Abstract

Objective To assess the effect of an innovative training exercise on post-graduate healthcare trainees’ knowledge and perspectives of medication adherence and skills gained within an interprofessional training program. Methods Postgraduate trainees (medicine, pharmacy, advanced practice nursing, and mental health) at the Michael E. DeBakey VA Medical Center’s Center of Excellence in Primary Care Education interprofessional training program participated in a medication adherence exercise and training session. The session included a formal PowerPoint presentation, an innovative medication adherence simulation exercise, clinical scenarios, and a journal club. Verbal feedback during the debriefing session occurred after the medication adherence simulation exercise and throughout the session. Results Six trainees participated in the exercise and training session (2 medical residents, 2 nurse practitioner residents, 1 pharmacy resident, and 1 clinical psychology fellow). Trainees reported developing a greater understanding for barriers patients face with medication adherence, empathy, and strategies to manage patients’ medication adherence. Conclusions The medication adherence exercise and training session provided an opportunity for healthcare professionals from different professions to discuss medication adherence and share their educational training and previous clinical experiences within an interprofessional training program. Received: 01/30/2018 Accepted: 03/17/2018 © 2018 Adams et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Assessment of an Innovative Medication Adherence Training Exercise EDUCATIONAL STRATEGY 3(3):eP1152 | 2 Introduction Adherence is defined as “the extent to which a patient’s behavior (in terms of taking medication, following a diet, modifying habits, or attending clinics) coincides with medical or health advice” (Medication Adherence Clinical Reference, 2011). Medication nonadherence is a major issue within healthcare. Nonadherence to medication in the United States is estimated to cause approximately 125,000 deaths, at least 10% of hospitalizations, and a substantial increase in morbidity and mortality (Medication Adherence Clinical Reference, 2011; Peterson, Takiya, & Finley, 2003; Haynes, Ackloo, & Sahota, 2008). As many as 20-30% of medication prescriptions are never filled and 50% of medications for chronic diseases are not taken as prescribed (Peterson, Takiya, & Finley, 2003; Haynes, Ackloo, & Sahota, 2008; Fischer, Stedman, Lii, Vogeli, Shrank, Brookhart, &Weissman, 2010). Adherence to medications can be affected by many factors, including health-system factors, conditionrelated factors, patient-related factors, therapy-related factors, and social/economic factors. As such, there have been numerous strategies to facilitate and encourage improved medication adherence. One of them is the acronym, “SIMPLE” (simplify the regimen, impart knowledge, modify patient beliefs and behaviors, provide communication and trust, leave the bias, and evaluate adherence), which is a useful mnemonic for healthcare providers when providing medication education. Script Your Future (http://www.scriptyourfuture.org/) is another tool, which is a website that provides medication adherence resources for healthcare providers and patients (Medication Adherence Clinical Reference, 2011; Script Your Future, 2017). Medication adherence affects all healthcare professions with each having their own learning strategies and techniques to teach students, residents, and fellows. Previous research has examined methods and formal education activities to teach students the importance of medication adherence. For example, Ulbrich and colleagues developed a simulated medication regimen with Starburst jellybeans for pharmacy students over a one-week timeframe (Ulbrich, Hamer, & Lehotsky, 2012). Divine and Cain implemented a 10-day medication adherence project where health professional students (99% pharmacy students) received six “medications” consisting of demonstration inhalers and small candies (Divine & Cain, 2009). Darbishire and colleagues also evaluated a similar medication simulation activity over a two week period with and without an automated medication dispenser (Darbishire, Plake, Kiersma, & White, 2012). Students then used their knowledge of the automated medication dispenser to identify patients during their experiential rotations who would benefit from the automated medication dispenser and educate the selected patients about the features of the dispenser for use. These simulation activities developed empathy, improved student confidence, and increased awareness of difficulties that are encountered by patients with medication adherence. At the Michael E. DeBakey VA Medical Center, a curriculum was developed as part of an interprofessional training program called the Center of Excellence in Primary Care Education (CoEPCE). This program was funded by the Veterans Health Administration and Office of Academic Affiliations to develop a training program focused on interprofessional education and training for post-graduate trainees from the different professions including medicine, pharmacy, advanced practice nursing, and mental health. Under the supervision of faculty, CoEPCE trainees work together as an interprofessional team (following a patient-centered medical home model) to co-manage a panel of patients over the year. Medical residents manage 90 patients, and nurse practitioner residents manage 60 patients throughout the year while working collaboratively with other trainees through consults, co-visits, and CoEPCE training activities. This article will describe a training session that was developed to provide education and strategies on the interprofessional management of medication adherence through a pre-session medication simulation activity and debriefing exercise, a lecture, role play with clinical scenarios, and a journal club review. It will also discuss how this activity led to more interprofessional collaboration amongst CoEPCE trainees in regards to medication adherence within the ambulatory care clinic.