Introduction
The analysis of changes in the conditions of the clinical organization should be accompanied by the construction of an implementation plan, according to PICOT. In particular, the question posed in this study is as follows: In patients, age 50 years and older (P), will consistent adherence to antihypertension drugs (I) compared to inconsistency or nonadherence to antihypertension drugs (C) decrease overall hypertension and increase patient outcomes (O) when done consistently over six months? (T). In this regard, this essay aims to discuss a plan for implementing the PICOT, as mentioned above, the issue in light of financial, professional, and research factors.
Setting and Subjects
The definition of the main parameters on which the medical impact will be made and the conditions of the experiment are of primary importance for the solution of the problem. The application of antihypertensive drugs was reflected in the works of Laurent (2017), in which the author demonstrated that under normal conditions, the effect of the drug is reduced to a decrease in blood pressure. This is of particular relevance for patients with hypertensive disease, a chronic disease of the cardiovascular system, in which a person’s blood pressure is continuously or frequently increased (Laurent, 2017). It is known that hypertension leads to acute and chronic complications.
Accordingly, for the implementation of PICOT, it is proposed to obtain approval for medical intervention and monitoring from 50 adult patients whose age exceeds 50 years (Figure A1). It should be noted in particular that there is a strong correlation between age and prevalence: about 70% of older people have elevated blood pressure (Buford, 2016). Several groups of antihypertensive drugs have been identified, but in this study, patients will be asked to take a drug in the form of an oral tablet, in particular, an angiotensin-converting enzyme inhibitor compound (Messerli et al., 2018). Observation is carried out within the framework of a clinical organization, so if a patient is discharged early, the experiment continues at home with regular monitoring of health indicators.
Timeline
As described in PICOT, a clinical trial takes six months. It is not difficult to note that this is a long for an individual patient, because according to data, the average time spent in the hospital does not exceed 4.5 days (“Decreasing the patient length of stay,” n.d.). Nevertheless, due to the simplicity of the tablet taking procedure, the experiment is quite flexible, in case the observation of selected participants can continue from home (Table B1). Intermediate examinations are carried out each week when the attending staff measures the patient’s basic biological and physiologic parameters.
Solution Process and Resources
The proposed solution has the property of versatility and complexity of expertise, therefore, the successful implementation of PICOT in clinical practice requires several specialists responsible for specific tasks. Applying the policy of differentiation and delegation of authority, the medical organization will be able to create an environment characterized by high reliability, honesty, and objectivity of the practice and the results obtained. In other words, the PICOT described requires medical professionals (doctor, nurse, attendants), analysts and statisticians, managers, tax officials, and patients (Table C2). Since updating the working staff during the research is possible, it is necessary to conduct a training program for new employees so that they have a clear understanding of goals and objectives, as well as the degree of responsibility. From the processes used, it is necessary to carry out a smooth communication between all parts of the team in order to make observation qualitative and reliable. During a trial, psychophysiological, social, and personal barriers to active monitoring can be created. To overcome these barriers, it is suggested that training sessions be conducted for clinic staff and patients, a comfortable environment be provided for all participants, and that patients not feel uncomfortable with the gender, religion, or worldviews of staff.
Solution Methods and Instruments
The PICOT implementation plan is being achieved through the regular monitoring of one pilot group (25 patients) and one control group (25 people) who do not take the tablet daily. Monitoring is carried out by analyzing the patient’s physiological parameters and by means of surveys to determine the patient’s psychological state from daily tablet intake (Appendix D). The results of the survey are processed by specialists weekly, resulting in a patient satisfaction schedule.
Data Collection and Management
The data obtained during the survey are subjected to multiple two-dimensional regression analysis, in which experts determine the nature of the relationship of three variables: tablet intake, physiological parameters, and the degree of satisfaction with care (Appendix D). For the successful implementation of the plan, the results must be processed weekly when the doctor receives the patient’s data. This approach allows not only to obtain timely clinical data (and, in the case of unexpected circumstances, to help the patient in time) but also to track the nature of the changes. A positive effect will likely be achieved much earlier, and prolonged therapy will only make the situation worse.
Budget
The study’s technological, financial, and management components do not threaten the implementation of the plan. Nevertheless, it is crucial to emphasize the expenditure structures necessary for the implementation of PICOT separately. This refers to the planned costs associated with paying for medical staff, analytical agents, and project managers. Moreover, training costs, as well as unforeseen costs, may occur during the implementation. As shown in Table E3, considering all possible categories, the monthly minimum estimated cost of the study is $7,100.
Plans to Maintain
It is evident that the trial is tied to certain risks, as not all patients will be observed within the time frame, or the expected results will not be achieved. In this case, project managers should consider extending the trial only if it does not hurt the participants. Conversely, if results are given within the first months, further research can be stopped if the statistics prove reliable.
References
45 Medical consent forms. (2017). Printable Templates.
Buford, T. W. (2016). Hypertension and aging. Ageing research reviews, 26, 96-111.
Decreasing the patient length of stay. (n.d.). CentRak.
Laurent, S. (2017). Antihypertensive drugs. Pharmacological research, 124, 116-125.
Messerli, F. H., Bangalore, S., Bavishi, C., & Rimoldi, S. F. (2018). Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use? Journal of the American College of Cardiology, 71(13), 1474-1482.
Patient satisfaction survey template – 9+ Free Word, PDF Documents Download. (n.d.). Template.net.