Jennifer O ’ Callaghan, PharmD
PGY1 Community Pharmacy Resident
University of Wisconsin Hospital and Clinics

Disclosure Statement
I have no conflict of interest to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation.

Learning Objectives
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Identify ways pharmacy staff and other healthcare providers can recognize patients with low health literacy.
Define the Wisconsin Pharmacy Quality
Collaborative (WPQC) program.
Describe ways the Wisconsin Pharmacy
Quality Collaborative (WPQC) is identifying patients with low health literacy and implementing services aimed at improving medication adherence.

Health Literacy
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Ability to understand:
 prescription drug bottles
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 educational brochures doctor ’ s directions consent forms
Ability to calculate medication dosages
Ability to interpret test results

Identification of Patient with Low
Health Literacy
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“ Even very literate people may have trouble obtaining, understanding, and using health information: a surgeon may have trouble using an insurance form, a science teacher may not understand information about a test of brain function, and an accountant may not know when to get a mammogram.
”

Identification of Patient with Low
Health Literacy
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Ask for medications by color or shape
Unable to explain purpose or dosing of medication
Non-compliance with medications
Lack of follow through on labs
Incomplete registration forms

Identification of Patient with Low
Health Literacy

May need more time to make health care decisions

Patients may hide their lack of understanding or may not even realize they have trouble understanding

Take 2 tablets twice daily
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Low health literacy
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71% believed they understood the directions
35% able to demonstrate properly
Marginal health literacy
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84% believed they understood the directions

63% able to demonstrate properly
Adequate health literacy
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89% believed they understood the directions
80% able to demonstrate properly

Fostering Open and Welcoming
Attitudes
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Smile and acknowledge the patient
Always introduce yourself
Speak in a slow, relaxed pace in a conversational tone
Listen and be empathetic
Encourage patients to ask questions
Ask “ Am I clear?
”

Fostering Open and Welcoming
Attitudes
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Use interpreter services if available
Use signs with pictures to tell patients where to go and what they need
Provide a waiting area
Decorate the pharmacy

Maintaining Consistency
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Use larger prints
Use 12-point Times or 11-point Arial
Include brand and generic names
Include medication purpose
Use the same generic if possible
Post questions to ask pharmacist

What is this medication for?

What are the side effects?

Incorporating Basic Healthcare
Information
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Use multiple types of learning styles

People typically only remember 50% of what they hear
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Create written materials at 8 th grade or lower (Goal for 5 th grade reading level is best)
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Average reading level: 8-9 th grade
Patient education materials in chain pharmacies
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2% of materials at 7-8 th grade
69% of materials at 9-12 th grade
29% of materials at 12 th grade or higher

Incorporating Basic Healthcare
Information

Avoid difficult medical terminology
Screening Oral
Dermatologist Diabetes
Immunization Diet
Contraception Hygeine
Hypertension Prevention
Mental Health Monitor
Annually Cardiovascular
Depression
Respiratory problems
Community
Resources
Referral
Eligible
Arthritis

Incorporating Basic Healthcare
Information

2012 United States Pharmacopeial (USP)
Convention Standards
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Use explicit directions
Avoid from necessity of numerical skills

Examples
“ Take 2 tablets twice daily ”
“ Take 1 tablet every
4 to 6 hours ”
“ Take 1 tablet at 8am ”
“ Take 2 tablets in the morning and take 2 tablets in the evening ”
“ Take 1 tablet 4 to 6 times daily ”
“ Take 1 tablet at the same time every morning ”

Incorporating Basic Healthcare
Information

Use a Pill Chart
Name: Sarah Smith Date Created: 12/15/12
Pharmacy phone number: 123-456-7890
Name Used For Instructions Morning Afternoon Evening Night
Simvastatin
20mg
Furosemide
20mg
Insulin
70/30
Cholesterol Take 1 pill at night
Fluid
High blood sugars
Take 2 pills in the morning and 2 pills in the evening
Inject 24 units before breakfast and
12 units before dinner
24 units 12 units

Incorporating Basic Healthcare
Information
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Focus on how to incorporate medications and health changes into the patient ’ s current lifestyle
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Create a medication list for patients to bring to all appointments
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Give patients a plan for their goals or other healthy lifestyle changes

Wisconsin Pharmacy Quality
Collaborative (WPQC)

WPQC is an initiative of the Pharmacy
Society of Wisconsin (PSW) that is designed to engage health plans and pharmacy providers in a collaborative effort to improve medication use in
Wisconsin
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WPQC has established a credentialing
Process and uniform set of pharmacistprovided medication therapy management services for participating
Wisconsin pharmacy providers.

Show and Tell
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Showing the patient what the medication looks like

What your pharmacist did for you today
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Updated your information
Checked your records
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Allergies
Interactions
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Safe and effective medications for your age and conditions
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Ways to save you money
Reviewed with you
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Why you are taking your medication
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How to take your medication
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How you can monitor your own therapy
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When to contact your doctor

Teach-back Method
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Teach-back is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands
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Ask the patient to explain to you what you taught them

Common Questions to Use for
Teach Back
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“ I want to be sure that I explained your medication correctly. Can you tell me how you are going to take this medicine?
”
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“ We covered a lot today about your diabetes, and I want to make sure that I explained things clearly. So let ’ s review what we discussed. What are three strategies that will help you control your diabetes?
”
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“ What are you going to do when you get home?
”

WPQC and Health Literacy
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Offers customized patient services and private medication appointments to ensure patients best understand their medications

Health Literacy Criteria
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Requires the use of a trained medical translator
Is unable to demonstrate pill count(s)
Is familiar with personal medications by color only
Is unable to read or is suspected to have very low literacy
Is suspected to have adherence problems due to low literacy
Takes medications obtained from another country

WPQC Interventions
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Focused adherence intervention
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Use lifestyle cues
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Set medications by kitchen if taken with food
Set medications by bedside table if taken at bedtime
Use pill boxes
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Use alarms
Create a schedule

WPQC Interventions
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Comprehensive medication review and assessment
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Personalized medication appointment
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Medications use, directions, and side effects teaching
Device technique review
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Adherence consult

How to refer your patients for a medication appointment
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Patients with
Medicaid, Unity,
UnitedHealth Care, and Network
Health are eligible
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Check out pswi.org for a list of all participating pharmacies

Jennifer O ’ Callaghan, PharmD
PGY1 Community Pharmacy Resident
University of Wisconsin Hospital and Clinics