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PATIENT EDUCATION

The Role of Health Literacy and Written Medicine Information in Nonsteroidal Antiinflammatory Drug Risk Awareness

Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences - Tulsa, College of Pharmacy, The University of Oklahoma, Tulsa, OK

Michael R Schmitt, PharmD

Research Assistant, Department of Pharmacy: Clinical and Administrative Sciences - Tulsa, College of Pharmacy, The University of Oklahoma

Jeroan J Allison, MD MS

Vice-Chair and Associate Vice-Provost for Health Disparities, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA

Daniel J Cobaugh, PharmD FAACT DABAT

Senior Director for Research and Operations, American Society of Health-System Pharmacists Research and Education Foundation, Bethesda, MD

Midge N Ray, MSN CCS

Associate Professor, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham

Kenneth G Saag, MD MSc

Director and Professor, University of Alabama at Birmingham, Center for Education and Research on Therapeutics of Musculoskeletal Diseases and Center for Outcomes & Effectiveness Research & Education, School of Medicine, University of Alabama at Birmingham

Reprints: Dr. Miller, Department of Pharmacy: Clinical and Administrative Sciences - Tulsa, College of Pharmacy, The University of Oklahoma, 4502 E. 41st St., 2H36, Tulsa, OK 74135, fax 918/660-3009, michael-miller{at}ouhsc.edu

BACKGROUND: Despite widespread use of prescription nonsteroidal antiinflammatory drugs (NSAIDs), patients are commonly unaware of their risks. Pharmacies regularly distribute written medicine information (WMI) describing the risks and benefits of NSAID therapy at the time of dispensing.

OBJECTIVE: To clarify the relationship among common sociodemographic factors, education, health literacy, reading of WMI routinely distributed at pharmacies, and NSAID risk awareness.

METHODS: Generalized linear latent and mixed models (GLLAMM) ordered logistic regression and confirmatory path analysis were used to evaluate multivariable relationships in a cross-sectional dataset of 382 patients in the second phase of the Alabama NSAID Patient Safety Study.

RESULTS: The majority of the analytical sample was female (72.0%) with 38.7% African American, 38.1% age 65 years or older, and 43.3% reporting at least some college education. Health literacy was positively associated with reading of WMI (p = 0.001) and NSAID risk awareness (p = 0.025), while age was negatively associated with reading WMI (p = 0.001) and NSAID risk awareness (p = 0.005). Medicaid/uninsured status was negatively associated with risk awareness (p = 0.013). Reading of WMI was not associated with NSAID risk awareness (p = 0.659). The final path model demonstrated excellent fit.

CONCLUSIONS: The lack of relationship between reading of WMI and NSAID risk awareness questions the current strategy of distribution of patient-targeted print education materials at pharmacies. To maximize limited resources, future research should identify more effective strategies to deliver risk information to patients and ensure its retention, especially in high-risk groups such as the elderly, the indigent, and those with inadequate health literacy.

Key Words: literacy, nonsteroidal antiinflammatory drug, risk awareness, written medicine information

Published Online, January 26, 2010. www.theannals.com, DOI 10.1345/aph.1M479