Journal of the American Pharmacists Association
ReviewsHealth literacy: A barrier to pharmacist–patient communication and medication adherence
Section snippets
Objectives
The goal of this article is to present a summary of the existing literature on health literacy and its effect on medication nonadherence and pharmacist–patient communications and the use of written patient information in health care and pharmacy.
Search strategy
Potentially relevant articles were identified by searching the Medline, PubMed, and International Pharmaceutical Abstracts databases using the following terms: adherence/nonadherence, compliance/noncompliance, printed/written information, literacy, patient education, communication, and health literacy. These terms were combined with the following search terms: drug information, readability, medication/drug, patient, pharmacy/pharmacist, and prescription. References of pertinent articles were
Medication adherence
Compliance was defined more than 2 decades ago as “the extent to which a person's behavior (in terms of taking medications, following diets or executing other life-style changes) coincides with medical or health advice.”3 This term was later criticized for implying paternalism. The terms adherence and concordance have replaced compliance. Adherence is favored because of its connotation that the patient–provider relationship is based on respect and collaboration.27 It also includes the patient
Health literacy
Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”54 Thus, health literacy relates to both the cognitive and functional skills used to make health-related decisions.55 This definition also implies that literacy goes beyond the ability to read a sentence to the ability to comprehend the written word. Health literacy includes
Effectively communicating health information
Most of the health education information that is provided to patients, both oral instructions and written information, is presented in a format that is too complex for the average person to understand.2,58,65., 66., 67. This communication mismatch is one of the causes of nonadherence.2,10,68,69 Approximately one-third of all patients and two-thirds of physicians know someone who has had health problems because they did not understand how to take a prescription medication correctly.70 Inadequate
Implications for pharmacy practice
Substantial evidence indicates that inadequate health literacy adversely affects adherence behavior, patients' knowledge, self-care for chronic diseases, and health care costs.25,119,120 The IOM report To Err Is Human68 noted that management of complex medication therapies, especially in elderly patients, is extremely difficult and requires special attention to the ability of the patient to understand and remember the amount and timing of a dose, as well as behavioral modifications required by
Looking ahead: Pharmacist–patient interactions
Health care delivery continues to shift from inpatient to outpatient settings, and the practice of quality control over medication use is becoming more the responsibility of the patient and less the responsibility of the provider.109 These trends indicate the importance of the pharmacist–patient interaction in ensuring that patients have the skill and knowledge needed to perform self-care medication-taking behaviors. Pharmacists have the essential technical knowledge for assisting patients with
Conclusion
Although pharmacy-specific recommendations are still lacking for the most part, the need for health literacy education for pharmacists and students remains high. Such education should promote awareness of how to recognize patients with low literacy skills and provide strategies to enhance understanding and adherence in this population. Although the information provided in this article is not exhaustive or comprehensive, it can assist pharmacists in their efforts to communicate more effectively
Assessment Questions
Instructions: The assessment test for this activity must be taken online; please see “CPE processing” below for further instructions. There is only one correct answer to each question. This CPE will be available at www.pharmacist.com no later than August 31, 2009.
- 1.
What percent of patients typically take medications as prescribed according to the World Health Organization?
- a.
10%
- b.
20%
- c.
30%
- d.
40%
- e.
50%
- a.
- 2.
What percent of patients are adherent with taking prescribed medications during a 1-year period?
- a.
10–20%
- b.
30–40%
- c.
- a.
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Introduction
Compliance: definitions and key issues
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Disclosure: The author and APhA's editorial staff declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.