Interdisciplinary Approach to Teaching Medication Adherence to Pharmacy and Osteopathic Medical Students
Dana L. Singla, PharmD; George E. MacKinnon III, PhD; Karen J. MacKinnon, RPh; Wisam Younis, PharmD; Ben Field, DO†
The purpose of this project was to demonstrate to pharmacy and osteopathic medical students the value of interdisciplinary education through participation in an interdisciplinary medication adherence project. Each pharmacy student, assuming the role of a pharmacist, was paired with a medical student acting as a physician with a needlestick exposure requiring HIV prophylaxis therapy. Medical students were randomized to participate in one of three levels of pharmacist counseling. After completion of therapy, all students met to discuss adherence barriers, complete an attitudinal survey, and obtain a tablet count. Most pharmacy and medical students agreed or strongly agreed that participation in this project will help them work better within the health care team (82% and 87%, respectively) and that they should have more participation in interdisciplinary projects (83% and 76%, respectively). At the end of the project, these students reported positive attitudes concerning working on interdisciplinary health care education initiatives.
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he benefits of interdisciplinary health care have been demonstrated throughout the health care system. Patients with chronic conditions such as obesity, diabetes, hypertension, and heart disease benefit from the expertise of various health care professionals in providing optimal care.1-8 This benefit is especially pronounced in the elderly population, which uses multiple health care resources and providers.2,9 Despite the benefits associated with interdisciplinary medicine and the team approach to health care, interdisciplinary education is not often formally integrated into health professionals’ education, and there is limited literature available
Dr Singla is assistant professor of
References: 1. American Dietetic Association. Position of the American Dietetic Association: medical nutrition therapy and pharmacotherapy. J Am Diet Assoc. 1999;99(2):227-230. 2. Riffer J. Geriatric units stress the team approach to care. Hospitals. 1986;60(6):90-91. 3. Rippe JM, Crossley S, Ringer R. Obesity as a chronic disease: modern medical and lifestyle management. J Am Diet Assoc. 1998;98(10 Suppl 2):S9-S15. JAOA • Vol 104 • No 3 • March 2004 • 131 MEDICAL EDUCATION 4. Wells S, Benett I, Holloway G, Harlow V. Area-wide diabetes care: the Manchester experience with primary health care teams. Diabet Med. 1998 Nov;15 Suppl 3:S49-S53. 5. Sadur CN, Moline N, Costa M, et al. Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits. Diabetes Care. 1999;22(12):2011-2017. 6. Earles JE, Hartung GH, Dickert JM, et al. Interdisciplinary treatment of diabetes mellitus in a military treatment facility. Mil Med. 2001;166(10):848852. 7. Bernard DB, Townsend RR, Sylvestri MF. Health and disease management: what is it and where is going? What is the role of health and disease management in hypertension? Am J Hypertens. 1998;11(8 Pt 2):103S-108S. 8. Shaffer J, Wexler LF. Reducing low-density lipoprotein cholesterol levels in an ambulatory care system. Results of a multidisciplinary collaborative practice lipid clinic compared with traditional physician based care. Arch Intern Med. 1995;155(21):2330-2335. 9. Wieland D, Lamb VL, Sutton SR, et al. Hospitalization in the Program of AllInclusive Care for the Elderly (PACE): rates, concomitants, and predictors. J Am Geriatr Soc. 2000;48(11):1373-1380. 10. Greene RF, Cavell GF, Jackson SH. Interprofessional clinical education of medical and pharmacy students. Med Educ. 1996;30:129-133. 11. Yarborough M, Jones T, Cyr TA, Phillips S, Stelzner D. Interprofessional education in ethics at an academic health sciences center. Acad Med. 2000;75:793800. 12. MacKinnon GE III. Preparing medical students for the changing healthcare environment in the United States. J Am Osteopath Assoc. 2000;100:560564. 13. Bedell S, Jabbour S, Goldberg R, et al. Discrepancies in the use of medication: their extent and predictors in an outpatient practice. Arch Intern Med. 2000;160:2129-2134. 14. Cramer JA. Relationship between medication compliance and medical outcomes. Am J Health Syst Pharm. 1995;52 suppl 3:27-29. 15. Hughes DA, Bagust A, Haycox A, Walley T. The impact of non-compliance on the cost-effectiveness of pharmaceuticals: a review of the literature. Health Econ. 2001;10(7):601-615. 16. Esposito L. The effects of medication education on adherence to medication regimens in an elderly population. J Adv Nurs. 1995;21(5):935-943. 17. Lipton H, Bird J. The impact of clinical pharmacists’ consultations on geriatric patients’ compliance and medical care use: a randomized controlled trial. Gerontologist. 1994;34:307-315. 18. DeYoung M. Research on the effects of pharmacist-patient communication in institutions and ambulatory care sites, 1969–1994. Am J Health Syst Pharm. 1996;53(11):1277-1291. 19. Bluml BM, McKenney JM, Cziraky MJ. Pharmaceutical care services and results in project ImPACT: hyperlipidemia. J Am Pharm Assoc. 2000;40(2):157165. 20. Radecki S, Abbott A, Eloi L. Occupational human immunodeficiency virus exposure among residents and medical students. Arch Intern Med. 2000; 160:3107-3111. 21. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000; 133:21-30. 22. Committee on Quality Healthcare in America, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. March 1, 2001. Available at: www.iom.edu. 23. Morbidity and Mortality Weekly Report: Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. May 15, 1998. Vol. 47/No. RR7. Available at: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/ 00052722.htm. Accessed August 10, 2000. 24. Cramer JA et al. How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989;261:3273-3277. 132 • JAOA • Vol 104 • No 3 • March 2004 Singla et al • Medical Education