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      Development and evaluation of a medication counseling workshop for physicians: can we improve on ‘take two pills and call me in the morning’?

      research-article
      , MD, MSc 1 , * , , PhD, MPH 1 , , MD, PhD 2 , 3 , , MD 3
      Medical Education Online
      CoAction Publishing
      medication adherence, health literacy, health communication

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          Abstract

          Background

          Physicians often do not provide adequate medication counseling.

          Purpose

          To develop and evaluate an educational program to improve physicians’ assessment of adherence and their medication counseling skills, with attention to health literacy.

          Methods

          We compared internal medicine residents’ confidence and counseling behaviors, measured by self-report at baseline and one month after participation in a two-hour interactive workshop.

          Results

          Fifty-four residents participated; 35 (65%) completed the follow-up survey. One month after training, residents reported improved confidence in assessing and counseling patients ( p<0.001), including those with low health literacy ( p<0.001). Residents also reported more frequent use of desirable behaviors, such as assessing patients’ medication understanding and adherence barriers ( p<0.05 for each), addressing costs when prescribing ( p<0.01), suggesting adherence aids ( p<0.01), and confirming patient understanding with teach-back ( p<0.05).

          Conclusion

          A medication counseling workshop significantly improved residents’ self-reported confidence and behaviors regarding medication counseling one month later.

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          Most cited references41

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          A meta-analysis of the association between adherence to drug therapy and mortality.

          To evaluate the relation between adherence to drug therapy, including placebo, and mortality. Meta-analysis of observational studies. Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality. Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11). Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.
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            Development of a brief test to measure functional health literacy.

            We describe the development of an abbreviated version of the Test of Functional Health Literacy in Adults (TOFHLA) to measure patients' ability to read and understand health-related materials. The TOFHLA was reduced from 17 Numeracy items and 3 prose passages to 4 Numeracy items and 2 prose passages (S-TOFHLA). The maximum time for administration was reduced from 22 minutes to 12. In a group of 211 patients given the S-TOFHLA, Cronbach's alpha was 0.68 for the 4 Numeracy items and 0.97 for the 36 items in the 2 prose passages. The correlation (Spearman) between the S-TOFHLA and the Rapid Estimate of Adult Literacy in Medicine (REALM) was 0.80, although there were important disagreements between the two tests. The S-TOFHLA is a practical measure of functional health literacy with good reliability and validity that can be used by health educators to identify individuals who require special assistance to achieve learning goals.
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              Patient adherence to treatment: three decades of research. A comprehensive review.

              Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enormous amount of quantitative research undertaken is of variable methodological quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many authors do not even feel the need to define adherence. Often absent in the research on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patient relationship. The backbone of the concordance model is the patient as a decision maker and a cornerstone is professional empathy. Recently, some qualitative research has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compliance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required to study the effects of compliance in enhancing the effects of interventions.
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                Author and article information

                Journal
                Med Educ Online
                MEO
                Medical Education Online
                CoAction Publishing
                1087-2981
                08 September 2011
                2011
                : 16
                : 10.3402/meo.v16i0.7133
                Affiliations
                [1 ]Department of Medicine, Vanderbilt University, Nashville, TN, USA
                [2 ]Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
                [3 ]Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
                Author notes
                [* ] Sunil Kripalani, MD, MSc, Division of General Internal Medicine and Public Health, 1215 21st Ave S, Suite 6000 Medical Center East, Nashville, TN 37232, USA. Tel: 615-936-3525. Fax: 615-936-1269. E-mail: sunil.kripalani@ 123456vanderbilt.edu
                Article
                MEO-16-7133
                10.3402/meo.v16i0.7133
                3171175
                21915162
                c02b3b9c-e51c-4469-bded-ab1a436e557a
                © 2011 Sunil Kripalani et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 March 2011
                : 13 July 2011
                : 20 July 2011
                Categories
                Research Article

                Education
                medication adherence,health literacy,health communication
                Education
                medication adherence, health literacy, health communication

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