1. EMPOWERING PATIENTS TO OPTIMIZE THEIR MEDICATION REGIMENS:
A Multidisciplinary Approach
Susan D. Wolfsthal, MD1; Leah S. Millstein, MD1; Christine Choy, PharmD, BCPS2; Elizabeth M Lamos, MD1;
Neda Frayha, MD1; Majid E Cina, MD1; Robert Habicht, MD1; Nikkita Southall, MD1; Kate M Gibson, MD1
1. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; 2. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
INTRODUCTION RESULTS RESULTS
Background • Residents rated the seminars and practice based learning process as excellent. Figure 3: Self‐Efficacy of the PGY‐2 and PGY‐3,4,5 Residents as a Group
IM residents care for patients with increasing economic burdens, rising medication costs, and • Self‐efficacy assessment by residents showed areas of strength and weakness, with all
chronic illnesses who would greatly benefit from evaluation of their medication needs and improving through the grant period. 100
P = 0.007
• All patients rated the resident highly for all competencies regardless of level of training. 90
barriers through a multidisciplinary approach by the resident and a clinical pharmacist. P = 0.001
P = 0.02
P = 0.03
80
• Residents tended to rate themselves lower than the clinical pharmacist.
70
Goals and Objectives • Collaborative process resulted in modifications to patients’ medication regimens.
60 Pre‐PGY‐2
• Development of a curriculum, tools to assess patients’ medication needs and barriers, 50 Post‐PGY‐2
and multisource instruments to assess resident competency and deliver feedback Figure 1: Self‐Efficacy by Year of Training (Pre‐OMASES) 40 Pre‐PGY‐3,4,5
• To encompass Picker Always Events for patients: 100 30 Post‐PGY‐3,4,5
P = 0.004
20
– Feel safe expressing values, preferences and needs to PCP so that care plan aligns 90
P = 0.001
10
with patient’s psychological framework 80 P = 0.002 P = 0.284
P = 0.842
0
– Receive care that emanates from an integrated care plan developed from 70
P = 0.436
P = 0.0001
P = 0.107
Side effects and Insurance coverage Medicare D Literacy, education Working as an
multidisciplinary approach P = 0.021
P = 0.009 P = 0.646 drug‐drug
interactions
and cost level and cultural
barriers
interprofessional
team
60
– Be informed of and understand benefits, side effects, cost and effective alternatives P = 0.017
50 PGY‐1
– Be relieved of fear and anxiety PGY‐2 Table 1: Adjustments Made to the Patients’ Medication Regimen
P = 0.141
40
PGY‐3,4,5
P = 0.858
30
P = 0.135 Number Percent
METHODS 20
Changed medication timing (e.g., twice to once daily) 9 20.5
10
Started combination pill 8 18.2
0
Side effects and drug‐ Insurance coverage and Medicare D Literacy, education level Working as an
Used generic $4 plan 7 15.9
• Development and delivery of core curriculum drug interactions cost and cultural barriers interprofessional team
Evaluated indications 4 9.1
– Seminars on prescription plans, polypharmacy and financial issues
Discontinued medication 3 6.8
• Development of study instruments Figure 2: Residents (PGY‐2,3,4,5) report of Self‐Efficacy Pre and Post OMASES Changed medication to formulary medication 0 0.0
– Practice base learning (PBL) instrument and post‐PBL questionnaire 100
Other 13 29.5
– Evaluation tools of resident competency by patient, resident, and clinical 90
P = 0.001
pharmacist 44 100
80 P = 0.006 P = 0.008
– Self‐efficacy assessment instrument titled the Out‐patient Medication Adherence 70
P = 0.01
Self‐Efficacy Scale (OMASES)
60
Pre‐
OMASES
CONCLUSIONS
• Residents at all levels completed OMASES at baseline. Upper level residents completed
50
OMASES again at the conclusion of the study period.
40 Post‐
• Implementation and completion of medication PBL exercise by the residents P = 0.065 OMASES • Learning to work in a multidisciplinary team was a positive experience for internal
30
• Multidisciplinary session with the patient, resident, and clinical pharmacist to address medicine residents and helped them gain insight into their patient’s understanding of
issues identified by the patient and in the PBL exercise 20
and ability to adhere to medication regimens.
• Evaluation of project outcomes, based on instruments developed and resident self‐ 10
• Patients participated actively in the process and rated residents highly.
reflection process 0
• Valuable changes were made to patient’s medication regimens.
• Comparison of pre and post‐study resident self‐efficacy ratings using unmatched t‐tests Side effects and drug‐ Insurance coverage and Medicare D Literacy, education level Working as an
drug interactions cost and cultural barriers interprofessional team • Durable materials were developed for ongoing use in resident education and assessment
of resident competency.