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.