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KEY CONCEPTS
Limited health literacy is common and must be considered when providing medication management services.
Some groups of people are at higher risk for having limited literacy skills, but in general, you cannot tell by looking.
Patients with limited health literacy are more likely to misunderstand medication instructions and have difficulty demonstrating the correct dosing regimen.
Limited health literacy is associated with increased healthcare costs and worse health outcomes, including increased mortality.
Despite numerous efforts to improve safe medication practices, current strategies have been inadequate, and this may have a larger impact in patients with limited literacy.
Most printed materials are written at higher comprehension levels than most adults can read.
The United States Pharmacopeia has set new standards for prescription medication labeling to minimize patient confusion.
Several instruments exist to measure health literacy, but some experts advocate “universal precautions” under which all patients are assumed to benefit from plain language and clear communication.
Obtaining a complete medication history and providing medication counseling are vital components in the medication management of patients with limited health literacy.
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Every day, thousands of patients are not taking their medications correctly. Some take too much. Others take too little. Some use a tablespoon instead of a teaspoon. Parents pour an oral antibiotic suspension in their child’s ear instead of giving it by mouth because it was prescribed for an ear infection. Others are in the emergency department because they did not know how to use their asthma inhaler. It is not a deliberate revolt against the doctor’s orders but rather a likely and an unfortunate result of a hidden risk factor—limited health literacy.
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Literacy, at the basic level, is simply the ability to read and write. When these skills are applied to a health context, it is called health literacy, but health literacy is more than just reading and writing. Health literacy, as defined by the Institute of Medicine (IOM), is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” A growing body of evidence associates low health literacy with less understanding, worse outcomes, and increased cost. These poor outcomes have led this topic to receive national attention. Health literacy has been made “a priority area for national action” by the IOM1,2 and Healthy People 2020.3 As a result, federal policy initiatives promoting health literacy continue to be highlighted in Healthy People 2020, the Patient Protection and Affordable Care Act of 2010, and the Plain Writing Act of 2010.4 A National Action Plan to Improve Health Literacy (Table e1-1) has also been developed by the Department of Health and Human Services (HHS).5 Likewise, the Agency for Healthcare Research and Quality (AHRQ),6,7 the National Institutes of Health (NIH),8 and Centers for Disease Control and Prevention (CDC)9...