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Which risk factors need to be modified to reduce the patient’s risk of readmission?

A. Nonadherence and financial barriers

B. Poor diet and lifestyle

C. NSAID use

D. Smoking

E. All of the above

Correct answer: E

Rationale: Identifying nonadherence and addressing barriers which contribute to poor compliance is important in optimizing medication therapy. If our patient has an educational deficit or a financial barrier that will prevent him from taking his prescribed medications correctly, our interventions will focus on addressing adherence and supporting our patient in resolving those financial barriers. Poor diet and lifestyle, including smoking, can also contribute to readmission and can be addressed when providing patient education. When reconciling medications, we should discontinue medications that can cause adverse effects for our patients, such as NSAIDs for patients with high blood pressure or cardiovascular events.

Which of the following nonadherence barriers must be addressed in the outpatient setting to ensure this patient remains compliant to all medications?

A. Cost of medications

B. Forgetfulness

C. Transportation issues

D. Lack of perceived benefit

Correct answer: A

Rationale: For this patient, cost is the major barrier. Our patient has Medicaid, states that he skips medication doses to prolong his refill and complains about lack of funds to pay for his medications. There are no apparent issues of forgetfulness or transportation issues, although these are important to address if they are a barrier to a patient. There is also no indication that the patient feels there is a lack of benefit. He skips doses due to cost.

How do you plan to address this patient’s adherence issues?

A. Tailor medication education and self-care to patient’s health literacy level

B. Employ motivational interviewing techniques

C. Tell him to download phone application to help him remember to take his medications

D. Assist JJ with figuring out how he can afford his medications

E. Recommend physician to change to medications taken once daily when possible

Correct answer: D

Rationale: How we address adherence issues will depend on the unique and individual needs of the patient. In this case, because ...

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