Stepping Up Patient Assessment: Part I

By: Anonymous on 9:50:00 AM

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The past month has kept me busy with administrative duties, teaching and writing a grant proposal.  After taking a bit of time to decompress from the intense hustle and bustle of meeting the grant submission deadline, I started to reflect on a common theme that appeared to be threaded across most of my work of late, including the grant proposal.  That thematic tendril was tied to the act of teaching or rather training students in patient assessment.

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It dawned on me that in pharmacy we do a pretty darn good job of teaching students patient assessment in the context of medications.   I mean "duh", isn't pharmaceutical care or medication therapy management what we're supposed to teach student pharmacists?  Isn't that our role as pharmacists? Certainly, but I also believe pharmacists are ideally position within healthcare to provide a whole host of patient assessment services and interventions, which reduce risk for injury.

So to help drive this premise home, this post and the next one will cover three of what are many potential assessment services that pharmacists could and should actively embrace:  medication adherence, substance use disorders, and falls risk assessments.   The first one, medication adherence, is already within our acknowledged wheelhouse of expertise.

Reams of information have been published over the past few decades on the occurrence, associated risk factors, predictors and costs, as well as strategies to improve medication non-adherence.   So why is it that despite how much better informed we are about the issue, medication non-adherence remains so prevalent, so problematic and so costly?  There are many factors, but I believe there are two key reasons.  First, non-adherence is a behavior coupled to both internal beliefs and external demands; and as we all know, human behavior is complex and very difficult to change.  Second and perhaps most importantly, no profession in healthcare has truly stepped up to own the issue of medication non-adherence.  Perhaps this is due to the complexity of the problem, but certainly pharmacists are well equipped to take on this multi-billion dollar problem.


I recently lectured on the topic of medication non-adherence in our Geriatrics Assessment elective course, open to second and third year student pharmacists.  As typical for my lecture, I covered the common non-adherence statistics, introduced the students to the World Health Organization's Five Dimensions of Adherence, demonstrated a number of adherence assessment tools and shared a variety of adherence aids and devices.   However, on this day, I also used an active learning strategy in class to engage small groups of students, using digital audio recordings, to critically think about the issues surrounding medication non-adherence and the pharmacist's role.   I did this through a series of quick responses to "impromptu" questions and a hand-held recording device, which was passed from one student to the next.  The following podcast link shares one group's quick response to the question "what can pharmacy/pharmacists do to step up to better own or take on the problem of medication non-adherence"?

Listen Here

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Now when you listen to these students' replies, I know experienced pharmacists will, through a skeptical ear, dismiss their responses as impractical musings of the naive and inexperienced.  However, if this is your first impression, I ask that you listen again, and listen not within the context of how pharmacy has been practiced, but with the ear and vision of what our practice should be.  Then ask, if we took up this challenge of owning the issue of non-adherence, and we followed the advice of these students, would we be closer to a solution?   I think so!  What do you think?  When was the last time you or a pharmacist you work with did a comprehensive medication non-adherence assessment?  Are we doing enough as pharmacists to change non-adherent behavior?  What are your thoughts on how we can step up as a profession?

Part II will address the pharmacist's role in stepping up assessment for substance use disorders and falls risk.  Until then, I look forward to your comments on adherence.