Systematic Review and Medication Capstone Project

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Evidence-Based Project Proposal

Graduate Project in Nursing

The incidence of sexually transmitted diseases has been increasing among adolescents in countries around the world, but there remains a dearth of timely and relevant studies concerning salient differences in knowledge level and attitudes between different cultures and ethnic populations. One common factor that has been consistently demonstrated in improving the effectiveness of treatments for sexually transmitted diseases is promoting adherence to treatment regimens, most especially for medications since these are used in all treatments for sexually transmitted diseases. While there have been some studies concerning various strategies for promoting adherence levels to treatment regimens, there remains a lack of studies concerning evidence-based practices that incorporate technological solutions. To this end, the proposed study intends to conduct an experiment using innovative face recognition and motion detection smartphone app to evaluate its effectiveness in promoting adherence to medication regimens among a population of adolescents and young adults with a sexually transmitted disease.

EVIDENCE-BASED PROJECT PROPOSAL 3

Evidence-Based Project Proposal

Introduction

Practice Issue

There has been growing emphasis of the use of evidence-based practice (EBP) over the past 2 decades (Reed & Reed, 2012). This growing emphasis is attributed in large part to the notion that EBP is widely regarded as providing the framework needed for the cost-effective delivery of high quality care while taking the patients' interests and preferences into account. In this regard, the American Psychology Association defines EBP as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (as cited in Reed & Reed, 2012, p. 20). Although the increased calls from the helping professions for the use of EBP is fairly recent and, the use of EBP actually dates to Florence Nightingale's seminal work on the battlefields of the Crimean War in the 1850s (Rahman & Applebaum, 2012) While EBP has its share of critics, most practitioners agree that the approach represents the best available strategy for improving the quality of healthcare services in the face of scarce resources (Rahman & Applebaum, 2012).

Background Information

The incidence of sexually transmitted diseases among adolescents has experienced a steady increase in recent years (Kaptanglu & Suer, 2014). Because incidence rates of sexually transmitted diseases vary by country, it is possible that there are substantive cultural and ethnic differences in the respective levels of knowledge among adolescents in and their attitudes towards sex (Kaptanglu & Suer, 2014). In addition, individual perceptions of locus of control and the responsibility for their actions differ even among homogeneous populations, making the need to identify those factors that are most responsible for exacerbating sexually transmitted disease levels (Estrada & Dupoux, 2006). Although precise figures are unavailable and many authorities believe official reports seriously underestimate the extent of the problem, current projections indicate that more than 340 million people become infected with some type of sexually transmitted disease each year (Timiun, 2012).

While there are also differences in the prevalence rates for the various types of sexually transmitted diseases, these infections all share some serious and potentially fatal healthcare implications left untreated. In the United States, the U.S. Centers for Disease Control (CDC) report that there has been a 19% increase in global syphilis rates among men and women, but men are responsible for the vast majority (90%) of all primary and secondary cases of syphilis, which are the most infectious stages of the disease (Reported STDs in the United States, 2015). Moreover, the studies to date also indicate that syphilis can seriously increase the risk of acquiring even more deadly diseases such as the human immunodeficiency virus (HIV) (Reported STDs in the United States, 2015).

Aim of the Project

The primary aim of this project is to identify EBP-based strategies for improving adherence rates to medication and treatment regimens for adolescent patients with sexually transmitted diseases. This aim is congruent with the tenets of EBP which include improving patient healthcare outcomes, as well as the quality of care and overall health status (Grove, Burns, & Gray, 2013).

PICOT Question

A properly formulated PICOT question can serve to identify those studies that are most relevant for the specific purposes of an empirical analysis (Burnett, 2013). In this regard, Burnett (2013) advises that, "PICOT works like a filter, targeting efforts and narrowing the search for information as it applies to a specific patient care issue" (p. 37). In the proposed study, the specific patient care issue of interest concerns adherence levels to treatment regimens among adolescences being treated for sexually transmitted disease and identifying ways to improve these levels.

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Significance

Poor patient adherence to treatment regimens is widely recognized as a significant problem, especially with certain population groups such as those with mental disorders and young people who lack the medical literacy to understand the significance of adherence to treatment regimens (Kalali & Richerson, 2016). According to the definition provided by Atibioke and Osinowo (2015), treatment adherence is "the extent to which a person's behavior coincides with medical or health advice, such as taking medication regularly, returning to a doctor's office for follow-up appointments, and observing preventive and healthful lifestyle changes" (p. 90). Because the treatment of sexually transmitted diseases always includes a medication intervention, adherence to treatment regimens should therefore include a focus on promoting patients' taking their medications precisely as they are instructed (Atibioke & Osinowo, 2015).

In this context, nonadherence to treatment regimens for sexually transmitted diseases fall into two general categories: 1) not taking prescribed medication in the recommended dosage or frequency, or not taking prescribed medication at all; and 2) non-attendance or irregular attendance at appointments with healthcare providers (Kalali & Richerson, 2016). It has been well documented that nonadherence to treatment regimens can adversely affect clinical outcomes. For example, Kalali and Richerson (2016) emphasize that, "Nonadherence can result in an increased risk of relapse, hospitalization, poor therapeutic response, and delayed remission and recovery" (p. 25).

Moreover, nonadherence levels among adolescents suffering from sexually transmitted diseases may be significantly underestimated due to fears that their parents will discover their condition (Leichliter & Copen, 2017). Recent changes in the U.S. healthcare system have allowed dependent children to continue as beneficiaries of their parents' health insurance plans until they reach age 26 years, and the potential therefore exists for even young adults to avoid or delay seeking treatment or adhering to treatment regimens for their sexually transmitted disease due to these confidentiality issues (Leichliter & Copen, 2017). Therefore, taken together, it is reasonable to assert that improving treatment regimen adherence rates will have a correspondingly positive effect on improving healthcare outcomes for adolescents with sexually transmitted diseases.

Evidence Review and Synthesis

Database Search and Keeper Studies

The search for scholarly articles pertaining to this evidence-based project started with the university library. Search terms, medical subject headings and keywords used to search for relevant resources included "sexually transmitted diseases," "STDs," as well as chlamydia, gonorrhea, syphilis and HIV/AIDS. In addition, searches were also conducted using the terms "adherence rates [and/or] levels," "nonadherent patients," "treatment regimens" and "medication regimens." 'The scholarly articles were delimited to those published in juried journals in the English language within the past 5 years. The following academic databases were consulted for this purpose:

• EBSCOHost;

• Medline;

• CINAHL Plus; and,

• Questia.

In addition, reliable governmental resources such as the U.S. Centers for Disease Control were also consulted for current prevalence rates of sexually transmitted diseases as well as the vendor (www.aicure.com) of a technological solution to promote adherence to medication regimens. The results of those peer-reviewed studies that were deemed sufficiently relevant (e.g., "keeper studies") and which satisfied the inclusion criteria described above were incorporated into the evaluation and synthesis tables at the appendix.

Synthesis of Evidence

Synthesizing the evidence that emerged from the evaluation of the selected studies required more than one review and assessment, and rather followed the iterative process recommended by Noblit and Hare (1988) concerning the synthesis of multiple studies of different types wherein each study evaluated serves to inform the evaluation of the following studies. Following this series of assessments, the findings that emerged from the studies synthesized below were incorporated into the evaluation and synthesis tables provided at the appendix.

A retrospective study by Leichliter and Copen (2017) analyzed data from the 2013 -- 2015 National Survey of Family Growth and found that 12.7% of sexually experienced youths (adolescents aged 15 -- 17 years and those young adults aged 18 -- 25 years who were on a parent's insurance plan) refused to access sexual and reproductive healthcare services due to concerns their parents would discover their interests and needs, a concern that was especially pronounced among those aged 15 to 17 years (Leichliter & Copen, 2017). The 2013 -- 2015 survey included 10,205 respondents and had a valid (69.3%) response rate (Leichliter & Copen, 2017). Although the concern over the confidentiality of their seeking healthcare services for sexually related issues adversely affected all type.....

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