Purpose: The goal of the performance improvement (PI) project was to decrease discontinuation rates of riociguat therapy by using a transcultural nursing model as opposed to a single nurse coordinator model.

Background: Pulmonary hypertension (PH) medications have been proven to be effective in improving outcomes for patients suffering from PH. These medications have significant and expected side effects with complex titration regimens which can be confusing to patients which led to poor compliance and high rates of discontinuation. Patients’ race and ethnicity have been associated to poor medication compliance due to varying cultural expectations, language barriers, and socioeconomic status. Evidence also shows that minority groups are less likely to take medications for PH demonstrating the need to eliminate this disparity.

Methods: A PI project was initiated to address high discontinuation rates in PH medications, specifically riociguat therapy. It was proposed that due to our highly culturally diverse patient population that we incorporate a transcultural nursing model to improve compliance and drug therapy continuation. The nursing model that was being used prior to the PI project was a single nurse coordinator model. In this model, the PH coordinator was responsible for educating patients on the therapies as well as assessing patients during their initial and follow up visits. The coordinator was primarily an English-speaking nurse that would use interpretation services during PH appointments in the outpatient clinic. Beginning in November of 2016, the clinic implemented the transcultural nursing model where nursing assignments paired according to patients’ language and cultural background in order to facilitate transcultural communication.

Results: After implementing the transcultural nursing model, the continuation rate for riociguat went from 55% to 79%. The model was very effective in improving patient compliance and drastically reducing the discontinuation rate of riociguat. The patients were able to converse with their nurse coordinating their care without the need for translation services which greatly improved the understanding of the plan of care.

Conclusion: The implementation of a transcultural nursing model is an effective way of increasing the continuation rates of PH medications in a culturally diverse practice setting helping to reduce disparities.

Publication Date


Presented At:

13th Annual BHSF Research Conference

Content Type


Open Access

Available to all.