Identifying and assisting low-literacy patients with medication use: a survey of community pharmacies

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.     

THE USE OF 'CONTROLLED DRUGS' IN GENERAL PRACTICE

A survey on the use of ‘Controlled Drugs’ (CD) was carried out, for the first time, in three socio-economic areas in Liverpool. These areas included the city centre, an affluent area and a poorer area. The purpose of this survey was to find out if there were any differences and trends in the use of CD in general practice and to suggest possible explanations for these findings. The average number of dose units of CD dispensed per pharmacy per year was determined by collecting and analysing the records in the CD registers which are kept in randomly selected pharmacies in each area. Over the 6-year period (1971-76) pharmacies in the city centre dispensed two to three times more narcotic analgesics (57,410 doses per pharmacy) than those in the poorer area (22,429 doses per pharmacy) and the affluent area (19,372 doses per pharmacy); Methadone (26,586 doses per pharmacy), diamorphine (5,504 doses per pharmacy) and pethidine (4,754 doses per pharmacy) were the most popular drugs used respectively in these areas. From 1973 to 1976 inclusive, the amounts of central nervous system (CNS) stimulant and hypnotic CD dispensed in pharmacies in the city centre, the affluent area and the poorer area were 28,836, 12,983 and 9,076 doses per pharmacy respectively. In the city centre amphetamine, was dispensed most, followed by methaqualone, phenmetrazine and methylphenidate. However, the rank order for both the affluent and poorer areas was methaqualone, amphetamine, phenmetrazine and methylphenidate. Cocaine, a CNS stimulant, was not dispensed as such because it was used as an ingredient in preparations containing diamorphine or morphine for relieving severe pain. Factors such as drug regulations, prescribing habit of doctors, presence of treatment centres for addicts, socio-economic influence were considered to affect the legal use of CD in the City of Liverpool. The present study may also give, indirectly, valuable information to identify the type of addictive drugs involved in poisoning and suicidal cases. More surveys of this type in big cities should be encouraged.