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Brown Bag Simulation to Improve Medication Management in Older Adults.

ABSTRACT: Introduction:Medical students must care for aging patients with growing medication lists and need training to address negative patient outcomes associated with polypharmacy. The literature shows that many trainees and practitioners are not confident in their abilities to care for this older population with complex medical conditions. We created an innovative simulation activity to teach safe, effective, and simplified medication management to second-year medical students. Methods:We developed the brown bag medication reconciliation simulation to improve self-efficacy and knowledge for trainees working with older adults. The case example was an older patient who presented with his brown bag of medications and prefilled pillbox for a medication reconciliation with his provider. Teams of medical students identified his medication-management errors and determined strategies for resolution. We assessed learner self-efficacy, knowledge, and satisfaction. Results:A class of 137 second-year medical students completed the simulation. The average number of learners confident about medication management in older adults increased overall by 41%, with a significant increase across all four self-efficacy domains (p < .001). The average percentage of correctly answered knowledge questions significantly increased from 85% on the presurvey to 92% on the delayed postsurvey (p = .009). Learner open-ended feedback indicated high satisfaction with the simulation. Discussion:The brown bag medication reconciliation simulation increased medical student self-efficacy and knowledge related to medication reconciliation and management for older adults. Interactive simulations like this one may be considered for inclusion in health science curricula to improve skills in medication reconciliation and management.

SUBMITTER: Hawley CE

PROVIDER: S-EPMC7050658 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Brown Bag Simulation to Improve Medication Management in Older Adults.

Hawley Chelsea E CE Triantafylidis Laura K LK Phillips Sarah C SC Schwartz Andrea Wershof AW

MedEdPORTAL : the journal of teaching and learning resources 20191122

<h4>Introduction</h4>Medical students must care for aging patients with growing medication lists and need training to address negative patient outcomes associated with polypharmacy. The literature shows that many trainees and practitioners are not confident in their abilities to care for this older population with complex medical conditions. We created an innovative simulation activity to teach safe, effective, and simplified medication management to second-year medical students.<h4>Methods</h4> ...[more]

PMID: 32166113

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Project description:IntroductionMedication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community-dwelling older adults, healthcare professionals and older adults must be engaged in co-designing processes that create sustainable approaches.MethodsAcademic researchers, older adults, and community- and health system-based healthcare professionals engaged in a participatory process to better understand medication reconciliation barriers and co-design solutions. The initiative consisted of two participatory research approaches: (1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and (2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person-centeredness, equity, and sustainability.ResultsSparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly-ranked solutions to improve medication reconciliation: (1) support for older adults to improve health literacy and ownership; (2) ensuring medication indications are included on prescription labels; (3) trainings and incentives for front-line staff in clinic settings to become champions for medication reconciliation; and (4) electronic health record improvements that simplify active medication lists.ConclusionEngaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well-being of community-dwelling older adults.

Project description:Background/objectiveAs pharmacists work to ensure reimbursement for chronic disease management services on the national level, evidence of their impact on important health metrics, such as medication adherence, is needed. However, summative evidence is lacking on the effectiveness of pharmacists to improve medication adherence in older adults. The objective was to assess the effectiveness of pharmacist-led interventions on medication adherence in older adults (65+ years).Design/setting/participantsUsing a systematic review and meta-analytic approach, a comprehensive search of publications in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar was conducted through April 2, 2020 for randomized clinical trials of pharmacist-led interventions to improve medication adherence in older adults. A standardized mean difference effect size (Cohen's d) was calculated for medication adherence in each study. Study effect sizes were pooled using a random-effects model, with effect sizes weighted by inverse of its total variance.MeasurementsMedication adherence using any method of measurement.ResultsAmong 40 unique randomized trials of pharmacist-led interventions with data from 8822 unique patients (mean age, range: 65-85 years), the mean effect size was 0.57 (k = 40; 95% Confidence Interval [CI]: 0.38-0.76). When two outlier studies were excluded from the analysis, the mean effect size reduced to 0.41 (k = 38; 95% CI: 0.27-0.54). A sensitivity analysis of medication adherence outcome by time point resulted in a mean effect size of 0.64 at 3 months (k = 12; 95% CI: 0.32-0.97), 0.30 at 6 months (k = 13; 95% CI: 0.11-0.48), 0.22 at 12 months (k = 12; 95% CI: 0.08-0.37), and 0.36 for outcome time points beyond 12 months (k = 5; 95% CI: 0.02-0.70).ConclusionThis meta-analysis found a significant improvement in medication adherence among older adults receiving pharmacist-led interventions. Implementation of pharmacist-led interventions supported by Medicare reimbursement could ensure older adults' access to effective medication adherence support.

Dataset Information

Brown Bag Simulation to Improve Medication Management in Older Adults.

Publications

Brown Bag Simulation to Improve Medication Management in Older Adults.

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