Abstract and Introduction
Abstract
Objective. To evaluate the impact of a medication adherence activity on introductory pharmacy practice experience students' perceptions of patient adherence as well as student development of empathy and confidence in patient counseling.
Design. Students participated in a personal medication simulation using an automated medication dispenser. Students then identified a patient with nonadherence and provided counseling on use of the dispenser. After 4 to 6 weeks, students interviewed the patient about their experience with the dispenser and assessed changes in adherence.
Assessment. One hundred fifty-three students completed the assignment and 3 surveys instruments. Following the experience, the majority of students agreed or strongly agreed that they developed more empathy for patients with multiple medications and felt confident counseling a patient in the use of a dispenser (92.0% and 88.2%, respectively). Most students (91.4%) reported feeling that their patient education session was successful.
Conclusion. An introductory pharmacy practice experience involving an automated medication dispenser and patient counseling to improve medication adherence resulted in the development of empathy and improved student confidence.
Introduction
Medication adherence is the extent to which individuals take their medications as prescribed by their healthcare practitioner. Either deliberate or unintentional, nonadherence includes failing to fill a prescription, discontinuing a medication prematurely, taking an incorrect dose, and taking medication at the wrong time. Medication nonadherence often leads to poor health outcomes and has a significant negative economic impact. Medication nonadherence accounts for more than 10% of older-adult hospital admissions, nearly 25% of nursing home admissions, and 20% of preventable adverse drug events among ambulatory elderly patients. Medication nonadherence results in an estimated 125,000 deaths annually and costs the US healthcare system $100 billion per year.
Pharmacists are in an ideal position to positively impact medication adherence because of patient trust, access to medication profiles, opportunities for patient consultation, and knowledge on the consequences of nonadherence. Spending only minutes communicating with a patient can reveal reasons for nonadherence, and pharmacist intervention with a patient's healthcare provider often can resolve adherence issues. For example, recommending a lower-priced generic or decreasing the complexity of a patient's drug regimen can improve medication adherence.
Introductory pharmacy practice experiences (IPPEs) have been identified as key opportunities for pharmacy students to practice patient-centered care and apply information learned in the curriculum. The Accreditation Council for Pharmacy Education's (ACPE's) accreditation Standards and Guidelines encourage pharmacy schools and colleges to identify or develop IPPEs that expose students to the assessment of medication adherence, the management and monitoring of drug regimens, the provision of patient education, and the use of technology to enhance patient outcomes. The Purdue University College of Pharmacy PharmD Program Outcome Ability Goals include teaching students behavioral modification approaches for promoting medication adherence and disease prevention as well as identifying and implementing strategies to encourage patient adherence.
Simulated healthcare experiences foster students' understanding of patients' difficulties and reasons for nonadherence. Various types of simulations have been used in health disciplines as a mechanism to help students understand patients and develop empathy. Students generally find these experiences valuable and believe they should be incorporated as part of the core curriculum.
Because an estimated 20% to 50% of patients are nonadherent with prescribed medications, adherence training is a fundamental component in the education of pharmacy students. Adherence simulations and patient experiences provide a basis for understanding this concept as well as opportunities to apply patient-care skills and develop empathy. Only 1 of the simulations identified in the literature focused on medication use with an adherence dispenser. There is little published literature focusing on the integration of medication adherence within IPPE programs, and there is no published literature on students' opinions about the reasons for medication nonadherence. Additional research is needed in this area.
A student simulation and a patient-based experience focusing on medication adherence were developed to integrate specific ACPE-required domains and college-specific goals into the IPPE program. This manuscript describes the student assignment and learning from the student perspective. The objective is to evaluate the impact of the students' simulation and patient-based experience on their perspectives of medication adherence and the development of empathy and confidence when counseling a patient.