Medication Adherence in Adults with Chronic Diseases in Primary Healthcare: A Quality Improvement Project

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

ABSTRACT- OBJECTIVE: specify the target audience, improve medication adherence in which audience? (Elderly? Children? Chronic patients....)

OBJECTIVE: The objective described in the abstract differs from the objective described in the body of the text.

ABSTRACT- Methods: Inform the study design; describe the period in which the study took place; inform the location and target audience of the study; inform the outcome or research question; inform how the study data was analyzed.

METHODS - Results: The results described in the abstract do not seem to portray the power of the results found by the study. Use space to detail the main findings.

METHODS: Report study design at the beginning of methods.

METHODS: A quality improvement activity does not require ethics committee approval. However, as this improvement activity is part of a research stage, it would be important to have been approved by the ethics committee. The data generated from the audit must be authorized via the ethics committee with the permission of the institution being audited, check with the local ethics committee. Or even cite the local ethics committee's bylaws where there is evidence of the possibility of dispensing with the ethics committee's assessment in such cases.

METHODS: to inform inclusion and exclusion criteria for study participants in each phase of the study.

Methods - PHASE 1: Describe how the audit took place. Was it face-to-face? How were participants selected? How was the data collected? Who administered the questionnaire? Where was the data collected?

TABLE 2: add the table legend. Inform the source on which the criteria used were based.

METHODS: to briefly explain the criteria applied by the JBI-GRiP tool

METHODS - Analysis: Detail how the data will be described in the results. Inform directly which statistical tests were used.

METHODS: provide information on the data collected from the participants (e.g. age, sex, etc.).

METHODS: If there is room, I suggest constructing a figure containing the study's methodological flowchart. As the study took place in stages, and each stage includes certain phases according to the instruments used, a figure could help clarify the path adopted by the authors.

FIGURE 2: Identify the number of participants (n) analyzed in the figure. The data looks promising, but we have to be critical when a lot of data jumps from 0% to 100%. Some limitation of the study may have weakened data collection.

RESULTS: Statistical significance data was not presented in the results. In line 218 of the methods, it was stated that this would be done. It is important to point out the forms of descriptive and analytical analysis of the study. It should also be made clear how the data was qualitatively assessed.

RESULTS: The results in table 3 need to be described in the body of the text. Try to highlight the main measures adopted.

DISCUSSION: include the limitations of the study at the end of the discussion.

DISCUSSION: The data in table 3 is valuable. They need to be discussed. After all, it was these efforts and measures that strongly helped the team get from the pre-intervention result to the post-intervention result.

REFERENCES: more than 60% of the references are from publications more than 5 years old. Update the references to reduce this proportion.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

1. Methods: Please cite the instruments and tools used in this research so that readers can refer to the original sources, including the JBI Evidence Implementation Framework, the JBI Practical Application of Clinical Evidence System (PACES), and Getting Research into Practice (GRiP).
2. What are the inclusion criteria for the patient participants? Please add.
3. The average age of the baseline sample is 78.74, while in the post-implementation sample it was 75.88. Were all patients at baseline and post-implementation older adults? If yes, I suggest authors revise the “adult” in the title and in the manuscript that refers to the sample as “older adult” to make it clearer and more specified.
4. On the baseline audit, adherence to criteria numbers 2, 4, 5, and 8 is absent. Please discuss and provide an explanation or analysis of why the adherence to those criteria is absent.
5. This manuscript will benefit from adding a figure that displays the procedure of this research from the beginning until the end so that it can be used by others who want to apply it in their setting for quality improvement.
6. Pay attention to punctuation and use it correctly; for example, on page 7, lines 228–229, for age and SD. It should be 78.74, not 78.74. Please check and use the correct punctuation for the whole manuscript. Also, please check the word numbers on page 7 lines 238–239 and on page 10 lines 339–341.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Congratulations to the authors for the relevant inclusions and changes to the manuscript. The objective was well described, it is long, however, it portrays the various stages used in the study. The new version of the manuscript presents an enlightening writing on the methodology, I highlight that figure 1 was well constructed. The results and discussion of the manuscript make thoughtful statements that accompany the limitations of the study. The authors were attentive to the requests highlighted in the first version and were coherent in the responses presented in the letter.

Author Response

Thank you for your positive and constructive feedback. We appreciate your recognition of our efforts to address the initial comments and enhance the manuscript. We are glad that the changes, especially to the methodology and Figure 1, met your approval. Thank you once again for your guidance and support.