Methods
The study consisted of 3 parts: (1) a national Web-based survey of faculty members at colleges and schools of pharmacy, (2) a national Web-based survey of student chapters of 2 national pharmacy organizations, Phi Delta Chi (PDC) and the National Community Pharmacists Association (NCPA), and (3) conference calls with a convenience sample of pharmacy preceptors and faculty members.
In the first part of the project, researchers conducted a national Web-based survey to pharmacy faculty members on communication topics taught in US colleges and schools of pharmacy. This cross-sectional survey instrument was developed by the Western University of Health Sciences (WesternU) team, based on the Kimberlin study. The study purpose was to identify what communication topics were covered by pharmacy colleges and schools and how they were delivered and evaluated. There were only 2 items that specifically related to medication adherence. The first item asked respondents to indicate whether adherence topics (defined as barriers to adherence and encouraging patient participation in care) were taught as a part of a required or elective course. The second item asked faculty respondents to indicate how this adherence content was delivered (lecture, multimedia, live actors/modeling, practice, and/or case-based). An e-mail with a link to the electronic survey instrument was sent to 269 deans, department chairs, and/or curriculum chairpersons at US colleges and schools of pharmacy (e-mails were sent to more than 1 person at some colleges and schools). The survey was available for completion from December 2010 to March 2011. To achieve an excellent response rate, 3 Web-based reminders to complete the survey instrument were sent. The survey instrument was approved by the university's institutional review board (IRB).
The second and third parts of the study were led by members of the National Community Pharmacists Association's (NCPA) Advisory Council on Medication Adherence. These researchers developed a 9-item Web-based survey instrument to send to representatives at 71 student chapters of Phi Delta Chi pharmacy fraternity and 90 student chapters of NCPA. The researchers targeted 2 student organizations to increase the odds of receiving a response from each of the colleges and schools. SurveyMonkey (SurveyMonkey, Palo Alto, CA) was used to distribute the survey to PDC student chapters and SurveyGizmo (SurveyGizmo, Boulder, CO) was used to distribute the survey to NCPA student chapters. Chapter representatives were asked to have 1 third or fourth-year (P3 or P4) student from their chapter to complete the survey instrument, with preference to be given to P4 students because questions about the third year were included in the survey instrument. As an incentive, chapters that participated in the survey were entered into a random drawing to win free registration for their organization's national meeting.
Because there was no prior research exploring specific adherence topics and how they were covered in curricula, all items were new and constructed for the study's goals to gain a better description of specific topics covered in colleges and schools of pharmacy. Students were asked to provide online consent to participate before completing the survey instrument. There were 3 items asking respondents to use a 4-point Likert-scale to indicate to what extent a topic was taught: not taught, somewhat taught, moderately taught, or extensively taught. Another item asked respondents to indicate in which courses and years in the pharmacy curriculum adherence topics were covered. Respondents were also asked to describe how adherence topics were presented in the curriculum (eg, lecture, video, textbook/readings, guest speaker, role playing, written patient cases, and other).
Students were queried about the extent to which they engaged in adherence interventions during their introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs). Specifically, students indicated whether they had: (1) no opportunity to do any adherence-related interventions, (2) identified patient non-adherence but could not determine intervention, (3) identified patient non-adherence and planned intervention, and (4) intervened and followed up on a patient. Students could also choose "not applicable" if the opportunity to engage in adherence interventions was not available during their IPPEs and APPEs. Students were asked 4 brief background questions about the name of their college or school of pharmacy, location, type of university (public/private/other), type of pharmacy program (0-6, 2-4, undergraduate then PharmD degree, or accelerated PharmD degree), and in what year of the program the student was enrolled (P1-P4).
In the third part of the study, the NCPA Advisory Council on Medication Adherence developed a list of questions addressing the nature and extent of coverage of adherence topics in the pharmacy curriculum to ask a convenience sample of 6 community pharmacy preceptors (4 from independent pharmacies and 2 from chain pharmacies) and 3 pharmacy faculty members with adherence interests. The independent pharmacy preceptors were all active members of NCPA and the 2 preceptors at chain pharmacies were known to the authors through their preceptor service at their respective pharmacy schools.
These questions were administered during a scheduled conference call (2 group conference calls with preceptors and 1 group conference call with faculty members) conducted by a member of the research team. Consent to participate in the study was obtained prior to the call. The calls were recorded for purposes of transcription and review of key themes. Preceptor questions were focused on what activities students undertake during their practice experiences in the areas of detecting, monitoring, and intervening in medication non-adherence. Preceptors also were asked to what extent they thought students were competent to implement strategies to improve medication adherence. Finally, preceptors were asked to indicate what changes they would make in the pharmacy curriculum to better prepare students to engage in detecting, monitoring, and intervening in medication adherence of patients in community pharmacy practice.
Prior to the telephone interview, the 3 faculty members indicated that they did not have a thorough enough knowledge of the entire curriculum to give an accurate estimate of the extent to which adherence topics were covered, where such topics were taught in the curriculum, and how much time was spent on the different adherence topics. Therefore, 2 survey questions asking for this information were deleted from the interviews with the faculty members. The 3 faculty members provided feedback on whether various adherence topics should be required; how prepared they felt students were to detect, monitor, and intervene in medication non-adherence; and how competent they thought students were in implementing various intervention strategies. The 3 faculty members also identified possible opportunities to better prepare students to engage in adherence-related activities.
All survey data were entered in SPSS 18.0 (SPSS Inc, Chicago, IL) and analyzed using descriptive statistics such as medians and frequencies where appropriate. In a few cases, responses were received from both the Phi Delta Chi and NCPA student chapters of a college or school, and/or 2 or more responses were received from the Phi Delta Chi and/or the NCPA student chapter of a college or school. To ensure only 1 response from each college or school of pharmacy was included in the data analysis, we eliminated the second response if that response was from an individual in their first or second year as we believed that students in the third and fourth years of the program had more knowledge of the entire curriculum. If there were 2 responses from a third or fourth year student at a college or school, we used the response of the more senior student as that student was more likely to be able to answer the APPE questions. In cases where we received 2 or more responses from students in the same year at a college or school, we combined the responses and imputed the averaged score for the college or school. The conference call tapes were transcribed using the Cogi iPhone application (Cogi, Santa Barbara, CA). Student researchers categorized the key themes identified from the phone conversations. Both the student survey instruments and the scripts used during the conference calls were approved by multiple IRBs. (Copies of the survey instruments and the questions asked during the phone interviews are available by request from the corresponding author.)