Learning About Medication Management Difficulties of Low-Vision Patients
Learning About Medication Management Difficulties of Low-Vision Patients
Objective. To implement and evaluate a simulation activity and related assignments within a geriatric elective to teach pharmacy students about the medication management difficulties experienced by low-vision patients.
Design. Students wore low-vision simulation goggles while engaging in medication management tasks. Students also reflected on their experiences in journals and developed modalities to improve low-vision patients' access to prescription information.
Assessment. Results of a perception survey indicated that students were able to identify and differentiate among various low-vision medication management difficulties. Students' reflections suggested that they recognized the challenges encountered by low-vision patients. All patient assistance project submissions were suitable for the targeted populations and medication management difficulties. Peer review and student feedback of the activities were favorable.
Conclusion. Through this low-vision goggle simulation exercise and other activities, students were able to identify the medication management difficulties encountered by low-vision patients and propose solutions to their drug information access problems.
"Low vision" is visual impairment that cannot be corrected by standard glasses, contact lenses, medicine, or surgery, and interferes with a person's performance of daily activities. Low vision is usually a consequence of age-related eye diseases such as cataracts, glaucoma, diabetic retinopathy, or macular degeneration, but may also be a result of genetic diseases such as retinitis pigmentosa. The condition affects up to 14 million Americans and as many as 135 million people worldwide, most of whom are over 65 years of age. Older adults with vision impairment are 3.1 times more likely to have difficulty managing medications compared to people with no vision loss. They have difficulty reading prescription and nonprescription medication information and may take the wrong medication or incorrect doses of medication, resulting in serious negative consequences, including overdoses or inadequate treatment of health problems, which may lead to emergency room visits or hospitalization. The majority of individuals with vision loss also report increased anxiety related to medication management and having to rely on companions, or in some cases complete strangers, to obtain necessary drug information. Furthermore, 65% of Americans indicate that if they were to have severe vision loss, they would be most concerned about not being able to properly identify their medications.
To address these medication safety issues, in 2008 the American Society of Consultant Pharmacists (ASCP) Foundation and the American Foundation for the Blind (AFB) jointly published the Guidelines for Prescription Labeling and Consumer Medication Information for People with Vision Loss to "provide pharmacists and pharmacies with specific recommendations for making important medication information accessible for patients with vision loss." The magnitude of this problem will increase dramatically in the next 20 years, as the number of visually impaired Americans is expected to double. Also, with many older adults living independently at home without the support of a caregiver to read prescription labels for them, future pharmacists must be aware of the difficulties experienced by individuals in this population and be prepared to accommodate them.
The American Association of Colleges of Pharmacy's (AACP) Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes state that doctor of pharmacy (PharmD) programs should prepare students to carry out duties in accordance with professional guidelines, such as those published by ASCP and AFB. Furthermore, AACP and the Accreditation Council for Pharmaceutical Education (ACPE) both recommend that PharmD programs employ strategies by which students are active in and take responsibility for their learning and through which they think critically and learn to solve problems related to drug therapy. Among the methods recommended for accomplishing these tasks are active-learning strategies, including simulations.
Simulation activities may be the most effective method to achieve some educational objectives and can be specifically structured to meet learning objectives and tailored to fit individual needs. Simulations allow the instructor to move away from teacher-centered direction and present more student-centered learning opportunities that improve student interest in material, increase learning, and contribute to students' affective growth. Although studies in healthcare education, including pharmacy, have described classroom simulations of a variety of age-related impairments including vision loss, none have specifically focused on visual impairments. Some of these multi-factorial activities have included awareness of the medication management difficulties of older adults, but the activities did not target identification of students' ability to identify particular medication-related problems of the visually impaired. The AACP suggests that professional pharmacy programs should not only prepare students to provide population-based care by identifying patients who require special attention, but should also teach students to provide patient-specific care, as therapeutic management is most effective on an individual level. Since not all patients with low vision are impaired as a result of the same disease, it is important to provide students with simulation experiences that include a variety of low-vision diseases. Although 1 article described an activity in which pharmacy students were exposed to a series of visual impairment simulations as part of a comprehensive geriatric experience, the article did not spotlight the impairment differences among the diseases nor address the medication management difficulties associated with each impairment. In order to prepare students to provide assistance to this underserved population, learning situations must include first-hand exposure to a variety of visual impairments as well as a detailed investigation of the difficulties related to medications.
This paper describes a low-vision simulation activity in which students experience the medication management difficulties of patients with various low-vision conditions and use their new-found knowledge to devise methods for improving access to prescription information for these patients. Students first participated in this simulation at the University of Louisiana at Monroe (ULM) College of Pharmacy in 2005 in the geriatric elective course Aging and Drug Use in the Elderly. The major objective of this course is to define medication-related problems that affect medication use and therapeutic outcomes in older adults, including age-related eye diseases and low vision. Subjects that cannot be addressed in great detail in the geriatric components of the required curriculum due to course time constraints are covered in this elective course. This experience was designed to provide students with a better understanding of the various medication-related difficulties faced by visually impaired patients and to expand students' opportunities to develop patient- and population-specific services related to low vision.
Abstract and Introduction
Abstract
Objective. To implement and evaluate a simulation activity and related assignments within a geriatric elective to teach pharmacy students about the medication management difficulties experienced by low-vision patients.
Design. Students wore low-vision simulation goggles while engaging in medication management tasks. Students also reflected on their experiences in journals and developed modalities to improve low-vision patients' access to prescription information.
Assessment. Results of a perception survey indicated that students were able to identify and differentiate among various low-vision medication management difficulties. Students' reflections suggested that they recognized the challenges encountered by low-vision patients. All patient assistance project submissions were suitable for the targeted populations and medication management difficulties. Peer review and student feedback of the activities were favorable.
Conclusion. Through this low-vision goggle simulation exercise and other activities, students were able to identify the medication management difficulties encountered by low-vision patients and propose solutions to their drug information access problems.
Introduction
"Low vision" is visual impairment that cannot be corrected by standard glasses, contact lenses, medicine, or surgery, and interferes with a person's performance of daily activities. Low vision is usually a consequence of age-related eye diseases such as cataracts, glaucoma, diabetic retinopathy, or macular degeneration, but may also be a result of genetic diseases such as retinitis pigmentosa. The condition affects up to 14 million Americans and as many as 135 million people worldwide, most of whom are over 65 years of age. Older adults with vision impairment are 3.1 times more likely to have difficulty managing medications compared to people with no vision loss. They have difficulty reading prescription and nonprescription medication information and may take the wrong medication or incorrect doses of medication, resulting in serious negative consequences, including overdoses or inadequate treatment of health problems, which may lead to emergency room visits or hospitalization. The majority of individuals with vision loss also report increased anxiety related to medication management and having to rely on companions, or in some cases complete strangers, to obtain necessary drug information. Furthermore, 65% of Americans indicate that if they were to have severe vision loss, they would be most concerned about not being able to properly identify their medications.
To address these medication safety issues, in 2008 the American Society of Consultant Pharmacists (ASCP) Foundation and the American Foundation for the Blind (AFB) jointly published the Guidelines for Prescription Labeling and Consumer Medication Information for People with Vision Loss to "provide pharmacists and pharmacies with specific recommendations for making important medication information accessible for patients with vision loss." The magnitude of this problem will increase dramatically in the next 20 years, as the number of visually impaired Americans is expected to double. Also, with many older adults living independently at home without the support of a caregiver to read prescription labels for them, future pharmacists must be aware of the difficulties experienced by individuals in this population and be prepared to accommodate them.
The American Association of Colleges of Pharmacy's (AACP) Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes state that doctor of pharmacy (PharmD) programs should prepare students to carry out duties in accordance with professional guidelines, such as those published by ASCP and AFB. Furthermore, AACP and the Accreditation Council for Pharmaceutical Education (ACPE) both recommend that PharmD programs employ strategies by which students are active in and take responsibility for their learning and through which they think critically and learn to solve problems related to drug therapy. Among the methods recommended for accomplishing these tasks are active-learning strategies, including simulations.
Simulation activities may be the most effective method to achieve some educational objectives and can be specifically structured to meet learning objectives and tailored to fit individual needs. Simulations allow the instructor to move away from teacher-centered direction and present more student-centered learning opportunities that improve student interest in material, increase learning, and contribute to students' affective growth. Although studies in healthcare education, including pharmacy, have described classroom simulations of a variety of age-related impairments including vision loss, none have specifically focused on visual impairments. Some of these multi-factorial activities have included awareness of the medication management difficulties of older adults, but the activities did not target identification of students' ability to identify particular medication-related problems of the visually impaired. The AACP suggests that professional pharmacy programs should not only prepare students to provide population-based care by identifying patients who require special attention, but should also teach students to provide patient-specific care, as therapeutic management is most effective on an individual level. Since not all patients with low vision are impaired as a result of the same disease, it is important to provide students with simulation experiences that include a variety of low-vision diseases. Although 1 article described an activity in which pharmacy students were exposed to a series of visual impairment simulations as part of a comprehensive geriatric experience, the article did not spotlight the impairment differences among the diseases nor address the medication management difficulties associated with each impairment. In order to prepare students to provide assistance to this underserved population, learning situations must include first-hand exposure to a variety of visual impairments as well as a detailed investigation of the difficulties related to medications.
This paper describes a low-vision simulation activity in which students experience the medication management difficulties of patients with various low-vision conditions and use their new-found knowledge to devise methods for improving access to prescription information for these patients. Students first participated in this simulation at the University of Louisiana at Monroe (ULM) College of Pharmacy in 2005 in the geriatric elective course Aging and Drug Use in the Elderly. The major objective of this course is to define medication-related problems that affect medication use and therapeutic outcomes in older adults, including age-related eye diseases and low vision. Subjects that cannot be addressed in great detail in the geriatric components of the required curriculum due to course time constraints are covered in this elective course. This experience was designed to provide students with a better understanding of the various medication-related difficulties faced by visually impaired patients and to expand students' opportunities to develop patient- and population-specific services related to low vision.
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