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AMBULATORY CARE

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

Clinical Pharmacy Specialist, Department of Veterans Affairs, Denver, CO

Sunil Kripalani, MD MSc

Assistant Professor, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA

Antoinette L Seright, MA MPH

Research Assistant, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta

Terry A Jacobson, MD

Professor, Department of Internal Medicine, Emory University School of Medicine

Reprints: Dr. Praska, Department of Veterans Affairs, Pharmacy Service (119), 1055 Clermont St., Denver, CO 80220-3808, fax 303/393-4624, jessica.praska{at}med.va.gov

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.

Key Words: adherence, compliance, health literacy

Published Online, July 26, 2005. www.theannals.com, DOI 10.1345/aph.1G094

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