Patient understanding – The cornerstone of patient adherence and safety

What percent of patients walk out of a pharmacy not knowing how to use their medicine correctly?

According to the Institute of Medicine, chances are that one in every three patients will have some difficulty understanding their medication instructions. [IOM, 2004] These patients have low health literacy. With 4.45 billion prescriptions dispensed in the United States last year, over 1.5 billion prescriptions pose a potential safety risk if the patient doesn’t take their medicine properly.

While any medication potentially can cause harm if not taken properly, a select group of drugs called high-alert medications (HAMs) carries a higher risk for patients. According to The Joint Commission, HAMs frequently are associated with harm, the harm they cause is serious, or when they are misused, the risk of a fatal outcome is high. Even when administered correctly, these drugs carry a significant risk of causing harm. Understanding the medications and the correct way to administer them are critical to help ensure patient safety.

What is Health Literacy?

Health literacy is a personal skill that includes the ability to 1) gather, 2) understand and 3) act on appropriate health information. Patients with low health literacy have difficulty with one or more of these steps. All steps are important because an inability in any step detrimentally affects subsequent steps. Health literacy is such an important skill that it is a stronger predictor of health than age, income, employment status and race. [AMA, 1999]

Addressing health literacy is a good, practical approach to improving patient adherence and safety because it directly impacts the patient’s ability to self-manage their medications. Let’s take a look at each of the three skills to see what we can do to overcome low health literacy.

Gather: Many patients don’t know where to go to find information about their medicines. The internet has so much information about medicines – from reputable and non-reputable sources – that many people quickly become overwhelmed. Once someone has collected information, they often do not have the experience needed to sift through credible information and find the proper, actionable content.

Pharmacists can guide patients to reputable resources. If a patient doesn’t have internet access, a pharmacist can offer a printout of the medication information. A good rule of thumb is that half of all people forget what the pharmacist tells them once they walk out of the pharmacy door, so giving them written information is important.

Understand: If patients have difficulty reading, it’s hard for them to understand. Approximately one in eight patients has some vision loss. [AFB, 2013] As our population becomes older, vision loss is becoming increasingly prevalent. Those patients might do well with information and prescriptions in larger font sizes or to have someone read the material to them.

Another 30 million Americans have limited English proficiency. If they cannot read the English-language medication instructions, it is a barrier to understanding and increases the safety risk. There are a few vendors that now offer multi-language medication instructions for patients. Pharmacists can avoid only giving out the dense, English-only medication instructions sheets that have been traditionally dispensed with medicines in the past, hoping that patients can somehow figure out what they mean.

Another approach to improving understanding is a visual one. There is growing support for the Universal Medication Schedule (UMS), which can be graphically represented as four daily dosing times with the amount of medicine a patient must take at each time. Some pharmacy management systems can now print UMS images on container labels and on handouts.

Act: In the adherence phase, we are looking to patients to take action. The challenge of medication adherence is multifaceted and can be affected by many other issues, such as financial resources and transportation to the pharmacy. One of the benefits of the health literacy approach is that it can improve the patient’s self-management skills, increase their awareness of the importance of each medicine and improve the chance they will take the medicine properly. Additionally, including periodic reviews by pharmacists to patients, such as a Medication Therapy Management (MTM) session, can reinforce proper adherence and safe behavior.

This low health literacy approach helps everyone, although low health literate patients with the highest risk of taking medications improperly, benefit the most.

Understanding is the cornerstone of patient adherence. Remember, that a third of the people who see pharmacists likely face obstacles to their ability to understand their instructions. Accommodating low healthy literacy provides a practical method to improving health outcomes and safety for all patients.

About the Author

Dr. Charles Lee has advocated to reduce disparities in access to health information for underserved populations since he immigrated to the U.S. with his Korean family at age seven. In 2001, Dr. Lee founded Polyglot Systems, acquired by FDB, and invented Meducation®, a cloud-based technology that enables providers to create personalized patient medication instructions in more than 20 languages, including drug, dose and time of day.

Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004.
https://www.statista.com/statistics/238702/us-total-medical-prescriptions-issued/
American Medical Association, JAMA, Feb 10, 1999.
American Federation for the Blind, Website 2013.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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