Medication Literacy: A Pharmacy Based Intervention

Background: Prescription medication errors are costly in terms of human life, suffering and dollars.  Our project is designed to improve medication literacy (ML) and reduce medication errors in patients with low literacy or limited English proficiency using a public health system pharmacy. 

Program background: Philadelphia Department of Public Health (PDPH) healthcare centers dispense prescription drugs with brief instructions written at a 9^th grade or higher reading level. Many patients cannot read at this level due to disparities in basic education, or because their primary language is not English. We are testing the feasibility and effectiveness of the Meducation® computer application which provides prescription-specific information in simplified English and 16 foreign languages. We are conducting a controlled, randomized effectiveness trial that received IRB approval (Philadelphia PDPH and U Sciences) in June 2013. Here we report on the first site which we have used as a pilot to develop and test our procedures. 

Evaluation Methods and Results: We enrolled 109 patients in our pilot site. Of these, 85 had sufficient data for analysis. Forty- three were randomly assigned to standard care (Group=S), in which they received only standard instructions generated by the pharmacy, and 42 were in the intervention group in which they received both the standard instructions and the Meducation® instructions (Group=M). The two groups were non-distinguishable in terms of sex, language preference, education level, format of the drug (e.g. pills, inhalers), or total number of medications taken daily. We assessed baseline ML by asking patients to review a dummy pill bottle and standard drug leaflet and asking a series of questions. Patients who could not read English at all, or identify the information with the help of an interpreter translating the question only, scored a 0 on this section. Patients who answered all questions correctly scored a 5. The median score in both groups was 4. On follow-up, 79.07% of patients in M group knew what time of day to take their medications compared to 54.76% in S group, p=0.0171.  Patients in M group were also less likely to miss a dose of their medication (21.62%) compared to S group (44.74%), p=0.0337. M group patients who reported using their leaflets had higher ML scores (4; 4-5) than S group patients who reported using their information (3; 3-4), p=0.1270. 

Conclusions: We are encouraged by these preliminary findings and are continuing the study in 3 additional PDPH healthcare centers. We also made slight changes in the protocol to strengthen the logic model linking the intervention to the outcomes. We have found we need to modify the recruitment materials for the study in each center to be consistent with that center’s “micro culture.” 

Implications for research and/or practice: If the procedures tested in our research are effective at assessing language needs and then improving patient comprehension of prescription medication, it can make public health pharmacy safer. With inclusion in the EHR, it can be efficient. We also focus on medication literacy as an important component of health literacy.