Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications

Lindquist, Lee A.; Go, Lise; Fleisher, Jori; Jain, Nelia; Friesema, Elisha M.; Baker, David W.

doi:10.1007/s11606-011-1886-3

Cited by 145 publications

(144 citation statements)

References 27 publications

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“…This is consistent with the quantitative surveys, as medication dosing and side effects were among the most problematic issues. Other studies have noted the need to address complex health information at discharge ( Chugh, Williams, Grigsby, & Coleman, 2009;Coleman, Parry, Chalmers, Chugh, & Mahoney, 2007;Lindquist et al, 2012). These qualitative findings were further supported by the results of the quantitative survey, in which understanding the side effects of their medications was ranked as the most problematic issue.…”

Section: Discussionsupporting

confidence: 52%

Care Transition Experiences of Older Veterans and Their Caregivers: Table 1:

Ford¹,

Ingersoll‐Dayton²,

Burgio³

2016

Health Social Work

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This study's main objective was to examine care transition experiences of older veterans and their caregivers. Fifty patients age 65 years and older, discharged from a Veterans Affairs Medical Center hospital, completed the Care Transitions Measure-15 TM survey three to four weeks postdischarge. Seven patients and six caregivers participated in semistructured interviews. Overall, the quality of care transitions was rated as good; however, some items were indicated as problematic for veterans. Themes that emerged included agreeableness, frustration with complex information, caregiver education, and the timing and methods of information delivery. These findings have implications for all clinical staff working with veterans, and particularly for social workers facilitating care transitions for veterans and their caregivers.

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Section: Discussionsupporting

confidence: 52%

Care Transition Experiences of Older Veterans and Their Caregivers: Table 1:

Ford¹,

Ingersoll‐Dayton²,

Burgio³

2016

Health Social Work

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“…This gap may result in medication nonadherence that tends to be unintentional among adults with inadequate health literacy as compared to adults with adequate health literacy. 24 As we have previously reported, 5.4 % of all patients have an ED visit or are readmitted for medicationrelated issues, 14 so the closing of this gap may be enough to improve outcomes for this population. On the other hand, patients with adequate health literacy may have fewer barriers to safe post-discharge medication use, or their barriers may be related to attitudes and skills more than knowledge.…”

Section: Discussionmentioning

confidence: 97%

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial

et al. 2016

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BACKGROUND: Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. OBJECTIVE: The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. DESIGN: Randomized, controlled trial with concealed allocation and blinded outcome assessors SETTING: Two tertiary care academic medical centers PARTICIPANTS: Adults hospitalized with a diagnosis of ACS and/or ADHF INTERVENTION: Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge MAIN MEASURES: The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Prespecified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) are reported. KEY RESULTS: A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95 % CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95 % CI 0.51-1.15; BWH aHR = 1.44 (95 % CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95 % CI 0.17-1.00). There was no difference in treatment effect by patient cognition. CONCLUSION: A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce postdischarge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.

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“…9 Likewise, Lindquist et al also found that patients with inadequate or marginal health literacy were more likely to make unintentional medication errors. 26 These studies emphasize that in order to adequately assess a caregiver's skills to manage HF, both classic health literacy measures and practical caregiving tasks should be administered. Our findings support the need for measuring such practical caregiving tasks with an emphasis on tasks requiring numeric manipulation to determine whether a caregiver has the necessary skill set to manage chronic HF.…”

Section: Discussionmentioning

confidence: 99%