Effect of a Pharmacy‐Based Health Literacy Intervention on Medication Refill Adherence in an Inner‐City Health System

Background:

Low health literacy is associated with poor understanding of medication instructions and, in some studies, with lower medication adherence, We developed and evaluated a 3‐part system intervention intended to increase refill adherence through attention to health literacy. The intervention consisted of automated telephone reminder calls to refill prescriptions, a pictorial medication instruction card (“picture prescription”), and clear health communication training for pharmacists.

Methods:

Within a health system that serves a primarily indigent, minority population, 3 pharmacies were selected as intervention sites, and 1 pharmacy served as the control site. Pharmacy refill data were used to calculate the cumulative medication gap (CMG), a valid measure of refill adherence that ranges from 0 to 1; values close to 0 indicate better adherence. The primary measure of treatment effect was a comparison of the change in refill adherence in the intervention and control groups from baseline (6 months prior to intervention) to follow‐up (6‐month intervention period).

Results:

A total of 275 patients were enrolled, 173 patients in the intervention group and 102 patients in the control group. Medication adherence was significantly different between the intervention (CMG = 0.25) and control (CMG = 0.18) groups at baseline (P = 0.004). Refill adherence in the intervention group improved slightly during follow‐up (CMG = 0.23), whereas it worsened slightly in the control group (CMG=0.21), but the change in adherence between intervention and control groups was not significantly different (P = 0.4). In subgroup analyses, no patient characteristics were consistently associated with adherence or with the effect of the intervention. Patients who received the intervention provided very favorable feedback about its components. For example, approximately 80% of intervention patients felt that the use of the picture prescription improved counseling from the pharmacy “a lot,” and 70%–80% noted that the picture prescription and refill reminder calls improved their overall satisfaction with the pharmacy “a lot.”

Conclusions:

Implementation of a 3‐part system intervention to address health literacy resulted in very positive patient feedback but did not significantly improve refill adherence among inner‐city patients. Future research should explore whether other medication‐related outcomes, such as understanding of the regimen, medication discrepancies, or adverse drug events, can be improved through interventions that address health literacy.

Author Disclosure:

S. Kripalani, PictureRx, Consultant, equity interest; J. Gazmararian, none; K. Jacobson, none; Y. Pan, none; B. Schmotzer, none.