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Improvements in health literacy may lead to greater medication adherence
For physicians who wish to improve medication adherence in patients, the answer may lie in targeting patient education and health literacy, says Chuck Lee, MD, an internal medicine doctor. Lee is senior director for clinical knowledge/education and senior advisor on health literacy and language barriers at First Databank, a healthcare data management company in San Francisco, California.
Medication non-adherence is remarkably common, affecting as many as 40 to 50 percent of patients, says Lee, many of whom have chronic conditions, low health literacy, and are especially vulnerable to adverse outcomes.
Physicians can help their patients improve adherence through a number of simple, practical communication steps ranging from how they discuss medications to simplifying printed materials, Lee says.
Lee, a first generation immigrant from Korea, has seen firsthand his own relatives’ struggles with health literacy, which has made him more sensitive to these concerns in his patients.
“When talking with a lot of my patients to communicate instructions it was obvious that many didn’t quite understand the documents we’d been giving to them,” he says.
He recommends that physicians consider revisiting any pamphlets, documents or medication information. “It should be simplified, written at a fifth to eighth grade reading level, with large font sizes, pictograms and explanatory videos,” he says.
They should also take into account the elderly or those with vision problems and not be printed too small.
Additionally, physicians can engage in teach back methods where they ask if the patient understands what they’ve read or been told and then asks them to repeat the essentials before they leave the office or encounter.
Lee says it’s equally important that physicians don’t assume patients know how to use devices such as inhalers or injectable medications. “You might discover later that a patient has been using it incorrectly for a long time.”
Physicians should also keep in mind the varied languages that patients may speak in their practice and attempt to have information available in the most common of these languages. While legislative efforts have been working to improve the availability of medical information in multiple languages, Lee says “It shouldn’t have to be a legislative process; we should look at it from a patient safety perspective.”
He also feels that during the COVID-19 pandemic, given that people with co-morbidities are at greater risk of catching and dying from the virus, it’s very important that patients know why they’re taking each medication they’re on. He’d like to see pharmacies label medications for their usage, but in the meantime, he says, physicians can be sure to tell patients verbally.
“If we only did one thing and that was to say to them ‘this is for your high blood pressure and this is for your high cholesterol,’ the patient might be more likely to take the meds on a regular basis,” he says.
Otherwise, when patients are unclear on what a medication is for, particularly if it has a high co-pay each month, he says they might try to stretch or even stop taking a medication to save money, among other reasons.
While some practices may have analytics in place to help them identify low health-literacy and high medication non-adherent populations, he acknowledges that most do not. Instead, he recommends physicians assume that most of their patients have low health literacy and make information as accessible as possible.
“Just because you give something to the patient doesn’t mean they’re going to use or understand it. You have to make it accessible to everybody.”