Both have dedicated their careers to researching and teaching methods to support patients in their medication routines. In this blog, they share their motivations, experiences, and insights from developing and piloting the "Tools and Techniques for Medication Adherence Support Training" course, designed to equip healthcare practitioners with the skills needed to improve patient adherence and outcomes.
What inspired you to develop the "Tools and Techniques for Medication Adherence Support Training" course?
The course forms a core part of the education work of the Centre for Adherence Research & Education (CARE), which started around 7 years ago with invaluable encouragement and support from King’s Health Partners (KHP). In addition to our ongoing research on understanding and improving treatment adherence, KHP were keen for us to develop training for healthcare practitioners (HCPs) to improve their ability to detect and manage non-adherence across all areas of treatment. To achieve this, we first spent time talking to patients and HCPs in order to understand their perspectives of treatment adherence, and this was crucial in influencing our thinking and planning.
Patients told us that they wanted to be able to discuss medication worries and adherence challenges in a straightforward “no-blame” way, and this led to us developing a simple validated screener, to be completed prior to a consultation. For HCPs, the training, which involves both on-line and in-person components, is based on using the screener to identify and discuss the medication challenges, which individual patients have indicated on the screener. They are also provided with training in adherence support strategies and behaviour change techniques to help them to manage each type of challenge revealed by the screener.
The training has evolved over the years and now involves a mix of information giving, video demonstrations and role play to enhance HCPs’ knowledge and skills. Over 600 HCPs have completed the course with very positive feedback on its content and style, and we are now developing customized versions for those working with different patient groups, such as children/adolescents and people with renal disease. We have really enjoyed delivering this training and have a much greater sense of the adherence challenges faced by patients and HCPs.
How was the training received by the participants when it was first delivered at the University of Brighton?
As we now want to train others to be able to deliver our training, we have designed an approach for training trainers. We have recently completed our first experience of running this for colleagues in Brighton University’s School of Pharmacy, who wanted to incorporate the CARE training into their undergraduate and postgraduate teaching. The feedback from this was extremely positive and we are now discussing further “train the trainer” work with other different groups, including universities and regional integrated care systems in England and Wales.
We were both pleased and surprised by how well our first course was received. A crucial insight we gained from running this course was the importance of understanding the local context into which the training was going to be delivered. This meant that, in addition to providing our training details and tools, we worked closely with the participants to enable them to identify how they were going embed the training into the different levels of their own curricula. This is ongoing work and we are looking forward to seeing how the CARE training is implemented within their courses and to evaluate its impact.
Are there specific areas within adherence studies that you aim to change or improve with this training program?
Yes, there are several key areas within adherence studies that we aim to improve with the "Tools and Techniques for Medication Adherence Support Training" program. This course provides comprehensive understanding of adherence factors. We aim to deepen healthcare professionals' understanding of the various factors leading to medication adherence. This includes not only the patient-related factors but also the systemic and interactional elements that can influence adherence. By providing a robust foundation on these factors, we hope to improve the overall approach to medication adherence within healthcare settings.
A significant focus of our training is on the factors affecting the delivery of medication adherence support by healthcare professionals. Common barriers such as the perception that adherence management is outside their remit ("Not my job"), underestimating the prevalence of non-adherence, and feeling ill-equipped to manage the underlying reasons are directly addressed in the course. Our training aims to empower professionals by equipping them with the necessary knowledge and tools to effectively manage these challenges. Our approach, the CARE approach to non-adherence, targets both patient and clinician barriers. By focusing on these dual aspects, we aim to create a more holistic and effective intervention strategy. Clinicians, being well-placed to deliver adherence interventions, are provided with five brief adherence support strategies, enhancing their capability to manage non-adherence within routine care settings. Practical barriers such as lack of time during routine appointments, failure to pick up on patient cues, and feeling overwhelmed are also addressed. The training provides strategies to integrate adherence support seamlessly into routine care without significantly adding to the clinicians' workload.
In addition to improving the delivery and understanding of medication adherence, our training also focuses on helping healthcare professionals develop their approach to evaluating adherence training. We provide tools and methodologies to measure the effectiveness of adherence interventions, including pre- and post-training assessments, feedback mechanisms, and long-term follow-up strategies. By equipping HCPs with these evaluation techniques, we aim to ensure that the impact of adherence training is continually assessed and refined, allowing for data-driven improvements and sustained positive outcomes in patient adherence behaviors.
We have emphasized the importance of accurately identifying non-adherence and supporting adherence through relevant methods. The training includes a brief CARE screener that alerts healthcare providers to non-adherence and guides them to understand the underlying reasons. This tool helps in ensuring that non-adherence is approached in a friendly and supportive manner, addressing the common issue of non-friendly approaches to non-adherence. Another key area we aim to enhance is the ability of healthcare professionals to deliver training on adherence support. By the end of the course, participants are equipped to use a range of techniques to train others, ensuring that the knowledge and skills gained are effectively disseminated within their teams and institutions.