Academic journal article American Journal of Pharmaceutical Education

Teaching Medication Adherence in US Colleges and Schools of Pharmacy

Academic journal article American Journal of Pharmaceutical Education

Teaching Medication Adherence in US Colleges and Schools of Pharmacy

Article excerpt

INTRODUCTION

The effectiveness of medications depends largelyon patients' adherence to a prescribed medication regimen. (1) Although patients' medication-taking behaviors vary, most only adhere to their regimens approximately 50% of the time, and half stop taking medication for a chronic illness after 1 year. (2-5) When patients do not adhere to their regimens, they are at increased risk for hospitalizations, emergency department visits, worsening disease, and poorer quality of life. (6-10) Medication non-adherence costs the United States $290 billion per year in unwarranted health care spending and results in an increased incidence of preventable illness and death. (1,11)

Medication non-adherence is a significant public health concern and has received attention from various stakeholders including the National Council on Patient Information and Education (NCPIE), Agency for Healthcare Research and Quality, The New England Healthcare Institute, the Pharmacy Quality Alliance (PQA), and the National Consumers League. Multi-stakeholder involvement in this issue brought about a national campaign in 2011, "Script Your Future," to improve consumer awareness of the importance and value of medication adherence and to encourage and increase practitioner efforts to discuss adherence with their patients. (12) Additionally, US health care reform policies such as coordinated care (eg, accountable care organizations) and new payment models will rely on the appropriate use of medications. Pharmacists will be required to implement adherence strategies and improve outcomes in practice to receive outcomes-based health care payment.

Over the last 50 years, we have learned much about medication adherence, including epidemiologic factors, predictors of medication non-adherence, and barriers and interventions to improve medication adherence. (1) The extent to which academic medicine and pharmacy and educators in the allied health professions have transferred this knowledge and experience to students is less clear. The World Health Organization (WHO) recommends that healthcare professionals be trained in adherence assessment. (1) NCPIE, a coalition working to advance communication with patients about appropriate medication use, convened a stakeholder panel of experts to address medication non-adherence. The panel created a consensus on 10 national priorities with the greatest potential to improve medication adherence. (13) NCPIE addresses the need for multidisciplinary curriculum development on medication adherence, including pharmacy school curricula, that focuses on increasing public awareness of the adherence problem and implementing solutions. PQA, an organization that focuses on the improvement of medication use across health care settings, has developed metrics to evaluate the impact of pharmacy-level interventions on patient medication adherence. (14)

Pharmacists are accountable for patients' medication-taking behavior and future pharmacy graduates need to be prepared to detect, monitor, and intervene to improve patients' medication adherence. There is a paucity of literature describing the extent to which pharmacy educators teach students about medication adherence. Only 22% of 50 pharmacy colleges and schools surveyed indicated having assessment instruments to evaluate students' skills related to promoting medication adherence to patients. (15) Only 18% had students work with patients to schedule medication doses, tailor therapy, and establish cues to remind them to take their medicine; 12% had educational content focused on determining patient motivation to adhere to a medication regimen; and 8% taught students interventions to improve patients' medication adherence.

The Accreditation Council for Pharmacy Education's (ACPE) standards for pharmacy colleges and schools discuss the importance of "optimal medication therapy outcomes and patient safety," but there is no direct mention of medication adherence, how adherence affects patient outcomes, or the severity of the problem. …

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