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Author(s): Vicki S. Conn[sup.1] , Todd M. Ruppar[sup.2] , Jo-Ana D. Chase[sup.3] Author Affiliations: (1) School of Nursing, University of Missouri, S317 Sinclair Building, 65211, Columbia, MOUSA (2) University of [...], This systematic review applied meta-analytic procedures to integrate primary research that examined blood pressure outcomes of medication adherence interventions. Random-effects model analysis calculated standardized mean difference effect sizes. Exploratory dichotomous and continuous moderator analyses using meta-analytic analogues of ANOVA and regression were performed. Codable data were extracted from 156 reports with 60,876 participants. The overall weighted mean difference systolic effect size was 0.235 across 161 treatment versus control comparisons. The diastolic effect size was 0.189 from 181 comparisons. Effect sizes were significantly heterogeneous. Common risks of bias included lack of allocation concealment, unmasked data collectors, and absent intention-to-treat analyses. Exploratory moderator analyses suggested that habit-based interventions may be most effective. The largest effect sizes were for interventions delivered by pharmacists. The modest magnitude effect sizes suggest future research should explore novel higher dose interventions that might address multiple levels of influence on adherence behavior.

Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Random-effects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge, health outcomes, and health services utilization. Results: Data were synthesized across 11,827 participants. Interventions significantly improved MA (ES = 0.33), knowledge (ES = 0.48), and diastolic blood pressure (ES = 0.19). Nonsignificant effects were found for systolic blood pressure (ES = 0.21), other health outcomes (ES = 0.04), and health services utilization (ES = 0.16). Moderator analyses showed larger adherence ESs for interventions employing special medication packaging, dose modification, participant monitoring of medication effects and side effects, succinct written instructions, and standardized (not tailored) interventions. Larger effects were found when a moderate proportion of participants were women, for participants taking 3-5 medications, and when pill count adherence was measured. Implications: The findings document that interventions increase MA in older adults. The considerable heterogeneity in the magnitude of effects across studies and results of the moderator analyses demonstrate the need for additional empirical research to optimize interventions.

Purpose: The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. Design and Methods: A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing homes in Missouri and classified into resident outcome groups. Resident outcomes were measured by use of quality indicators derived from nursing home Minimum Data Set resident assessment data. Cost and staffing information were derived from Medicaid cost reports. Participant observation methods were used to describe the care delivery processes. Results: In facilities with good resident outcomes, there are basics of care and processes surrounding each that staff consistently do: helping residents with ambulation, nutrition and hydration, and toileting and bowel regularity; preventing skin breakdown; and managing pain. The analysis revealed necessary organizational attributes that must be in place in order for those basics of care to be accomplished: consistent nursing and administrative leadership, the use of team and group processes, and an active quality improvement program. The only facility characteristic across the outcome groups that was significantly different was the number of licensed beds, with smaller facilities having better outcomes. No significant differences in costs, staffing, or staff mix were detected across the groups. A trend in higher total costs of $13.58 per resident per day was detected in the poor-outcome group compared with the good-outcome group. Implications: For nursing homes to achieve good resident outcomes, they must have leadership that is willing to embrace quality improvement and group process and see that the basics of care delivery are done for residents. Good quality care may not cost more than poor quality care; there is some evidence that good quality care may cost less. Small facilities of 60 beds were more likely to have good resident outcomes. Strategies have to be considered so larger facilities can be organized into smaller clusters of units that could function as small nursing homes within the larger whole.

Examined the association of TriTrac-recorded activity among older women with commonly-used measures of activity and associated constructs. A moderate correlation was found between TriTrac and the main criterion measure, the Physical Activity Index. Respondents wore the TriTrac units only 78 percent of the requested days and underreported time not wearing the TriTrac. (SM)

Purpose: Research development and regional consortium strategies are described to assist schools in all countries extend their gerontological nursing research productivity. The strategies, collaboration and mentoring experiences, and outcomes are also shared to illustrate a highly successful approach in increasing faculty programs of nursing research in a focused area of inquiry. Design: A case description of gerontological nursing research development and regional consortium strategies in schools of nursing is used. The regional consortium included 17 schools of nursing that are working to increase faculty programs of gerontological nursing research. Survey responses describing publications, presentations, and research funding awards from 65 of 114 total faculty participants in consortium opportunities (pilot and mentoring grant participants, participants in summer scholars' grantsmanship seminars) were collected annually from 1995 through 2008 to describe outcomes. Findings: From 1994 through 2008, faculty participants from the consortium schools who responded to the annual surveys reported a total of 597 gerontological nursing publications, 527 presentations at research conferences, funding of 221 small and internal grants, and 130 external grant awards, including 47R-series grants and 4 K awards. Conclusions: There is an urgent need for more nurse faculty with programs of research to inform the health care of persons and support the preparation of nurse clinicians and faculty. The shortage of nurse scientists with active programs of gerontological research is especially serious and limits the number of faculty who are needed to prepare future gerontological nurses, particularly those with doctoral degrees who will assume faculty positions. Further, junior faculty with a gerontological nursing research loci often lack the colleagues, mentors, and environments needed to develop successful research careers. The outcomes of the development and regional consortium strategies suggest that the principles of extending collaboration, mentoring, and resource sharing are useful to augment faculty research opportunities, networking and support, and to increase productivity in individual schools. Clinical Relevance: Clinical relevance includes: (a) implications for preparing nurse scientists and academicians who are and will be needed to train nurses for clinical practice, and (b) development of more faculty programs of research to provide systematic evidence to inform nursing practice. Key words Gerontological nursing research, faculty programs of research, nursing school research capacity, nursing school research resource sharing