Poster Presentations (Group II)

Studies show that patients are less likely to understand medication instructions when they have limited health literacy, and/or when they do not speak English well.  However, little is known about the complex interplay between basic literacy, English comprehension, health literacy, and understanding medication instructions.

A series of projects designed and evaluated by the Center for Urban Health, and implemented at the Hennepin County Medical Center (HCMC) outpatient pharmacy, addressed these issues.  The projects:  1) Assessed patient levels of health literacy in both English and Spanish; 2) Determined associations between health literacy and comprehension of medication instructions; 3) Assessed uptake of the teach-back method among pharmacists; and 4) Determined associations between patients’ receipt of teach-back and comprehension of medication instructions.

The HCMC pharmacy serves a large number of Spanish-speaking natives, many newly arrived from rural areas of Mexico and South America.  Little is known about their health literacy in either Spanish or English.  In the summer of 2006, native Spanish-speaking health professional research assistants approached patients waiting to receive medications at the pharmacy, and using the STOFHLA-S (Short Test of Functional Health Literacy in Adults - Spanish), determined their levels of health literacy.  After patients had received their prescriptions, the research assistants assessed their comprehension of instructions for use.

In November 2007, a certified health education specialist trained the pharmacists on the teach-back method.  This method is an interactive communication loop that in observational studies, has shown promise for improving patient understanding.   Spanish-speaking pharmacists, or English-speaking pharmacists using interpreters, were trained to provide dosing instructions at the time they dispensed medications to patients.  The pharmacist then asks the patient to repeat the instructions. If the patient answers incorrectly, the pharmacist either repeats the information or offers additional clarification, and again asks the patient to describe how to take their medication. The cycle is repeated until the patient demonstrates full understanding.

To assess pharmacist use of the teach-back method, we interviewed three hundred (300) Spanish-speaking pharmacy patients after they had received their medications.  Patients were selected using a convenience sampling method during a three month period; over 90% of patients approached agreed to be interviewed.  Based on process evaluation of the program, 21% of participants obtaining a new prescription medication received a teach-back educational session from the pharmacist. The average duration of teach-back sessions was less than 5 minutes.

Barriers towards delivering teach-back included:  1) Pharmacists perceive that teach-back will impose an additional time burden in the midst of other work demands; 2) In the hospital outpatient pharmacy setting, there is limited physical space available for private and more extensive patient education.  When teach-back sessions took place, pharmacist and patients readily communicated, and patients willingly participated.  Quantitative analysis of associations between receipt of teach-back and comprehension of medication instructions is underway.

The presentation will include data on associations between health literacy and medication usage comprehension in these patients, associations between receipt of teach-back and comprehension of instructions, and issues that must be confronted in order to implement teach-back in pharmacies.