One hundred ten survey responses were received from 92 different colleges and schools of pharmacy (representatives from 18 of the 92 colleges and schools completed the same survey instrument twice). A majority of faculty respondents (n = 99, 90%) indicated that curricular content/education on medication adherence was required by their college or school of pharmacy, and 1 respondent indicated the school included it as an area of focus within an elective course. Three respondents indicated either that the question was not applicable to their college or school, or that adherence was not covered in their program. A large number of respondents indicated that medication non-adherence was covered through lecture (n = 93), practice-based experiences (n = 74), or case-based problems (n = 60). A smaller number of respondents indicated that adherence was taught using multimedia resources (n = 29) or by live actors and/or modeling (n = 36).
The NCPA Advisory Council on Medication Adherence received 37 of the 71 survey instruments sent to PDC student chapters, and 58 of 90 survey instruments sent to NCPA student chapters. One or more survey instruments were received from 52 (43.7%) of the 119 accredited (full or candidate status) colleges and schools of pharmacy.20
Of the 52 colleges and schools represented, 56% (n = 29) were public and 44% (n = 23) were private. The types of pharmacy programs represented were: 0/6 PharmD programs (4), 2/4 PharmD programs (16), undergraduate degree then PharmD programs (2), accelerated PharmD programs (10), and other types of programs (2). Six (12%) of the survey respondents were fourth-year students, 28 (54%) were third-year students, 17 (33%) were second-year students, and 1 (2%) was a first-year student.
Approximately two-thirds (>70%) of the study sample was “moderately or extensively taught” background topics on medication adherence, including models for understanding adherence; predictors, causes, and consequences of medication non-adherence; and impact of medication adherence on clinical outcomes (). All of these background topics had a median score of 3 or higher on a 5-point scale, indicating the topics were “moderately or extensively taught.” On the 6 topics relating to adherence interventions, only 2 topics, motivational interviewing and educational interventions, had median scores of 3, indicating the topic was moderately taught. Over 50% of respondents indicated “not being taught at all” or “only somewhat taught” about reminder systems, coordinating refill dates, and technology-based solutions. Student responses were split with regard to behavioral cueing; half of the respondents were “not at all taught” or “somewhat taught” and the other half of respondents were “moderately or extremely taught” the topic.
Pharmacy Students’ Perspectives on Medication Adherence Topics Taught in the Doctor of Pharmacy Curriculum (N = 52)
shows the frequencies at which adherence topics are covered. Lecture was a common mode of instruction for all medication adherence topics. Motivational interviewing and educational intervention concepts were largely taught through role playing, written patient cases, videos, textbook readings, and guest speakers. Reminder systems and coordinating refill dates were largely taught through lecture, written patient cases, and role playing. Almost a third of the sample had not been taught how to coordinate refill dates. Behavioral cueing was largely presented via lecture, role playing and written patient cases. Technology-based solutions were primarily presented in lectures and about 29% of the sample indicated the topic was not presented at their college or school of pharmacy.
Modes of Teaching Medication Adherence Concepts in the Pharmacy Curriculum (n = 52)a
shows responses to open-ended questions regarding which courses in the curriculum taught the adherence topics. Background adherence topics and the impact of medication adherence on clinical outcomes were presented mostly in clinical and social and administrative courses, with some content covered in pharmaceutical science and other courses throughout the curriculum. Examples of courses in which background concepts on adherence were taught are: Therapeutics/Pharmaceutical Care, Health Care Systems, Psychosocial Aspects of Health Care, Communications, and other courses on medication safety and self-care therapeutics. During the first year (P1), the majority of students were exposed to background topics on medication adherence in clinical and social administrative courses. During the P2 and P3 years, students were exposed to background topics on medication adherence mainly in their clinical courses.
Types of Courses in Which Medication Adherence Topics Were Covered in the Doctor of Pharmacy Curriculum According to Pharmacy Students
Almost 50% of students indicated that during their IPPEs, they had the opportunity to identify non-adherent patients and plan an intervention. Some students (13.5%) indicated that during their IPPEs they had the opportunity to identify non-adherent patients but not to perform an intervention. Other students (13.5%) reported they had the opportunity to intervene and follow-up on patients. Approximately 11.5% of the sample indicated they had no opportunity to do adherence-related activities during their IPPEs. The remainder of respondents indicated the question was not applicable or their experience did not fit in any of the categories. Using a coding scheme of 1 = no opportunity, 2 = identified non-adherent patient but could not determine intervention, 3 = identified non-adherent patient and planned intervention, and 4 = intervened and followed up with patient, the mean score on this item was 2.7 ± 0.9.
Only about 12% of the respondents were in their fourth year, thus, 50% of the sample indicated that the question was not applicable to them or that they had no opportunity to do adherence-related activities during their APPEs. Fifty percent reported participating in some medication adherence activities during APPEs. Of the 50% who responded, more than half (27%) indicated they had APPEs in which they had the opportunity to intervene and follow-up with patients. Approximately 21% indicated they could identify non-adherent patients; however, 11.5% of these individuals indicated they had identified non-adherent patients and planned an intervention, while the remainder (9.6%) had not planned an intervention. Using the same coding scheme, the APPE mean for this question was 3.2 ± 1.0.
lists the general themes that arose during the telephone conversations with the 3 preceptors. While most points reflected concerns about students’ educational experiences while on an APPE, some of the comments reflected on the broader challenges faced by community pharmacists to more fully and consistently care for their patients. Preceptors indicated consistent medication monitoring could yield opportunities to detect medication non-adherence but this was not seen as a priority for students and preceptors given the time constraints associated with point-of-service care and other practice experience activities. Preceptors, in general, believed that students have the skills to handle patient questions and follow-up on medication non-adherence, but do not have enough time to improve their skills given the short length of practice experiences.
Summary of Preceptor Comments From Telephone Interviews (N = 6)
The preceptors felt they lacked knowledge about the medication adherence curriculum taught to students in the classroom such as key interventions and communication approaches to improve adherence. They expressed a need for greater communication with colleges and schools on how to teach and assess medication adherence-related skills and how to make learning in the classroom optimally reflect the realities of practice. Preceptors felt their lack of education and time to do adherence interventions was not serving as a good model for students on how to engage in adherence interventions. They suggested that better computer technology and workflow designs could assist pharmacists and students in more consistently and proactively detecting, monitoring, and intervening on medication non-adherence.
The 3 faculty members who were interviewed agreed that background topics on medication adherence are important and should be integrated throughout the PharmD program, both in required and elective courses. This integration could be achieved through the development of active-learning techniques such as role-playing exercises. One faculty member highlighted the value of pharmacy faculty members joining students on practice experiences to facilitate and support medication adherence principles. Faculty members also indicated the need for better balance in the curriculum on instructing students to think about patients at both the individual and population levels. From their perspective, barriers to the development of a national pharmacy curriculum on medication adherence are resources and curriculum flexibility. Two solutions that were suggested were to implement adherence concepts and applications into a structured component of the experiential program and to create more efficiency in how adherence topics are interwoven in the curriculum.