How targeted education can reduce health literacy hurdles, improve adherence

One of the few certainties about COVID-19 is that patients with diabetes, heart disease, obesity, hypertension and other chronic conditions are at the highest risk for coronavirus complications.

Keeping these patients as healthy as possible through adherence to their drug therapy may not prevent them from contracting COVID-19, but it may lead to a better prognosis — and it’s recommended by leading medical associations and the Centers for Disease Control and Prevention. 

Community pharmacist-led interventions can improve patient adherence to medications and have been demonstrated to help in managing blood pressure, hyperlipidemia, chronic obstructive pulmonary disease and asthma.

Multiple causes of nonadherence
Apart from protection from COVID-19 exacerbation, adherence to treatment plans — including medication therapy — can improve outcomes. The CDC reports, however, that the majority of patients with cardiovascular and other chronic conditions take less medication than prescribed or stop the medication altogether after only six months. For hypertension, this nonadherence costs the Centers for Medicare and Medicaid Services at least $13.7 billion annually, and contributes to 100,000 emergency department visits and 7 million inpatient hospital days. 

Nonadherence is multifactorial and may be due to a patient’s reluctance to take medication or forgetting to take it. In addition, low health literacy can be a major obstacle. Low health literacy is associated with patients forgetting to take their medications and being more likely to take less medication than instructed compared with patients who have fewer health literacy challenges. 

Visual elements aid in learning
Information technology can play an important role in helping pharmacists educate patients about their medications in order to close knowledge gaps and increase adherence. For example, community pharmacists can integrate patient education tools into pharmacy management systems and dispensing workflows to deliver personalized medication information and education. Patients with low health literacy, visual challenges or language barriers also can be identified in the system so that pharmacists are alerted when opportunities for
education arise.

The way the patient education is delivered matters. Patient education aimed at medication adherence should include simplified, patient-specific medication instructions written at a 5th- to 8th-grade reading level, with large font sizes to ensure readability for the elderly and visually impaired. 

Education can be enhanced by visual elements as well. For example, simplified graphical calendars of all of a patient’s medications and dosing pictograms can be powerful adherence-building tools and can help prevent dosing errors. Instructional videos can also be provided for the patient to review at home for drugs that require some skill to administer, such as inhalers and injectable medications.

Multilingual instructions are crucial
Instructions should also be available in many languages to support the large, limited English-proficient population in the United States, which is at high risk for medication errors. I understand these challenges firsthand. As an immigrant from Korea to the United States at age 7, I witnessed family members struggle with health literacy and language barriers, which inspired me to dedicate my career to effective patient education focused on health literacy and language.

Education about patients’ medications is one of the most important and personal roles pharmacists can perform, especially for those patients who tend to need greater assistance but might hesitate to ask for it. By leading the medication adherence charge through enhanced education and overcoming patients’ health literacy obstacles, community pharmacists in the age of COVID-19 can play an even more important disease prevention and management role.