By Megan Chapman, PharmD/MPH Candidate 2018
As healthcare professionals, it is easy to tell patients that they must take their medications exactly as prescribed in order for their conditions to be well controlled. However, we may not be taking medications regularly ourselves. Until one experiences taking multiple medications several times daily, he or she may not be able to fully relate to barriers and facilitators related to adhering to medication regimens. The experience of attempting to adhere to a complex medication regimen can help develop empathy for how patients feel about this experience and how tough it really can be.
During the Spring 2017 semester, second year student pharmacists (n=114) at the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy experienced a taste of what it is like to be a patient with a complicated medication regimen. Students were required to complete seven days of a typical heart failure medication regimen consisting of eight different medications (Skittles and M&Ms) needing to be taken 1 to 3 times daily on a fixed schedule. Students were required to report their daily adherence and reflect each day on why doses were missed and what barriers prevented them from taking their medications. The final aspect of the project was to measure the students’ empathy before and after the medication trial using the Jefferson Scale of Empathy (JSE).
During the week-long experience, student pharmacists had an average adherence rate of 78%. Of the three times daily medication, student pharmacists most frequently missed the lunchtime dose, only remembering to take it 42% of the time. Student pharmacists’ empathy after the experience improved from an average score on the JSE pre-survey of 112.7 to 115.7 out of a total 140 points on the post-survey (p=0.04).
Why This Matters
Medication non-adherence is one of the leading contributors to the rise in healthcare costs. It also contributes to increased hospital admissions amongst patients with chronic conditions that would otherwise be controlled through adherence to their medication regimen. If student pharmacists struggle to remember to take several medications on time each day, it may be easier for them to realize that patients also struggle with medication adherence. Thus, students may become more empathetic towards their patients.
Pharmacists play such an important role in the overall healthcare outcomes of patients. Therefore, having student pharmacists try to understand what it is like to be a patient with a complicated medication regimen is critical to helping develop a greater level of empathy towards patients. This experience allowed student pharmacists to become more understanding of the barriers patients face when it comes to adherence. It also gave them the opportunity to consider innovative methods to help patients improve medication adherence.
What the Students are Saying
Here’s how two second-year student pharmacists reacted to the experience:
“It is one thing to learn these concepts and treatment plans, but is another thing to try to experience them. It was a lot more work, and frustrating at times to remember. That is something I will hold on to when communicating and listening to patients.”
“I believe this experience did enhance the [pharmacology] course. It allowed me to view [medication adherence] from the patient’s perspective and it gave me a great respect for those who are required to take many medications.”
Role of the Pharmacist
The goal of this experience was to bring awareness to how difficult it is for patients to be 100% adherent to their medications. In order to help patients, healthcare providers must be mindful of the barriers patients face daily and show empathy towards them. Here are some of the unique opportunities that pharmacists have to make a significant impact in patients’ lives by helping them improve adherence.
- Listen to the patient to really understand the barriers they face with medication adherence and develop a plan specific to him or her.
- Don’t give up on patients if they continue to be nonadherent.
- Always do a medication reconciliation with every visit to look for unnecessary medications.
- Help providers choose appropriate medications in the fewest number of pills possible.
Performing tasks like those mentioned above can greatly help your patients. It is likely that you will see an improvement in adherence when you make these things a habit with every patient you see.
Activities like this should be a part of PharmD curricula to help student pharmacists who probably do not take many, if any, medications consistently to understand the challenge and inconveniences of treatment adherence in order to be able to empathize and help patients with complicated regimens.
This activity also may encourage discussion of pharmacy educators on unique ways to encourage empathy in student pharmacists. Further this discussion by sharing activities you have implemented to encourage empathy in student pharmacists.
Sarah Thornton, PharmD; Kelly Newton, PharmD Candidate 2018; Erika Livingston, PharmD Candidate 2018; Sathyanand Kumaran, PharmD Candidate 2018; and Ashley N. Castleberry, PharmD, MAEd are collaborators on this initiative. The authors wish to thank the UAMS College of Pharmacy Women’s Giving Circle for their grant to make this project possible and acknowledge the makers of the Jefferson Scale of Empathy for providing the survey at a discounted rate.
Megan Chapman is a fourth year Doctor of Pharmacy and Masters of Public Health student at the University of Arkansas for Medical Sciences. Her educational scholarship interests include ambulatory care and public health. In her free time, Megan enjoys spending time with her husband and two dogs, Penny and Megpie, and enjoys hiking Pinnacle Mountain in Little Rock, AR.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning