View source for Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications.

This is the first review of the article "Creating Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications".<ref name="Health literacy"> Lindquist LA, Go L, Fleisher J, Jain N, Friesema E, Baker DW. Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications. J Gen Intern Med.2012;27:173–8. doi: 10.1007/s11606-011-1886-3. http://www.ncbi.nlm.nih.gov/pubmed/21971600 </ref>
==Introduction==
In this article authors have explored the relationship between health literacy and medication compliance. Medication discrepancy is defined as the difference between the medications regimen prescribed at discharge versus the regimen taken at home. Adherence was described as decision to follow the prescribed plan of care.
Medication discrepancy has been noted in the literature and is a significant cause of adverse events after discharge. Coleman et al.<ref name="Coleman">Coleman EA, Smith JD, Raha D, Min S. Posthospital Medication Discrepancies: Prevalence and Contributing Factors. Arch Intern Med. 2005;165(16):1842-1847. doi:10.1001/archinte.165.16.1842.</ref> found that more than double of the patients who experienced medication discrepancies were readmitted as compared to the ones who did not have any medication discrepancy. In this article authors have prospectively assessed the impact of health literacy in medication discrepancies post-hospitalization using the discharge instructions from  [[EMR|Electronic Health Records (EHRs)]].

==Methods==
The patients under this study were community dwelling adults 70 years or older who resided within 60 miles radius of the research facility; these participants were competent, independent in their daily living situation and were managing their own medications. These patients with these characteristics were selected consecutively from the hospitalized patients who were discharged home from the inpatient hospital services. On the day of discharge these patients were evaluated for their health literacy and were grouped in adequate, marginal or poor health literacy. A pre-hospitalization medication history was also obtained and compiled by a researcher trained in this task. After the discharge, discharge medication list was obtained from the discharge instructions I the [[EMR|Electronic Medical Records (EMR)]]. Between 48-72 hours after the discharge, patients were contacted on the phone and were asked what medications they were taking. They were also asked open ended questions about any discrepancies between the discharge medications and the current medications.

==Results==
The mean age of the participants was slightly under 80, slightly over half were females and over half of them had some college education. Of the participants 32.3% had inadequate health literacy, 22.3% were marginal in health literacy and  56% had one or more mediation discrepancy. The most common reason was inaccurate discharge instructions (39.3%) followed by intentional non-adherence (22.4%) and unintentional non-adherence (21.9%). Multivariate analysis revealed that while unintentional non-adherence was more common in marginal and inadequate health literacy groups, intentional non-adherence was more common in patients with adequate health literacy group.


==Discussion==
Prior to this study, there was no concrete evidence of association between health literacy and medication discrepancies. However this study was able to unmask a relationship in which patient with poor health literacy are more likely to make an unintentional [[Medication errors|medication error]] and patients with adequate health literacy make a conscious decision for not adhering to the prescribed scheduled medications. Almost 40% of the medication discrepancies were due to inaccurate discharge instructions. This is a significant percentage and is an area for improvement.

==My comments==
Since primary care providers may not be affiliated with the hospitals in their practice areas at the time of patient hospitalization and discharge, there is a potential of developing medication discrepancies. Electronic Health Records--by allowing the flow of information between the inpatient and out-patient providers--may reduce medication discrepancies at discharge. In another article [[Communicating discharge instructions to patients: a survey of nurse, intern, and hospitalist practices]] a coordinated method to improve communication of discharge instructions to the patients. This coordinated effort may also result in better adherence to discharge instructions. In another article [[Better transitions: improving comprehension of discharge instructions]] authors outline an approach for patients with low health literacy and poor cognition. 

== Related Articles ==

[[Effect of Standardized Electronic Discharge Instructions on Post-Discharge Hospital Utilization]]

[[Communicating discharge instructions to patients: a survey of nurse, intern, and hospitalist practices]]

[[Medication errors]]

== References ==
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[[ Category:Reviews]]
[[Category:HI5313-2015-FALL]]
[[ Category:EHR ]]
[[Category: Electronic discharge]]
[[Category: Medication Error]]