Two complementary personal medication management applications developed on a common platform: case report

Background

Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs.

Objective

Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet).

Methods

The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC.

Results

We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children.

Conclusions

These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.     

Help needed in medication self-management for people with visual impairment: case–control study

Background

Visual impairment (VI) is rising in prevalence and contributing to increasing morbidity, particularly among older people. Understanding patients’ problems is fundamental to achieving optimal health outcomes but little is known about how VI impacts on self-management of medication.

Aim

To compare issues relating to medication self-management between older people with and without VI.

Design and setting

Case–control study with participants aged ≥65 years, prescribed at least two long-term oral medications daily, living within the community.

Method

The study recruited 156 patients with VI (best corrected visual acuity [BCVA] 6/18 to 3/60) at low-vision clinics; community optometrists identified 158 controls (BCVA 6/9 or better). Researchers visited participants in their homes, administered two validated questionnaires to assess medication adherence (Morisky; Medication Adherence Report Scale [MARS]), and asked questions about medication self-management, beliefs, and support.

Results

Approximately half of the participants in both groups reported perfect adherence on both questionnaires (52.5% Morisky; 43.3%, MARS). Despite using optical aids, few (3%) with VI could read medication information clearly; 24% had difficulty distinguishing different tablets. More people with VI (29%) than controls (13%) (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.6 to 5.0) needed help managing their medication, from friends (19% versus 10%) or pharmacists (10% versus 2.5%; OR = 4.4, 95% CI = 1.4 to 13.5); more received social service support (OR = 7.1; 95% CI = 3.9 to 12.9).

Conclusion

Compared to their peers without VI, older people with VI are more than twice as likely to need help in managing medication. In clinical practice in primary care, patients’ needs for practical support in taking prescribed treatment must be recognised. Strategies for effective medication self-management should be explored.     

eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature

Background

eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources.

Objective

This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults.

Methods

A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles.

Results

Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design.

Conclusions

Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population.     

Barriers to use of antiretroviral drugs in Rakai district of Uganda

Background

About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries.

Objective

To investigate the barriers to use of ART in Rakai district of Uganda

Methods

We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART.

Results

The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs.

Conclusions

Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music, dance and videos, increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care, bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS.     

Patients' experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study

Background

Self-management of hypertension, comprising self-monitoring of blood pressure with self-titration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it.

Aim

To explore patients’ views of self-monitoring blood pressure and self-titration of antihypertensive medication.

Design and setting

Qualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient self-management of hypertension from 24 general practices in the West Midlands.

Method

Taped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method.

Results

Patients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study finished and report home readings to their GP, but few wished to continue with a self-management plan.

Conclusion

Participants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.     

Age-Sensitive Design of Online Health Information: Comparative Usability Study

Background

Older adults’ health maintenance may be enhanced by having access to online health information. However, usability issues may prevent older adults from easily accessing such information. Prior research has shown that aging is associated with a unique pattern of cognitive changes, and knowledge of these changes may be used in the design of health websites for older adults.

Objective

The goal of the current study was to examine whether older adults use of a health information website was affected by an alternative information architecture and access interface (hierarchical versus tag-based).

Methods

Fifty younger adults (aged 18-23) and 50 older adults (aged 60-80) navigated a health information website, which was organized hierarchically or used tags/keywords, to find answers to health-related questions while their performance was tracked. We hypothesized that older adults would perform better in the tag-based health information website because it placed greater demands on abilities that remain intact with aging (verbal ability and vocabulary).

Results

The pattern of age-related differences in computer use was consistent with prior research with older adults. We found that older adults had been using computers for less time (F _1,98= 10.6, P= .002) and used them less often (F _1,98= 11.3, P= .001) than younger adults. Also consistent with the cognitive aging literature, younger adults had greater spatial visualization and orientation abilities (F _1,98= 34.6, P< .001 and F _1,98= 6.8, P= .01) and a larger memory span (F _1,98= 5.7, P= .02) than older adults, but older adults had greater vocabulary (F _1,98= 11.4, P= .001). Older adults also took significantly more medications than younger adults (F _1,98= 57.7, P< .001). In the information search task, older adults performed worse than younger adults (F _1,96= 18.0, P< .001). However, there was a significant age × condition interaction indicating that while younger adults outperformed older adults in the hierarchical condition (F _1,96= 25.2, P< .001), there were no significant age-related differences in the tag-based condition, indicating that older adults performed as well as younger adults in this condition.

Conclusions

Access to online health information is increasing in popularity and can lead to a more informed health consumer. However, usability barriers may differentially affect older adults. The results of the current study suggest that the design of health information websites that take into account age-related changes in cognition can enhance older adults’ access to such information.     

Prevalence of poor self-rated health and associated risk factors among older adults in Cali,Colombia

Introduction:

Self-rated health (SRH) has beeen considered an important marker of quality of life and an independent predictor of mortality in older adults.

Objective:

To determine the prevalence of poor SRH and identify risk factors associated with poor SRH among older adults residing in the Commune 18 of the city of Cali, Colombia, in 2009.

Methods:

A population-based cross-sectional study with a single-stage cluster sampling design. Sample included 314 persons aged 60 and older. The dependent variable, SRH was dichotomized into good (excellent, very good, good) and poor (fair, poor). Independent variables were sociodemographic, biological, mental, functional and geriatric syndromes. Logistic regression was used for multivariate statistical modeling.

Results:

Overall, 40.1% reported poor SRH (women 42.9%, men 35.0%). Factors independently associated with poor SRH were diabetes mellitus, depression, fear of falling and frailty syndrome (frail and pre-frail vs. non-frail). Widowed men reported poorer health than married men while other marital status (single/separated/divorced) was associated with better self-rated health in women.

Conclusion:

Potential modifiable factors such as depression and frailty syndrome are important determinants for poor SRH in Colombian older adults.

     

Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers

Background

A number of studies have examined the effects of home visits and showed inconsistent results on physical functioning, institutionalisation, and mortality. Despite continuing interest from professionals in home visits for older people, reports on older people’s needs and preferences for such visits are scarce.

Aim

This qualitative study aims to explore the views and needs of community-dwelling frail older people concerning home visits.

Design and setting

A qualitative study including interviews with frail older persons and their informal caregivers living in the area of Nijmegen, the Netherlands.

Method

Semi-structured interviews were conducted with frail older people and informal caregivers. A grounded theory approach was used for data-analysis.

Results

Eleven frail older people and 11 informal caregivers were included. Most participants emphasised the importance of home visits for frail older people. They felt that it would give older people the personal attention they used to receive from GPs but miss nowadays. Most stated that this would give them more trust in GPs. Participants stated that trust is one of the most important factors in a good patient–professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient–professional relationship would enable the professional to provide better and more patient-centred care.

Conclusion

Patients’ expectations of home visits are quite different from the actual purpose of home visiting programmes; that is, care and wellbeing versus cure and prevention. This difference may partly explain why the effectiveness of home visits remains controversial. Future studies on home visits should involve patients in the development of home visiting programmes.     

The Effect of Modality and Narration Style on Recall of Online Health Information: Results From a Web-Based Experiment

Background

Older adults are increasingly using the Internet for health information; however, they are often not able to correctly recall Web-based information (eHealth information). Recall of information is crucial for optimal health outcomes, such as adequate disease management and adherence to medical regimes. Combining effective message strategies may help to improve recall of eHealth information among older adults. Presenting information in an audiovisual format using conversational narration style is expected to optimize recall of information compared to other combinations of modality and narration style.

Objective

The aim of this paper is to investigate the effect of modality and narration style on recall of health information, and whether there are differences between younger and older adults.

Methods

We conducted a Web-based experiment using a 2 (modality: written vs audiovisual information) by 2 (narration style: formal vs conversational style) between-subjects design (N=440). Age was assessed in the questionnaire and included as a factor: younger (<65 years) versus older (≥65 years) age. Participants were randomly assigned to one of four experimental webpages where information about lung cancer treatment was presented. A Web-based questionnaire assessed recall of eHealth information.

Results

Audiovisual modality (vs written modality) was found to increase recall of information in both younger and older adults (P=.04). Although conversational narration style (vs formal narration style) did not increase recall of information (P=.17), a synergistic effect between modality and narration style was revealed: combining audiovisual information with conversational style outperformed combining written information with formal style (P=.01), as well as written information with conversational style (P=.045). This finding suggests that conversational style especially increases recall of information when presented audiovisually. This combination of modality and narration style improved recall of information among both younger and older adults.

Conclusions

We conclude that combining audiovisual information with conversational style is the best way to present eHealth information to younger and older adults. Even though older adults did not proportionally recall more when audiovisual information was combined with conversational style than younger adults, this study reveals interesting implications for improving eHealth information that is effective for both younger and older adults.     

The Quality and Outcomes Framework and self-management dialogue in primary care consultations: a qualitative study

Background

Two key elements to improve the quality of care for people with long-term conditions in primary care are improved clinical information systems to support delivery of evidence-based care, and enhanced self-management support. Although both elements are viewed as necessary, their interaction is not well understood.

Aim

To explore the use of computer-based ‘disease management’ templates and their relevance to self-management dialogue within clinical encounters.

Design and setting

Qualitative study of general practices located in three primary care trusts in the north of England.

Method

A qualitative mixed methods study was conducted that included comparative analysis of (1) observations of general practice consultations (n = 86); and (2) interviews with health professionals in general practice (n = 17).

Results

The analysis suggested that use of the computer templates reinforced a checklist approach to consultations, which included professionals working through several self-management topics framed as discrete behaviours. As a consequence, conversation tended to become focused on the maintenance of the professional-patient relationship at the expense of expansion in self-management dialogue. The computer templates also shaped how patient-initiated self-management dialogue was managed when it arose, with a shift towards discussion around medical agendas.

Conclusion

In order to enhance the management of long-term conditions in primary care, the design and implementation of clinical information systems to improve evidence-based care need to take into account their potential impact on supporting self-management.     

Effects of Diabetic Case Management on Knowledge,Self-Management Abilities,Health Behaviors,and Health Service Utilization for Diabetes in Korea

Purpose

This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design.

Materials and Methods

The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007.

Results

The case management program significantly improved the study population''s knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population''s health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention.

Conclusion

This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.     

Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study

Background

Patient portals have the potential to support self-management for chronic diseases and improve health outcomes. With the rapid rise in adoption of patient portals spurred by meaningful use incentives among safety net health systems (a health system or hospital providing a significant level of care to low-income, uninsured, and vulnerable populations), it is important to understand the readiness and willingness of patients and caregivers in safety net settings to access their personal health records online.

Objective

To explore patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital, a safety net hospital.

Methods

We conducted 16 in-depth interviews with chronic disease patients and caregivers who expressed interest in using the Internet to manage their health. Discussions focused on health care experiences, technology use, and interest in using an online portal to manage health tasks. We used open coding to categorize all the barriers and facilitators to portal use, followed by a second round of coding that compared the categories to previously published findings. In secondary analyses, we also examined specific barriers among 2 subgroups: those with limited health literacy and caregivers.

Results

We interviewed 11 patients and 5 caregivers. Patients were predominantly male (82%, 9/11) and African American (45%, 5/11). All patients had been diagnosed with diabetes and the majority had limited health literacy (73%, 8/11). The majority of caregivers were female (80%, 4/5), African American (60%, 3/5), caregivers of individuals with diabetes (60%, 3/5), and had adequate health literacy (60%, 3/5). A total of 88% (14/16) of participants reported interest in using the portal after viewing a prototype. Major perceived barriers included security concerns, lack of technical skills/interest, and preference for in-person communication. Facilitators to portal use included convenience, health monitoring, and improvements in patient-provider communication. Participants with limited health literacy discussed more fundamental barriers to portal use, including challenges with reading and typing, personal experience with online security breaches/viruses, and distrust of potential security measures. Caregivers expressed high interest in portal use to support their roles in interpreting health information, advocating for quality care, and managing health behaviors and medical care.

Conclusions

Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Our findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy. Efforts to encourage portal use among vulnerable patients should directly address health literacy and security/privacy issues and support access for caregivers.     

Medication use in European primary care patients with lower respiratory tract infection: an observational study

Background

It is largely unknown what medication is used by patients with lower respiratory tract infection (LRTI).

Aim

To describe the use of self-medication and prescribed medication in adults presenting with LRTI in different European countries, and to relate self-medication to patient characteristics.

Design and setting

An observational study in 16 primary care networks in 12 European countries.

Method

A total of 2530 adult patients presenting with LRTI in 12 European countries filled in a diary on any medication used before and after a primary care consultation. Patient characteristics related to self-medication were determined by univariable and multivariable logistic regression analysis.

Results

The frequency and types of medication used differed greatly between European countries. Overall, 55.4% self-medicated before consultation, and 21.5% after consultation, most frequently with paracetamol, antitussives, and mucolytics. Females, non-smokers, and patients with more severe symptoms used more self-medication. Patients who were not prescribed medication during the consultation self-medicated more often afterwards. Self-medication with antibiotics was relatively rare.

Conclusion

A considerable amount of medication, often with no proven efficacy, was used by adults presenting with LRTI in primary care. There were large differences between European countries. These findings should help develop patient information resources, international guidelines, and international legislation concerning the availability of over-the-counter medication, and can also support interventions against unwarranted variations in care. In addition, further research on the effects of symptomatic medication is needed.     

Use of Behavioral Change Techniques in Web-Based Self-Management Programs for Type 2 Diabetes Patients: Systematic Review

Background

Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes.

Objective

We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes.

Methods

Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes.

Results

We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters.

Conclusions

A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management interventions should be based on the use of theories and BCTs and should be reported accurately.     

Internet Use Frequency and Patient-Centered Care: Measuring Patient Preferences for Participation Using the Health Information Wants Questionnaire

Background

The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured.

Objective

To explore (1) whether there is a significant relationship between Internet use frequency and patients’ overall preferences for obtaining health information and decision-making autonomy, and (2) whether the relationships between Internet use frequency and information and decision-making preferences differ with respect to different aspects of health conditions.

Methods

The Health Information Wants Questionnaire (HIWQ) was administered to gather data about patients’ preferences for the (1) amount of information desired about different aspects of a health condition, and (2) level of decision-making autonomy desired across those same aspects.

Results

The study sample included 438 individuals: 226 undergraduates (mean age 20; SD 2.15) and 212 community-dwelling older adults (mean age 72; SD 9.00). A significant difference was found between the younger and older age groups’ Internet use frequencies, with the younger age group having significantly more frequent Internet use than the older age group (younger age group mean 5.98, SD 0.33; older age group mean 3.50, SD 2.00; t ₄₃₆=17.42, P<.01). Internet use frequency was positively related to the overall preference rating (γ=.15, P<.05), suggesting that frequent Internet users preferred significantly more information and decision making than infrequent Internet users. The relationships between Internet use frequency and different types of preferences varied: compared with infrequent Internet users, frequent Internet users preferred more information but less decision making for diagnosis (γ=.57, P<.01); more information and more decision-making autonomy for laboratory test (γ=.15, P<.05), complementary and alternative medicine (γ=.32, P<.01), and self-care (γ=.15, P<.05); and less information but more decision-making autonomy for the psychosocial (γ=-.51, P<.01) and health care provider (γ=-.27, P<.05) aspects. No significant difference was found between frequent and infrequent Internet users in their preferences for treatment information and decision making.

Conclusions

Internet use frequency has a positive relationship with the overall preferences for obtaining health information and decision-making autonomy, but its relationship with different types of preferences varies. These findings have important implications for medical practice.     

Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

Background

The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers.

Objective

The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients.

Methods

A cross-sectional survey was administered to 444 patients of a federally qualified community health center.

Results

Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores.

Conclusions

Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers.     

Medication compliance aids: a qualitative study of users' views

Background

Despite the rapid rise in the use of multicompartmental compliance aids (MCAs), little is known about the role they play in self-management of medication.

Aim

To explore the perceived benefits of MCAs for people using them to manage their own or a relative''s medication.

Design of study

Qualitative study using in-depth interviews.

Setting

West Northumberland.

Method

Recruitment was via posters and leaflets in general practices and community pharmacies. In-depth interviews were conducted using a topic guide.

Results

Nineteen people were interviewed. Three overarching themes emerged in relation to medicine taking: disruption, organisation, and adherence, which impacted on control. The medication regime had caused disruption to their lives and this had led to the purchase of an MCA. The MCA enabled them to organise their medication, which they believed had improved the efficiency of medicine taking and saved time. Although the MCA did not prompt them to take their medication, they could see whether they had actually taken it or not, which alleviated their anxiety. To meet their individual needs and lifestyles, some had developed broader systems of medication management, incorporating the MCA. For a small cost – the initial outlay for the MCA and time spent loading it – they gained control over the management of their medication and their condition.

Conclusion

This group found the use of an MCA to be beneficial, but advice and support regarding how best to manage their medication and on the most appropriate design to suit their needs would be helpful.     

Exploring caregiver understanding of medications immediately after a pediatric primary care visit

Objective

Assess accuracy of caregiver understanding of children's prescribed medications and examine factors associated with accurate recall.

Methods

Cross-sectional, observational study of English- or Spanish-speaking caregivers of primary care patients aged 0–7 years. Child and visit characteristics and caregiver health literacy (Short Test of Health Literacy in Adults) were assessed. Post-visit, caregivers completed questionnaires on medications prescribed. Caregiver and medical record agreement on medication name and administration (dose and frequency) were examined using chi square and logistic regression.

Results

Analyses included 68 caregivers (28% low health literacy); 96% of children had public insurance. Caregivers indicated that the doctor provided clear medication information (100%) and they could follow instructions (98%). 101 medicines were prescribed; 6 were recalled by caregiver only. 71% of medications were accurately named; 37% of administration instructions were accurately recalled. Accurate naming was more often found for patients 3–7 years, without conditions requiring repeat visits, and new medications. Accurate administration responses were associated with having only 1 child at the visit.

Conclusion

Unperceived medication instruction understanding gaps exist at physician visits for caregivers of all literacy levels. Communication and care delivery practices need further evaluation.

Practice implications

Clinicians should be aware of the frequency of caregiver medication misunderstanding.