Can an illustrated pill card or refill-reminder postcard help improve medication adherence for low-literacy patients with coronary heart disease? An Emory University School of Medicine study may be the key to determining the answer.
According to the American Heart Association, coronary heart disease is the single leading cause of death in the United States. Patients with coronary heart disease often have high blood pressure, high cholesterol, or diabetes, making it more likely for them to suffer a heart attack. Although taking medications to control hypertension, diabetes and cholesterol can help prevent a heart attack, only 50 percent to 60 percent of patients take their medicines as directed. Those who don't take their medications regularly are considered to be noncompliant.
Yet thanks to a $260,000 grant from the American Heart Association, Sunil Kripalani, MD, MSc, assistant professor of medicine within Emory University School of Medicine's Division of General Medicine at Grady Memorial Hospital, hopes to impact those statistics by improving medication adherence among patients with coronary heart disease. The four-year AHA grant provides funding for a randomized, controlled trial focused on CHD patients at Grady Hospital, where a large percentage of patients have limited literacy skills. The aim of the study is two-fold: to learn more about the relationship between low health literacy and medication compliance, and to test two different strategies designed to help patients take their medicines more regularly. The trial is being conducted in the medical clinics at Grady Hospital.
Health literacy is defined as the ability to obtain, understand, and act on basic health information.
"There is some evidence that patients with low health literacy have difficulty understanding the instructions for how to take their medications correctly, and they also have difficulty obtaining refills on time," says Dr. Kripalani, principal investigator of the study. "Both of these factors can lead to lower medication adherence."
Two interventions are being used in the study to improve medication adherence. The first tool is a personalized, graphically-illustrated medication schedule that shows each patient pictures of the pills that he or she is taking. Symbols for morning, afternoon, and evening are given to make it easier for patients to remember when to take their medicine. Simple pictures like a blood pressure cuff and bacon and eggs, for example, show that certain medicines are used for hypertension and cholesterol, respectively. After receiving the card and instructions for using it, patients reiterate their understanding to pharmacists to make sure they understand their medications and the side effects.
A second group of patients receive a refill-reminder postcard before their medication runs out; a third group receives both interventions; and a fourth group receives regular care, which includes regular medication instructions printed on medicine bottles and no refill reminders. The goal is to determine how well each intervention works in isolation and in combination.
"What we're trying to do with the reminder postcard is help patients with the advance planning required to get their medications before they actually run out," Dr. Kripalani explains. "The graphically illustrated pill card provides patients an understandable schedule of how to take their medicines, which we hope will boost their understanding and confidence, making it more likely for them to take their medicines on time."