Medical College of Wisconsin
An interactive, “hands-on” polypharmacy experience paired with group reflection, improves learner knowledge of medication adherence barriers and solutions, resulting in decreased number and dosing frequency of medications of their elderly patients.
At the first session, each learner starts by filling out a 5 question pre-survey. Each learner is then given a pill box to fill with "medications" (various candies) according to the medication list of an actual geriatric patient. The learners fill the boxes, and a faculty member facilitates a discussion about challenges to filling the box (e.g., dementia, arthritis, visual loss, neuropathy). Learners are instructed to take the "medications", as prescribed, for one week.
At the second session, one week later, learners report back to the group and describe their experience. The faculty then facilitate a discussion about barriers and solutions (both physician and patient/family initiated) that could be used to aid adherence. Ideas that may be emphasized include: non-judgemental inquiry regarding adherence, understanding patient goals, collaboration with the patient in regards to medications prescribed and decreasing number and frequency of medication dosing. Learners end the exercise by taking a 5 question post-survey.
The exercise has been used with a variety of learner levels, M1 (N=30), M3,M4 (N=25), PGY 1-4 (N=23). This exercise has generally been used in small groups of 6 learners during their geriatrics rotation, but was also used in our Senior Mentor Program with a group size of 30.
Initial data (N=78) showed an increased understanding of adherence barriers (3.5 to 4.9) and solutions (3.0 to 4.8), as well as increased patient medication education (2.6 to 4.0) and increased medication discontinuance/dosing changes (3.0 to 4.3) on a scale of 1-6 with 6 as highest. Results varied by learner level with most medication dose changes at the resident level.
- List 5 barriers to medication adherence in elderly patients.
- List 3 solutions to medication non-adherence that physicians/providers could initiate.
- List 3 solutions to medication non-adherence that patients/families could implement.
- Increased learner behavior of educating patients in regards to medications.
- Increased learner behavior of discontinuing medications/decreasing medication frequency of patients.
- 1 pill box per learner (each pill box with small boxes for Sun-Sat., with 4 boxes/day for total of 28 small boxes per pill box.)
- Various small candies (M&Ms, Skittles, Wasabi peas, breath mints, other) sorted by type/color
- Pill bottles (15 bottles/set, 2-3 learners can use 1 set) filled with candies above
- Labels for each bottle with medication name and dosing schedule (e.g: lisinopril 5 mg po daily) (15 labels are needed for each medication set) 5. Large, gallon-size zip-lock bags (1 per each medications set of 15 bottles)
- Patient's medication list (1 list per every 2-3 learners)
- Pre-survey (1 per learner)
- Post-survey (1 per learner)
Flow of session: Session 1:
- Divide learners in groups of 2-3 learners
- Hand out pre-survey and empty pill box to each learner
- Hand out zip-lock bag containing: 15 labeled pill bottles (filled with candies) and patient medication list to each group
- Instruct learners to complete pre-survey and orient them to activity objectives and session flow
- Instruct learners to fill their pill box with "medications" according to the patient medication list provided.
- Facilitate discussion of potential difficulties in filling the pill boxes
- Instruct learners to take "medications" as prescribed for one week.
- Collect zip-lock bags with pill bottles and medication lists
Session 2: (1 week later) Facilitate discussion asking:
- "How did it go?"
- Ask learners to identify barriers to adherence they encountered
- Ask learners to identify potential solutions to non-adherence by patients
- Ask learners to identify potential solutions to non-adherence by providers
- Summarize experience
- Learners fill out post-survey
- Collect pill boxes to wash and use with other learners