All third-year pharmacy students (n = 92) and all second-year osteopathic medical students (n = 115) at Midwestern University were chosen to participate in the interdisciplinary medication adherence project. Pharmacy education is generally a 4-year professional program to obtain a doctor of pharmacy degree. However, unique to Midwestern University is a 3-year doctor of pharmacy professional program. Therefore, all students were in their final year of didactic education before entering clinical clerkships. This project was designed as a collaborative effort between the course coordinators of two required didactic courses in each of the colleges' curriculum. The medical students assumed the role of a physician with a needlestick exposure requiring HIV prophylaxis. All medical students received the same prescriptions for a placebo HIV prophylaxis regimen as described by the US Public Health Service (
Table 1): zidovudine—100 mg, 2 tablets three times daily for 4 weeks; lamivudine—150 mg, 1 tablet twice daily for 4 weeks; and indinavir—800 mg, 2 tablets every 8 hours for 4 weeks.
23 The pharmacy students played the role of the pharmacist dispensing and providing medication education on the placebo HIV prophylaxis regimen. Tic-Tac's were used as placebo tablets and were packaged in appropriately labeled prescription vials.
Before the start of the project, all pharmacy students received scripted materials on the medications in the HIV prophylaxis regimen following the 1990 Omnibus Budget Reconciliation Act (OBRA 1990) for patient counseling. The script included the name and description of the medication, directions for use, side effects, self-monitoring information, storage requirements, refill information, and instructions for missed doses for each medication. Pharmacy students also received preprinted patient education materials from the 2000 Drug Information Handbook for the HIV prophylaxis medications to be distributed at their initial intervention with the medical students.
Each pharmacy student was paired with one medical student, totaling 92 pairings. The remaining 23 medical students were assigned to a control group. Each pair was randomized to participate in one of three pharmacy counseling interventions: group A (30 pairs), OBRA 1990 counseling and distribution of medication information sheets; group B (30 pairs), group A intervention plus a postcard mail reminder sent after 2 weeks of therapy; group C (32 pairs), group A intervention plus compliance counseling session after 2 weeks of therapy; and group D (23 students), control group. The control group did not receive any written materials or pharmacy counseling interventions with their placebo medications.
All groups met at an initial session where the prescription for the HIV prophylaxis regimen was presented and the three prepackaged placebo medications were dispensed. Also at this session, the initial pharmacy intervention (OBRA 1990 patient counseling and distribution of medication information sheets) took place for those medical students assigned to one of the three intervention groups (A, B, and C). In addition, pharmacy students assigned to group B were given a prescripted medication adherence postcard mail reminder to be placed in their partner's campus mailbox at 2 weeks. The postcard included statistics relating adherence to treatment failure for HIV therapy, as well as suggestions on ways to improve medication adherence. For those assigned to group C, both the pharmacy and medical students met for a medication adherence assessment session at 2 weeks. During this session, the pharmacy students completed a medication adherence assessment form. This form was used to review and record adherence to each drug regimen by a tablet count, to identify barriers to adherence, and to record possible solutions to the identified barriers. Complete medication adherence to the drug regimen was defined as the number of tablets remaining in each bottle being equal to the expected amount in each bottle at the time of the assessment.
After 4 weeks of therapy, all groups met for a medication adherence assessment session and to complete an attitudinal survey. All groups used the medication adherence assessment form described previously. Students worked together to identify barriers to medication adherence and possible solutions to these barriers. A final tablet count was also obtained. After completion of the study, all participants were involved in a postsession discussion to review issues learned from the project.