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Transcript
Treatment by Tic Tac
Tanya Gurvich, Pharm.D
Background:
Medication non-compliance or non-adherence is an important issue clinicians have to
deal with daily with all patients. It is especially relevant in Geriatric Medicine where a
typical patient often takes 10 or more Rx and OTC medications each day. Drug regimens
can be confusing and difficult to follow. Patients often don’t take their medications the
way they are prescribed “ Non-adherence to medication regimens can cause adverse drug
events, sometimes leading to hospitalization, nursing home placement and death” (Lesson
in a Pill Box: Teaching About the Challenges of Medication Adherence. O’Connor et
al). This can be very frustrating for the physician who is trying to treat their patients in
the most pharmacologically rational way possible. They don’t realize how difficult it is
to comply with a complicated medication regimen for their patients, yet they themselves
report difficulty adhering to their own medication regimens.
A variety of educational efforts relating to medication adherence have been reviewed in
the literature. Mock prescription exercises have been incorporated successfully into
medical training of physicians and students with positive results. (Lesson in a Pill Box:
Teaching About the Challenges of Medication Adherence. O’Connor et al).
How Does UC Irvine do it?
Based on this information, we developed our own 1 week long “Mock Medication
Compliance Exercise” using different flavor tic-tac’s.
Medical residents are asked to take 5 mock medications for 7 days:
 “Lisinopril 20 mg” BID
 “Metformin 500 mg” TID
 ”Fosamax 70 mg” qweek
 “Coumadin 5mg” 1 tab Mon Wed Fri and ½ tab Tue Thurs Sat Sun
 “Pravastatin 40 mg” QHS.
The regimen above was designed very deliberately to address multiple issues physicians
must consider before prescribing.
1. Five mock prescriptions were given because research indicates that most
medication problems start when drug lists are at least 5 medications long .
2. All ‘medications’ prescribed are given various number of times during the day to
illustrate complexities of drug regimens.
3. Each ‘medication’ is to be taken as if it were a real drug.
a. “Fosamax”, for example, is to be taken on an empty stomach, with a glass
of water, in an upright position.
b. “Metformin” is to be taken with food to avoid potential GI intolerance.
Participants are forced to remember to take “Metformin” with them to
work so that they can take it at lunch time.
c. “Pravastatin” is deliberately prescribed, because it is one the statins less
likely to interact with “Coumadin”.
d. “Lisinopril” is given because “the patient” is diabetic and would normally
take an ACEI to prevent nephropathy.
Physicians are given medication information for each of the mock drugs that a real
patient would receive from a dispensing pharmacy. They are asked to read it to
understand what information the patient is given when they get their prescription filled.
Meetings with the Gero-pharmacist
They meet with the clinical geriatric pharmacist twice.
1. Once to receive the tic tac’s and discuss the way the regimen was designed, and
the second time 7 days later to talk about what happened during the week.
2. At the end of their rotation they are asked to bring all containers back with them
to assess their compliance.
What Happens
Feedback on this project is very interesting.
1. Most residents are not completely compliant with the drug regimen. There was
only 1 resident who was 100% compliant. He happened to work as a pharmacy
technician, before starting medical school.
2. The reasons residents did not take the tic tac’s are very similar to reasons patients
usually give: Forgot them at home, got too busy to take them at home, didn’t like
the way the tic tac’s tasted, had difficulty opening a child resistant prescription
vials, had difficulty cutting the “Coumadin” tic tac in half.
3. All residents reported that it was a difficult and very eye opening experience.