Refining the Practice of Prescribing: Teaching Physician Learners How to Talk to Patients About a New Prescription

Abstract

Background Clinician counseling about medication can improve patient understanding and adherence. This study developed a teaching session for physician learners about medication prescribing and communication, with evaluation at the physician and patient levels. Objective We analyzed whether patients would perceive and report more comprehensive clinician presentation of medication information when receiving prescriptions from their physician in the intervention clinic. Methods We conducted a single site, prospective intervention study that included lectures, role play, an objective standardized clinical examination (OSCE), and reminders displayed in patient care areas. For physician-level assessment, pretests and posttests included a written case presentation and a OSCE. For patient-level assessment, we used a cross-sectional observational design that included study of patient recall information, and assessment of patient satisfaction before and after intervention. Results Twenty-seven family medicine residents and sports medicine fellows participated in the teaching session, focused on presenting patients the reasons, risks, and regimen of prescribed medication. In written testing, learners presented significantly more comprehensive information in posttests. In the OSCE (n = 14), all learners presented risks and regimen information. However, patient-level assessment showed no significant difference between before and after intervention. Notably, the covariates patient activation and satisfaction with communication both had a significant association with patient recall information. Conclusions Our intervention improved learner presentation of medication information. However, patient recall of the information conveyed did not change. Although physician training did not have a positive effect on patient recall, patient activation emerged as a critical influence of patients' perceptions of medication discussions.

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

“…Moreover the single site study limits results' generalizability. This study design—frequently adopted in research testing the feasibility and potential impact of educational interventions (Hulsman et al, 1999; Berger et al, 2010; Lamiani et al, 2011; Meyer et al, 2011; Bartels et al, 2013; Ledford et al, 2014; Arnold et al, 2015; Shah et al, 2015; Robinson et al, 2016; Viau et al, 2016) is appropriate for the demonstration of feasibility and for initial proof of concept, it is cost effective, and it is pragmatic because it allows for “real world” variability in variables. Consistent with the intent of a pilot study, our goal was to examine feasibility and potential impact.…”

Aspects of Medication and Patient participation—an Easy guideLine (AMPEL). A conversation guide increases patients’ and physicians’ satisfaction with prescription talks

“…Compared with more complex interventions (e.g., training of physicians), the present study suggests a surprisingly high effectiveness of this simple intervention (Ledford et al 2014). Although addressing another outcome, studies on interventions aiming to increase medication adherence have already shown that simple, low-effort interventions can be just as effective or even more effective than complex approaches (Kripalani et al 2007;Matthes and Albus 2014).…”

A randomised controlled trial of patient information leaflets as a medication counselling aid

“…The actors’ perception of the information presented was measured as a surrogate for information transfer. However, previous studies have shown that improving the presentation of the information provided does not always correlate with an increase in the information retained . Similarly, the examination format prevented direct questioning of the student regarding satisfaction with the counselling aid, and usage was used as a surrogate marker of satisfaction.…”