Category: Professional Posters
Purpose: Fifty percent of patients do not take their medications as prescribed. Persistent medication non-adherence is associated with high mortality rates. Evidence suggests that pharmacists are less likely to attempt to identify non adherence compared to nurses and doctors. However patient counselling on medicines and how to use them is frequently central to their role.
Simulations have been shown to improve assessment performance in pharmacy students, however they have not shown an improvement in the psychosocial aspects of adherence. The purpose of this evaluation was to identify the benefits of locating a medication adherence simulation exercise within the pre-registration training year.
Methods: Trainees (n=76) where invited to participate in the simulation which involved taking pre-dispensed medicines (sweets) for seven days.
Trainees reported on their adherence in real time using an online reporting form. This involved stating whether each dose was taken and reasons for omitting doses. At the end of the simulation they wrote a reflective account on their experience of the process, impact of regular medication taking on their daily life and how this has changed their practice (n=20). A focus group (n=7) was conducted to gather perspectives and identify improvements for the training simulation.
Quantitative analysis was conducted on data collected from self-reported adherence in order to identify rates and reasons for non-adherence. Content analysis of the reflective accounts and focus group discussion was used for qualitative evaluation in order to identify the psychosocial impact and ascertain the benefit of conducting the simulation on pre-registration trainees as opposed to undergraduate students.
Ethics committee approval was not required as this was an evaluation of an educational exercise.
Results: Of 52 volunteers, 28 completed the simulation fully. Adherence to 42 doses in each regime over seven days ranged from 31-95% with an average of 71% adherence. Of a total of 1176 possible doses, 24% were missed (n=283). Reasons include: forgetting (12.24% n=144), medication unavailable (6.63% n=78), intentional omission (2.47% n=29), alternate dosage timing (1.19% n=14), poor taste (0.6% n=7), embarrassment (0.34% n=4) and packaging issues (0.09% n=1). In 0.51% n=6 of cases no reason was stated.
On completion trainees reported a greater understanding of the barriers patients face, putting into context their undergraduate teaching. They found taking the complex regime more difficult than anticipated and acknowledged that many patients take far more medications. Trainees valued new level of empathy they felt toward patients taking regular medications.
Trainees acknowledged that undertaking this experience whilst in practice has provided a more realistic experience than if it were located within the undergraduate degree. Trainees reported changing their practice regarding asking questions about non-adherence as a result.
Suggestions of future improvements to the exercise include provision of placebo tablets rather than sweets, printed patient information leaflets, paper self-reporting forms and extended simulation period to three weeks.
Conclusion: The simulations provided similar outcomes to previous reported studies; increased empathy and understanding of the reasons for non-adherence. However, in addition, trainees reported that they were more likely to attempt to identify and explore non-adherence with patients in their practice.
Consensus was that all trainees should experience this type of simulation in the pre-registration training year as undergraduates do not have a fixed routine or regular contact with patients to put their learning into context.
This service evaluation has informed some direct changes to the simulation exercise, which include extending the time period and multiple methods of recording adherence.