the forefront of health research for treating life-threatening diseases. Despite their therapeutical benefits stemming from providing great treatment hope against lethal diseases, biological drugs end up placing a financial burden on the American healthcare system. In the last decade, biological drug skyrocketing prices have significantly impacted net drug expenditures. The biological drug market needs more competitors. This impacted the passage of the Biological Price Competition and Innovation Act in 2010, introducing biosimilars, the highly safe and effective but less expensive biological copycat alternative drugs. However, a decade after biosimilars introduction, healthcare administration barriers limit American pharmacists and physicians from adopting biosimilars. Hence, the current low American health care provider biosimilar adoption rate must be improved to realize significant healthcare savings. Although many literature studies have examined biosimilar clinical adoption hurdles among American pharmacists and physicians in their siloed medical care settings, they have yet to focus on creating a comprehensive un-siloed biosimilar adoption plan based on their inputs. Therefore, to determine the essential elements to boost biosimilar adoption, this qualitative exploratory study thoroughly examined the literature. It then gathered the viewpoints of pharmacists and physicians who were acquainted with biosimilars by conducting semi-structured question interviews with 13 pharmacists and 8 physicians for a total of 21 participants. The findings of this study suggest that to create a dynamic and competitive biosimilar comprehensive clinical adoption plan, increasing HCPP education, having sufficient healthcare reimbursement, improving the roles of essential stakeholders, and increasing communication among key stakeholders are all necessary to increase biosimilars' trust and adoption, facilitati (open full item for complete abstract)

Committee: David Meckstroth (Committee Chair); Karen Lankisch (Committee Member); Bora Pajo (Committee Member) Subjects: Health; Health Care; Health Care Management; Health Education; Health Sciences; Higher Education; Higher Education Administration

Doctor of Nursing Practice , Case Western Reserve University, 2024, School of Nursing

Among hospitals, the number of chief executive officers (CEO) who are nurses is small. For example, only two of the 400 major academic medical centers-health care systems are led by nurses (Bean et al., 2022). Even fewer hospital and health system CEOs are advanced practice registered nurses (APRNs). The CEO is the highest ranking executive leader in an organization, in this case, a hospital. APRNs have grown from less than 68,000 before 1990 to over 355,000 in 2023 (American Association of Nurse Practitioners, 2023). The APRN brings essential and possibly unique knowledge, skills, and attitudes to the CEO role, as they are well versed in providing bedside nursing care, similar to a CNO's expectations. They are also licensed independent providers and can relate to other advanced practice providers (APPs) and physicians, much like the expectations of a chief medical officer (CMO). This project is a theory-driven narrative exploring the evolution of two nurse-manager-led quality improvement (QI) projects in which one chief executive officer-APRN (CEO-APRN) provided the initial vision and oversight and how reflection on this narrative led to an organizing, hard-wired framework to reduce patient harm through multiple QI projects hospital-wide. This report is a program evaluation specific to one institution and is not ready for generalizability outside one hospital system.

Committee: Chris Winkelman (Advisor); Peter Pronovost (Committee Member); Terry Winemiller (Committee Member); Shelly Loop (Committee Member) Subjects: Nursing