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PAs, health literacy, and medication safety

Carolyn Clancy, MD

Carolyn Clancy is the Director of the Agency for Healthcare Research and Quality, Rockville, Maryland.

This month, the health care profession observes two important occasions—National Physician Assistants (PA) Week and Health Literacy Month.

As frontline health care providers, PAs know better than most how important it is for patients to understand and act on health information. But a recent report from my agency, the Agency for Healthcare Research and Quality (AHRQ), found that only 12% of 228 million American adults have proficient health literacy skills (www.ahrq.gov/news/nn/nn051408.htm). Put another way, this means the vast majority of adults have some difficulty understanding instructions about how to take medicines correctly or weighing the risks and benefits of different medical treatments.

While low health literacy is widespread, patients who are of limited financial means, who are older, or who have limited education or English proficiency are especially vulnerable.

Low literacy puts patients at higher risk As AHRQ learns more about practices that promote patient safety, we’ve also discovered that patients with low health literacy are at a greater risk of medical errors, especially those involving medications. Errors can happen when patients don’t understand how to take their medicine correctly, are unaware of side effects when certain medicines are taken together, or don’t realize they are taking the wrong drug.

Medication errors are a common, serious, and costly problem. According to a 2006 report from the Institute of Medicine (IOM), medication errors are the most common type of medical mistake, harming at least 1.5 million people a year.¹ The additional costs of treating drug-related injuries that occur in hospitals amount to at least $3.5 billion a year.

In outpatient settings, medication-related injuries resulted in $887 million in extra costs in 2000, the IOM report found. This figure is undoubtedly understated because it factored in only injuries that occurred in the Medicare population.

Tools to help PAs bridge the literacy gap As trusted health providers with prescribing authority, PAs are ideally suited to identifying and helping to bridge the health literacy gap. However, this requires additional resources and may necessitate buy-in from hospital, pharmacy, or clinical staff. To promote more patient-friendly communication in hospital pharmacy departments, AHRQ developed the Pharmacy Health Literacy Assessment Tool (www.ahrq.gov/qual/pharmlit). Using surveys and focus groups, the tool captures the perspectives of patients, pharmacy staff, and objective auditors. The information acquired helps pharmacies to quantify the extent to which they are meeting the needs of patients with limited literacy and to identify areas for improvement. This tool was designed for outpatient pharmacies of large, urban hospitals. But it can be adapted for use in other settings.

AHRQ also has developed a simple checklist to remind patients about how to use medications safely. Check Your Medicines offers five tips to help patients ask questions and avoid potential medication mistakes (www.ahrq.gov/consumer/checkmeds.htm). In clear and simple language, the checklist also advises patients to

• Ask questions about their medicines. The checklist encourages patients to choose a pharmacist and doctor they feel comfortable talking to and to bring along a friend or relative to ask questions and help remind them of answers later.

• Make sure the medicine they get is what the doctor ordered. If something seems wrong, or if the patient isn’t sure, the checklist encourages them to ask the pharmacist to double-check the prescription, noting that most errors are first discovered by patients.

• Ask how to use the medicine correctly. The checklist prompts the patient to ask questions, such as whether there are other medicines, foods, or activities that should be avoided while using the medicine.

• Ask about possible side effects. The checklist informs patients that they should know that side effects are typical with many medicines but instructs them to call their doctor right away if a side effect is serious or if it does not go away.

A third tool from AHRQ is a booklet called Your Guide to Coumadin^®/Warfarin Therapy. It explains to patients what to expect and what to watch for during therapy. Developed under a grant to a group of clinicians at the Community Anticoagulation Clinic in Cedar Rapids, Iowa, the booklet describes what the drug is and how to take it, outlines possible side effects, and emphasizes the need to talk to health care professionals about other medicines the patient may be taking. Because the prescription and generic forms of the drug look different, the booklet also includes pictures of both.

Addressing patients’ health literacy skills is an enormous undertaking that cannot be handled by PAs alone. Working with physicians, nurses, pharmacists, and other health professionals, PAs can play a leading role in meeting the needs of our patients who have limited health literacy and in reducing the risk of medication errors. JAAPA

REFERENCE

1. Institute of Medicine of the National Academies. Preventing Medication Errors: Quality Chasm Series. July 2006.