Identifying and Assisting Low-Literacy Patients with Medication Use: A Survey of Community Pharmacies

Abstract

Spanish

French

BACKGROUND:

Nearly one-half of adult Americans have limited functional literacy skills. Low patient literacy is associated with poor medication adherence and health outcomes. However, little is known about how pharmacies address literacy-related needs among patrons.

OBJECTIVE:

To determine the frequency with which pharmacies identify and provide appropriate assistance to patients with limited literacy skills and provide specific recommendations to help improve pharmacists' recognition of low health literacy, as well as strategies to improve adherence in this population.

METHODS:

Through a telephone-based survey of Atlanta-area pharmacies, we obtained information on (1%) whether the pharmacy attempted to identify patients with limited literacy skills, (2%) what measures were taken by the pharmacy to optimize the health care of low-literacy patients, especially with regard to medication adherence, and (3%) what services the pharmacy offered to improve adherence in general.

RESULTS:

The response rate among eligible pharmacies was 96.8% (N = 30%). Only 2 (7%) pharmacies reported attempting to identify literacy-related needs among their patrons. One of these facilities provided additional verbal counseling to assist low-literacy patients, and the other pharmacy involved family members, provided verbal counseling, and had patients repeat instructions to confirm comprehension. Most pharmacies reported availability of adherence aids that could help low-literacy patients if such patients were identified and targeted to receive additional assistance. These included verbal and written counseling (offered at 73% of pharmacies), packaging or organizing aids (27%), refill services (17%), and graphic or multimedia aids (13%).

CONCLUSIONS:

Pharmacies infrequently attempt to identify and assist patients with limited literacy skills.

Keywords

adherence compliance health literacy.

Get full access to this article

View all access options for this article.

References

Kirsh

Jungeblut

Jenkins

Kolstad

. Adult literacy in America: a first look at the findings of the National Adult Literacy Survey. Washington, DC: National Center for Education Statistics, US Department of Education, 1993.

Institute of Medicine. Health literacy. A prescription to end confusion. Washington, DC: National Academies Press, 2004.

Baker

Williams

Parker

Gazmararian

Nurss

. Development of a brief test to measure functional health literacy. Patient Educ Couns 1999; 38: 33–42.

Youmans

Schillinger

. Functional health literacy and medication use: the pharmacist's role. Ann Pharmacother 2003; 37: 1726–9. Epub 2003 Sept 10. DOI 10.1345/aph.1D070

Gazmararian

Baker

Williams

Parker

Scott

Green

, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA 1999; 281: 545–51.

Baker

Parker

Williams

Clark

. Health literacy and the risk of hospital admission. J Gen Intern Med 1998; 13: 791–8.

Gokal

Echt

. Effect of health literacy on medicine management capacity in older adults (abstract). J Am Geriatr Soc 2003; 51 (suppl 4): S205.

Kalichman

Ramachandran

Catz

. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med 1999; 14: 267–73.

Weiss

Palmer

. Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population. J Am Board Fam Pract 2004; 17: 44–7.

10.

Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I: mortality results. JAMA 1982; 247: 1707–14.

11.

The Coronary Drug Project Research Group. Influence of adherence to treatment and response of cholesterol on mortality in the Coronary Drug Project. N Engl J Med 1980; 303: 1038–41.

12.

Parikh

Parker

Nurss

Baker

Williams

. Shame and health literacy: the unspoken connection. Patient Educ Couns 1996; 27: 33–9.

13.

Andrus

Roth

. Health literacy: a review. Pharmacotherapy 2002; 22: 282–302.

14.

Education statistics for metro Atlanta 2000. www.ersys.com/usa/13/1304000/educate.htm (accessed 2004 Dec 17).

15.

Williams

Parker

Baker

Parikh

Pitkin

Coates

, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA 1995; 274: 1677–82.

16.

U.S. Census Bureau. American FactFinder. http://factfinder.census.gov (accessed 2005 Apr 17).

17.

American Medical Association Council on Scientific Affairs. Health literacy. JAMA 1999; 281: 552–7.

18.

Weiss

Coyne

. Communicating with patients who cannot read. N Engl J Med 1997; 337: 272–4.

19.

Williams

Davis

Parker

Weiss

. The role of health literacy in patient–physician communication. Fam Med 2002; 34: 383–9.

20.

McDonald

Garg

Haynes

. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002; 288: 2868–79.

21.

Delp

Jones

. Communicating information to patients: the use of cartoon illustrations to improve comprehension of instructions. Acad Emerg Med 1996; 3: 264–70.

22.

Houts

Bachrach

Witmer

Tringali

Bucher

Localio

. Using pictographs to enhance recall of spoken medical instructions. Patient Educ Couns 1998; 35: 83–8.

23.

Kripalani

Seright

Robertson

Praska

Steadman

Jacobson

. Development of a graphic pill card to improve patient comprehension and compliance (abstract). Prev Med 2004; 39 (suppl 1): S39.

24.

Schillinger

Machtinger

Wang

Win

Chen

Rodriguez

, et al. Are pictures worth a thousand words? Communication regarding medications in a public hospital anticoagulation clinic (abstract). J Gen Intern Med 2003; 18 (suppl 1): 187.

25.

Rothman

DeWalt

Malone

Bryant

Shintani

Crigler

, et al. Influence of patient literacy on the effectiveness of a primary care–based diabetes disease management program. JAMA 2004; 292: 1711–6.

26.

Doak

Root

. Teaching patients with low literacy skills. 2nd ed. Philadelphia: JB Lippincott, 1998.

27.

Mayeaux

Murphy

Arnold

Davis

Jackson

Sentell

. Improving education for patients with low literacy skills. Am Fam Physician 1996; 53: 205–11.

28.

National Work Group on Literacy and Health. Communicating with patients who have limited literacy skills. J Fam Pract 1998; 46: 168–76.

29.

Plimpton

Root

. Materials and strategies that work in low literacy health communication. Public Health Rep 1994; 109: 86–92.

30.

Schillinger

Piette

Grumbach

Wang

Wilson

Daher

, et al. Closing the loop. Physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003; 163: 83–90.