The primary tool for treating people with chronic diseases is medication. Dr. Shauna Roberts, Truman Medical Centers’ clinical quality director, describes medication management as “the gauntlet” because of the challenge that taking medicines correctly presents to many patients.
Among many other things, Dr. Roberts oversees a program known as Guided Chronic Care at Truman Hospital Hill. The program focuses on patients diagnosed with more than one chronic disease. On average, people in this program have 12 medicines to manage. That’s an average of 12, so some folks in the program are taking more.
To bring home how hard it can be to be “medication compliant” or “medication adherent” — the terms that health care professionals use to describe people who are taking medicines as prescribed — Pat Law, Melody Morales and Tyler Wise, under the direction of Dr. Roberts, developed a simulation they call Medication Madness. They’ve come to the Health Care Foundation a couple of times this year to share the experience with staff and later with members of the Community Advisory Committee.
In the simulation you’re a patient who’s on 6 to 12 different medicines. Your task is to put two days’ worth of pills (which are actually M&Ms, Chicklets, Sweet Tarts, and other multi-colored candies) into plastic bags that represent each day’s dosages.
Sound easy? It’s not. Most of our CAC directors hold post-graduate degrees and a few of them are doctors and dentists; but only 3 of the 20 who were present managed to get the right daily dosages into the bags!
Medication Madness also emphasizes the use of “teach back” methodology and its usefulness in helping patients manage their health by adhering to their medications. In the simulation, participants are given two sets of instructions pertaining to changes in their medications, one without teach back and one with teach back.
When teach back is used, adherence increases because participants are asked to explain in their own words what the changes are to their medications. Any miscommunication or misunderstanding can be corrected immediately at that time, thus improving adherence and ultimately overall health outcomes. Using teach back, a health-literacy best practice, not only allows providers to verify patients are receiving the information they are giving them, it also allows patients to ask questions and seek clarification about the information they are receiving, thus improving the flow of communication and the likelihood of adherence or compliance.
Unlike the real deal, the meds in Medication Madness are color-specific, and use fake names, so Noazipene tabs are orange and Gurflutzaprils are yellow, etc. In reality, lots of meds look alike — little round white pills or white oblong caplets, an additional challenge to medication compliance that the simulation spares players. Moreover, in the real world of med adherence, liquids have to be measured out, some meds must be taken with food or on an empty stomach, and some can’t be taken with others. These complicating factors are also missing from the simulation.
Even without the added stressors, Medication Madness makes the point dramatically and offers a great cautionary tale. This world of multiple medication regimes awaits many of us who can’t or won’t eat wisely, get enough physical activity into our lifestyles or take charge of our health as as we should.