Capella 4030 Assessment 3 Picot Questions and An Evidence Based Approach

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Capella university

NURS-FPX 4030 Making Evidence-Based Decisions

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PICO (T) Questions and an Evidence-Based Approach

Stroke is a leading cause of disability and mortality worldwide, making it a critical focus for healthcare interventions. To improve patient outcomes through evidence-based practice, it is essential to gather credible, relevant, and trustworthy evidence for integration into clinical practices. Thus, a structured approach to clinical inquiry, such as the PICOT framework, will be beneficial. PICOT stands for Patient/Population, Intervention, Comparison, Outcome, and Time, and it helps formulate research questions that guide evidence-based practice (Hosseini et al., 2023). In this assessment, we apply this framework to inquire about the benefits of telehealth services in improving medication adherence among stroke patients, eventually enhancing patient outcomes. 

Practice Issue to be Explored and PICO(T) Inquiry

Patients encountering stroke are at high risk of developing medication non-adherence, leading to exacerbations, relapses, and poor disease control (Zeng et al., 2021). Thus, it has become a significant medical practice issue where providers strive to ensure that patients maintain medication adherence and engage in self-management practices to control further attacks. In the growing healthcare landscape and increasing disease burden, traditional in-person follow-up visits are insufficient for continuous monitoring, especially in elderly patients who face mobility challenges or other barriers to accessing care. Therefore, this paper explores the use of telehealth services to improve outcomes in this vulnerable population.

In patients who have suffered a cerebrovascular attack (stroke) (Population), does the use of telehealth for monitoring and follow-up (Intervention), compared to in-person follow-up visits (Comparison), improve medication adherence and disease control (Outcome)? 

Benefit of Using the PICO(T) Framework 

Exploring this practice issue through the PICOT approach allows for a structured and focused investigation that can lead to evidence-based interventions. The PICOT framework breaks down the research question into specific components, making it easier to identify relevant evidence and compare the effectiveness of different interventions (Hosseini et al., 2023). By applying this approach, healthcare providers can systematically evaluate the importance of evidence-based interventions in managing post-stroke patients. Ultimately, this can inform clinical guidelines and improve patient outcomes by promoting strategies that are proven to be effective in controlling the disease and reducing the risk of recurrence.

Sources of Evidence and Rationale/Criteria

Several online sources, including databases, journals, and websites, are capable of answering the PICOT question regarding the effectiveness of telehealth services versus in-person follow-up for medication adherence and disease control in stroke patients. 

1. Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed. 
2. Journals: Journal of Telemedicine and Telecare and the Journal of Stroke and Cerebrovascular Diseases. 
3. Authoritative Website: The American Stroke Association (ASA). 

The Rationale for Selecting These Sources 

The selected sources are capable of answering the PICOT question due to their focus on high-quality, peer-reviewed research and evidence-based guidelines. Additionally, these sources provide information that abides by the CRAAP criteria (currency, relevance, authority, accuracy, and purpose). According to Oermann et al. (2021), among other databases, CINAHL and PubMed are acknowledged for their comprehensive coverage of healthcare-related topics. Therefore, these databases are crucial to accessing literature studies that directly examine the impact of telehealth on chronic disease management, including stroke.

Simultaneously, the Journal of Telemedicine and Telecare explicitly focuses on telehealth, making it an invaluable resource for understanding the nuances of remote patient monitoring and follow-up care. Similarly, the Journal of Stroke and Cerebrovascular Diseases provides insights into the latest research on stroke management, ensuring that the information is both current and relevant. Finally, the authoritative website of ASA offers reliable guidelines, which are essential for supporting clinical decisions based on the latest evidence (American Stroke Association, n.d.). These sources collectively provide a robust foundation for exploring the efficacy of telehealth in improving post-stroke outcomes, directly addressing the PICOT question.

Findings from the Literature 

Several scholarly studies support the PICOT inquiry by elaborating on the effectiveness of telehealth and remote monitoring applications compared to standard in-person visits in improving medication adherence, addressing disparities, and enhancing health outcomes for post-stroke patients. 

• A literature review by Choi et al. (2023) concludes that telemedicine and mobile health applications are beneficial for stroke patients with minimal medication adherence. The study showed a substantial improvement of 37% compared to the control group with usual care. These interventions not only improve medication compliance but are also proven to reduce blood pressure and remain a cost-effective stroke management strategy. 
• Another literature review shows that compared to the patients who received the usual care, the individuals who were treated using mHealth technology had a better understanding of medication use and adherence. However, this study further mentions the effectiveness of instant messaging features compared to telephonic call intervention in significantly augmenting adherence rates (Zeng et al., 2021). 
• Sharrief et al. (2023) discuss how telehealth services address healthcare disparities for stroke patients. According to this study, these post-discharge telehealth visits reduce care barriers, such as transportation issues associated with in-person visits. Moreover, these services are crucial for preventing stroke readmissions by guaranteeing adherence to medication and treatment plans. Finally, these interventions also promote easy and accessible follow-up care, ensuring timely interventions. 

Capella 4030 Assessment 3 Picot Questions and An Evidence Based Approach

Among the sources mentioned, the most credible are the literature reviews by Choi et al. (2023) and Zeng et al. (2021). These peer-reviewed articles are rigorously examined, ensuring the accuracy, objectivity, and reliability of the research. Choi et al. (2023) are particularly credible due to their comprehensive analysis that demonstrates the efficacy of telemedicine in 37% improvement in medication adherence, underscoring its significance to integration in clinical practice. Similarly, Zeng et al. (2021) also present credible evidence, especially in their comparison of different telehealth modalities (instant messaging versus telephonic calls). This comparison provides precise guidelines for healthcare professionals to optimize telehealth interventions.

Decision-Making on PICO Question 

Based on these findings, the decision to implement telehealth interventions for monitoring medication adherence and disease control in stroke patients is strongly supported. The study by Choi et al. (2023) demonstrated a 37% improvement in medication adherence. This study is particularly relevant to the PICO(T) question, highlighting the efficacy of telehealth in achieving positive outcomes, such as improved treatment and drug adherence, better blood pressure control, reduced readmission rates, and enhanced accessibility to follow-up care.

Likewise, Zeng et al. (2021) found that instant messaging significantly augments adherence rates, suggesting that this specific telehealth feature could be crucial in enhancing patient compliance. Finally, Sharrief et al. (2023) further emphasize the role of telehealth in reducing healthcare disparities by overcoming healthcare barriers like transportation, thereby improving follow-up care and preventing readmissions. These findings collectively suggest that incorporating telehealth into post-stroke care plans is likely to lead to better patient outcomes, making it a valuable intervention for this population.

Conclusion 

In conclusion, managing stroke effectively demands an evidence-based approach. The PICO(T) framework was utilized to address the practice issue of improving medication adherence and enhancing disease control among stroke patients by recommending telehealth interventions. This assessment reviewed credible evidence highlighting the effectiveness of telehealth in improving medication compliance, addressing care disparities, and bettering patient outcomes. The findings underscore the importance of timely follow-up, patient engagement, and healthcare provider expertise in maximizing the benefits of telehealth. Implementing these interventions can lead to better patient outcomes and reduce the global burden of the disease. 

References

American Stroke Association. (n.d.). About the American Stroke Association. https://www.stroke.org/en/about-the-american-stroke-association

Choi, Y. Y. C., Fineberg, M., & Kassavou, A. (2023). Effectiveness of remote interventions to improve medication adherence in patients after stroke: A systematic literature review and meta-analysis. Behavioral Sciences (Basel, Switzerland), 13(3), 246. https://doi.org/10.3390/bs13030246 

Hosseini, M.-S., Jahanshahlou, F., Akbarzadeh, M.-A., Zarei, M., & Vaez-Gharamaleki, Y. (2023). Formulating research questions for evidence-based studies. Journal of Medicine, Surgery, and Public Health, 2(2), 100046. https://doi.org/10.1016/j.glmedi.2023.100046

Oermann, M. H., Wrigley, J., Nicoll, L. H., Ledbetter, L. S., Carter-Templeton, H., & Edie, A. H. (2021). Integrity of databases for literature searches in nursing. Advances in Nursing Science, 44(2), 102–110. https://doi.org/10.1097/ans.0000000000000349

Capella 4030 Assessment 3 Picot Questions and An Evidence Based Approach

Sharrief, A. Z., Guzik, A. K., Jones, E., Okpala, M., Love, M. F., Ranasinghe, T. I. J., & Bushnell, C. (2023). Telehealth trials to address health equity in stroke survivors. Stroke, 54(2), 396–406. https://doi.org/10.1161/strokeaha.122.039566 

Zeng, Z., Wu, T., Lv, M., Qian, J., Chen, M., Fang, Z., Jiang, S., & Zhang, J. (2021). Impact of mobile health and telehealth technology on medication adherence of stroke patients: A systematic review and meta-analysis of randomized controlled trials. International Journal of Clinical Pharmacy, 44(1), 4–14. https://doi.org/10.1007/s11096-021-01351-x