Lightbulb moments: Talking About Medicines recognised with national award

A ‘passion project’ created and self-funded by Waikato clinical pharmacist Fiona McNabb to help people better understand how and why their medicines work won the New Zealand Hospital Pharmacists Association (NZHPA) Max Health award in late 2022.   

The Talking about Medicines video series and website uses simple visuals to make information about medicines easy to understand. Fiona created the resource after seeing how well people responded to the simple drawings and short notes she used in her work.  

“They weren’t complicated drawings, just simple pictures of people’s airways to show how inhalers work; a brain neural gap to explain how selective serotonin reuptake inhibitors work,” says Fiona.  

“Clinicians often just talk to patients and expect them to go away and remember it. Or we might write things down or give people little booklets. But more and more people don’t want to read a lot of stuff.”   

Across the board, she says, the vast majority of people respond to a more visual approach, and providing information in that simple, visual way turns lightbulbs on.   

“I’d hear things like: ‘Thank goodness, I finally understand. I’ve been a diabetic for 20 years and never understood it.’”  

Raglan Medical Centre GP and practice owner, Mike Loten, works regularly with Fiona in her clinical pharmacist role at the practice.  

“When we have people who don’t have a full understanding of their meds, or have doubts about why they are taking them, Fiona’s explanations are really clear and make a big difference.  

“She shows people how a medicine works, what it does and how it helps, with enough detail so they understand the reasons for their medication. I’ve seen that lightbulb moment, it’s a really positive thing for patients and helps with adherence to prescriptions.” 

Working in community settings and the hospital system, Fiona said she knew this type of simple, visual communication isn’t available to everyone.  

“The medical system is under-resourced and we can’t get to everyone. There needed to be a better way to get simple, visual information to people who would otherwise miss out completely.”  

Video was the obvious choice. Fiona first created what she calls an “incredibly amatuer talking-head plus whiteboard drawings” first attempt about heart attack medication, filmed in her friend’s spare room. Only later did she realise the video also captured her friend’s parrot squawking in the background. Even then, that first video got great feedback from medical staff on the cardiac ward where she was working, and multiple requests from patients who wanted a copy.  

Looking to make a more professional version, Fiona pitched the idea to various potential funders and received lots of enthusiasm, but no workable offers. Instead, she funded a series of heart attack medication animated videos and set up the Talking About Medicines website out of her own pocket, employing her graphic designer son Sean to replicate her drawings.  

“It was exciting to develop the idea in a more professional way, and get something tangible out there to show people,” says Fiona.  

“We did the videos for post-myocardiac infarction (MI) patients because they are a very distinct group – often people who have never taken medicines before, catapulted into a major psychological shift of needing to take five medications a day.   

“There can be a bit of resistance to that change. Some studies show that two years after a heart attack, less than 50 per cent of people are taking three or more of their medicines on prescription. That has a massive impact on the success of secondary prevention – readmission rates, reinfarction rates, all of those things.”  

To demonstrate the effectiveness of the Talking About Medicines videos, a small research study was set up in the Cardiac Care Unit at Waikato Hospital during late 2022. Although disrupted by COVID-19 restrictions, there were incredibly positive results:  

• 93 per cent of participants said watching the videos positively influenced their thinking and changed their intent around taking their medicines after discharge 

• 80 per cent said they preferred video format to the available written material 
• 100 per cent of those who viewed the video series reported improved knowledge about their medicines.   

To quote one of the patients who watched the series: “The videos gave me exactly what I need to know about my medications. It was a quick and easy way to remember what I needed to do and why.” 

Anyone can access the Talking About Medicines heart attack videos free via the website, and Fiona is hoping the recognition of the Max Health award will help attract funding to produce more videos on other health issues, such as diabetes, which she can’t fund herself.   

The award itself came with $3,000 prize money that Fiona is using to start producing te reo Māori translations of the cardiac videos. The first video in the series, called 'How the heart works’, has been translated in full and this work has laid the foundations to translate the rest of the series, pending extra funding.   

Interest in research around the Talking About Medicines project is also growing, thanks to the Max Health award. Since the NZHPA 2022 conference, Otago University has started working with Talking About Medicines to set up a fourth-year medical student project, which expands on the original study in cardiac care. Auckland University is also in discussions with Fiona about possible Master’s or PhD research on outcomes, tracking adherence to prescribed medicines over time after using the Talking About Medicines resource.   

Auckland City Hospital is about to launch a pilot study using the Talking About Medicines videos, and combined data from Auckland and Waikato hospitals will be presented at this year’s Cardiac Society of Australia and NZ (CSANZ) conference, pending acceptance of the abstract submission.  

Meanwhile, Fiona is still drawing simple, effective explanations for patients in her work as clinical pharmacist at Raglan Medical Centre and Victoria Clinic in Hamilton.  

“I’ve had a long career in pharmacy, working in community pharmacy, hospitals and secondary care, teaching in my clinical role and as a tutor at Wintec, and designing and being involved in training programmes for junior pharmacists and trainees. The same principles apply, whether you’re talking to a pharmacy or medical student, or a patient: visual images help transfer complex information in really simple way.” 

Fiona is one of a growing number of clinical pharmacists integrated with primary care teams around Aotearoa New Zealand.   

At Raglan Medical Centre, where Fiona works one-day-a-week in her clinical pharmacist role, Mike Loten says there has been universally positive feedback from staff and patients.  

“It’s a complementary role with so many benefits. It’s great for all the doctors, especially the GP registrars, to have an open door down the corridor to consult about medications. If we have someone on a range of medications the clinical pharmacist can help pick apart the different interactions and how different medications may affect the patient’s health.   

“Fiona also works with our nurses around chronic conditions like diabetes, and supports those completing nurse practitioner training. She has an extended prescribing scope that is used to either start medications for patients or help manage chronic conditions like gout, blood pressure and diabetes.”   

Mike says the clinic would love to extend the clinical pharmacist job to more than one day a week, and absolutely recommends the role as part of a practice team. “It would be great to see more funding for clinical pharmacist roles in general practice.”