Second-year pharmacy students' perceptions of adhering to a complex simulated medication regimen

Activities to promote empathy for patients among pharmacy learners: A scoping review

BACKGROUND

Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners.

METHODS

This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included.

RESULTS

The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities.

IMPLICATIONS

A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.

A pilot study assessing the impact of a polypharmacy mock medication simulation on student adherence and empathy

INTRODUCTION

With non-adherence rates rising among patients, educational activities to prepare future practitioners to be more empathetic and have a more personal understanding of patients' complex medication regimens need to be developed and assessed. The objective of this study was to assess student adherence as well as change in empathy after students immerse themselves in a polypharmacy mock medication simulation.

METHODS

First professional year pharmacy (P1) students were recruited to participate in a pilot polypharmacy simulation consisting of eight prescriptions taken for seven days. Baseline characteristics and empathy (Kiersma-Chen Empathy Scale [KCES]) were assessed in pre-surveys, and student medication adherence, empathy (KCES), and insight into activity were assessed in post-surveys.

RESULTS

There was not a statistically significant change in the total mean empathy score between pre- and post-KCES (83 vs. 82, p = 1.0). One KCES question, "I will not allow myself to be influenced by someone's feeling when determining the best treatment," produced a significant change in mean score (4.77 vs. 4.10, p = 0.02). The average percentage of late and missed doses as self-reported by students, was 5.63% and 5.04%, respectively. Two themes emerged regarding student perception of the experience: improved patient counseling regarding adherence and improved empathy and patient perspective on medication regimen complexity.

CONCLUSIONS

Despite a lack of significant change in KCES after participating in the mock medication regimen, qualitative analysis revealed students believed the experience improved their patient counseling skills regarding adherence and further developed their empathy and patient perspective regarding medication regimen complexity.

Simulated medication adherence: First and second-year pharmacy students' perceptions of adhering to a multi-drug medication regimen

BACKGROUND AND PURPOSE

Through a realistic medication adherence activity, the objective was to improve students' ability to identify non-adherent patients, build empathy toward patients, and prepare them to provide patient-centered care.

EDUCATIONAL ACTIVITY AND SETTING

First- and second-year student pharmacists completed a two-month activity, which required adherence to a pre-specified medication regimen. Prior to starting, a survey was administered to assess students' perceived difficulty and success of the medication adherence activity. Upon completion, students were asked their perceived success and difficulty with the activity, challenges to maintaining adherence, and lessons learned from the project. Changes in perceived difficulty and success were analyzed using Wilcoxon signed rank tests. Challenges and lessons learned were coded for similar themes and frequencies.

FINDINGS

298 student pharmacists completed the pre- and post-survey (response rate 99%). Students' perceived difficulty of adherence was higher on the post-survey (median on post = 7.0 (out of 10) versus median on pre = 6.0, p = 0.023). Students' perceived success was higher on the presurvey (median on pre = 8.0 versus median on post = 6.0, p < 0.001). The most frequent challenges were remembering to take the medications (n = 133) and medication regimen timing (n = 98). The most frequent lesson learned was that "adherence is a difficult concept" (n = 143).

SUMMARY

Students participated in a "hands-on" medication adherence activity. Students found that medication adherence is more difficult than perceived. Future research should examine the long-term impact of students maintaining empathy toward patients and provision of medication adherence services.

Comparison of Student and Patient Perceptions for Medication Non-adherence

Objective. To compare pharmacy students' perceptions with patients' reasons for medication non-adherence. Methods. Pharmacy students completing an experiential rotation recruited patients exhibiting medication non-adherence from community pharmacies and asked them to respond to statements about reasons for their medication non-adherence. Patient responses were ranked in order of prevalence and compared to self-reported student perceptions on reasons for non-adherence. Results. There was a significant difference between patients' and students' rankings of reasons for medication non-adherence. Significant factors for patients included medications that interfere with lifestyle, sexual health and drinking alcohol; whereas, students believed that cognitive-related issues were patients' primary reasons for non-adherence to their medications. Conclusion. Educational opportunities to reflect on and discuss differing perspectives should be provided in the pharmacy curriculum to better equip students to address medication adherence issues and improve patient care.

Medication Simulation Affects Health Provider Students' Attitudes About Adherence and Concordance

INTRODUCTION

Assisting polypharmacy patients with complex health regimens is a part of health provider responsibilities. The concepts of adherence and concordance contrast the traditional emphasis on patient compliance. However, health provider students may not be able to empathize with polypharmacy patients. The purpose of this study was to measure the effect of a medication simulation on medical, nursing, and pharmacy students' beliefs about adherence and concordance.

METHODS

A prospective, quasi-experimental, pretest, and posttest design was used with institutional review board approval. The participants (N = 62) took four simulated medications (varied dosing schedules) for 1 week. Attitudes toward adherence and concordance were assessed before and after the intervention.

RESULTS

Subjects averaged 24.6 years (SD = 4.32), 72.6% female, and 79% white. Most were medical students (n = 33, 53%), followed by nursing (n = 21, 34%) and pharmacy students (n = 8, 13%). There were significant changes [t(61) = 3.92, P < 0.001] in beliefs about adherence from time 1 (mean = 25.13, SD = 5.77) to time 2 (mean = 22.05, SD = 6.06), and about concordance (mean = 41.85, SD = 5.58 time 1) to (mean = 44.29, SD = 6.32 time 2) [t(61) = 3.31, P < 0.05], for the entire group. Most students (84%) predicted that they would be able to take four medications correctly for 1 week. Fifty-eight students (94%) found that adherence was 'much harder' or 'a little harder' than anticipated. Most (89%) felt that the simulation will impact their patient care.

CONCLUSIONS

Participation in a medication simulation exercise affected health provider students' attitudes toward adherence and concordant behaviors. These experiences may influence future patient interactions.

Using a Polypharmacy Simulation Exercise to Increase Empathy in Pharmacy Students

Objective. To assess whether the Jellybean Polypharmacy Simulation Exercise (JPSE) improved empathy in pharmacy students. Methods. The JPSE was given to all third-professional year pharmacy students in a required Special Populations course with pre- and post-scores on the Kiersma-Chen Empathy Scale (KCES) assessed, and open-ended questions on lessons learned from the exercise. Results. Pharmacy students showed a statistically significant increase in KCES scores after completing the JPSE. Open-ended question responses reflected personal growth and appreciation for patients managing difficult medication regimens. Conclusion. This polypharmacy simulation showed the ability to increase empathy in pharmacy students, as well as mimic a realistic experience in managing a multi-drug, multi-dose medication regimen.

Comparison of a medication adherence simulation in professional pharmacy students versus undergraduate students

BACKGROUND AND PURPOSE

Previous research at colleges and schools of pharmacy showed that simulation learning is an effective method to teach pharmacy students about the issues patients face when prescribed complicated medication regimens. The purpose of this analysis was to compare reported medication adherence rates, perceived barriers, and methods used to increase adherence between undergraduate students and pharmacy students based on a medication-taking simulation course activity.

EDUCATIONAL ACTIVITY AND SETTING

In spring semesters 2014 and 2015, students in both a pharmacy course and an undergraduate seminar course participated in a short simulation involving a complicated medication regimen. Within one week of participating in the simulation activity, the students answered survey questions about the assignment through an online course sharing platform.

FINDINGS

Almost all students enrolled in the courses (237/246 pharmacy students and 34/36 undergraduate students) completed the assignment (> 96% response rate). A large percentage of each group reported some non-adherence; 95% (225/237) of first-year pharmacy students and 82% (28/34) of undergraduate students. The top two barriers reported were 1) simply forgetting and 2) difficulty following the food- and/or alcohol-related restrictions associated with some of the simulated medications. The top two methods used to increase adherence were phone/electronic reminders and paper/spreadsheet reminders.

DISCUSSION

A limitation to this study was the small sample size of undergraduate students. Even though the response rate was over 96%, the course was a small seminar-type course. Although it might be expected that pharmacy students would be more adherent since they may have had experience with non-adherence issues while working in a pharmacy, opposite results were found. Since the students were relatively young, most had not personally dealt with a complicated medication regimen.

SUMMARY

Pharmacy students reported lower adherence to a complicated medication regimen than undergraduate students. The most common reasons for non-adherence and most common methods used to increase adherence were similar between the two cohorts. The use of electronic reminders was common for both groups of students, and should be included in discussions about methods to improve adherence rates.

A Narrative Review of Medication Adherence Educational Interventions for Health Professions Students

Objective. To review published educational interventions focusing on medication non-adherence. Methods. A literature search was performed of educational articles on the topic of medication adherence. Data on interventions and learning assessments were abstracted for relevant studies meeting search criteria. Results. Twenty studies met inclusion criteria. Sixteen included pill-taking experiences with regimens of candies or placebos and varied in their inclusion of novel elements to highlight issues such as stigma, regimen complexity, and adherence measurement. Three studies involved interacting with the public. Qualitative and quantitative methods were used to assess a variety of learning outcomes. Conclusion. Pill-taking experiences can help future providers appreciate the complex logistics of medication-taking, but are less capable of addressing the psychosocial aspects of adherence. A promising area for learning is to interact with actual medication users to understand their experiences and perspectives.

Evaluating the Potential Impact of Pharmacist Counseling on Medication Adherence Using a Simulation Activity

OBJECTIVE

To evaluate the impact of counseling in a simulated medication adherence activity.

DESIGN

Students were randomized into 2 groups: patient medication monograph only (PMMO) and patient medication monograph with counseling (PMMC). Both groups received a fictitious medication and monograph. Additionally, the PMMC group received brief counseling. A multiple-choice, paper-based survey instrument was used to evaluate simulated food-drug interactions, adherence, and perceptions regarding the activity's value and impact on understanding adherence challenges.

ASSESSMENT

Ninety-two students participated (PMMC, n=45; and PMMO, n=47). Overall, a significantly higher incidence of simulated food-drug interactions occurred in the PMMO group (30%) vs the PMMC group (22%) (p=0.02). Doses taken without simulated food-drug interactions were comparable: 46.2% (PMCC) vs 41.9% (PMMO) (p=0.19). The average number of missed doses were 3.2 (PMMC) vs 2.8 (PMMO) (p=0.55). Approximately 70% of the students found the activity to be valuable and 89% believed it helped them better understand adherence challenges.

CONCLUSION

This activity demonstrated the challenges and important role of counseling in medication adherence.