Pharmacy Intervention for Limited Literacy
PILL
Kara L. Jacobson, MPH, CHESJulie A. Gazmararian, PhD,
MPHSunil Kripalani, MD, MSc
Karen J. McMorris, BASarah Blake, MA
•To improve medication adherence in pharmacy patients with limited health literacy
•To use a systems-level approach to improving patient adherence
Purpose of HL Tools
Phases of the Study
Phase 1:Health literacy assessment of the pharmacy environment
Phase 2:Implementation of a 3 “P” intervention
Phase 3:Outcome evaluation of intervention
Study Phase 1: Assessment
• Evaluated the extent to which the existing pharmacy environment accommodated patients with limited health literacy
• Included 3 parts:
• Part 1: Pharmacy assessment tour
• Part 2: Pharmacy staff survey
• Part 3: Patient focus groups
• Adapted from Literacy Alberta’s Health Literacy Audit Kit
Literacy-Alberta. The Literacy Audit Kit. Calgary: Literacy Alberta; 1997.
Part 1: Assessment Tour• Objective assessors identified existing barriers in
these areas:
• Promotion of Services
• Print Materials
• Clear Verbal Communication
• Assessment conducted by trained, objective assessors who were:
• Familiar with the principles of clear health communication
• Not pharmacy staff or patients
• Able to blend in with patients who use the pharmacy
Part 2: Survey of Pharmacy Staff• Evaluated staff opinions of pharmacy’s
sensitivity to the needs of limited-literacy patients in three areas:
•Print Materials
•Clear Verbal Communication
•Sensitivity to Literacy
Part 3: Pharmacy Patient Focus Groups• Pharmacy patients discussed their personal
experiences in 4 areas:• Physical Environment• Care Process and Workforce• Paperwork and Written Communication• Culture
Interested in Conducting a Health Literacy Assessment?
• Assessment guide developed during the PILL study is available at http://www.ahrq.gov/qual/pharmlit/
Study Phase 2: Intervention
PILL Study intervention involved a“3-P” approach:
1. Pharmacist training in clear health communication
2. Picture Rx (or “pill cards”)
3. Automated reminder phone calls
Intervention Part 1: Pharmacist Training
Training kit includes:
• PowerPoint slide set• Handouts for use• Hands-on practice activities• Available at: http://www.ahrq.gov/qual/pharmlit/pharmtrain.pdf
Strategies to Improve Communication Between Pharmacists and Patients
[Presenters Names Here]Developed by Sunil Kripalani, MD, MSc
and Kara L. Jacobson, MPH, CHES
Intervention Part 2:Pill Card• Patients called this their “pill card”
• Created automatically through a software program
• Personalized for each patient
• New card was created each time thepatient picked up meds
Pill CardName: Sarah Smith Date Created: 12/15/07Pharmacy phone number: 123-456-7890
Name Used For Instructions Morning Afternoon Evening Night
Simvastatin20mg
Cholesterol
Take 1 pill at night
Furosemide20mg
Fluid Take 2 pills in the morning and 2 pills in the evening
Insulin 70/30
Diabetes (Sugar)
Inject 24 units before breakfast and 12 units before dinner
24 units 12 units
Interested in Creating a Pill Card?• To learn how to create a pill card
using a word processor, please view the guide created during the PILL study at:
http://www.ahrq.gov/qual/pillcard/ pillcard.htm
Intervention Part 3: Automated Reminder Phone Calls
• Calls were placed through an automated system using a script written for a low-literate audience
• The reminder system was linked to the existing medication refill system to allow patients to refill their prescriptions right away
Interested in Using Automated Reminder Phone Calls with a Low-Literate Population?
• To view the phone call script developed during the PILL study, please visit: http://www.ahrq.gov/qual/callscript.htm
Phase 3: Outcome Evaluation
Patients felt that the card presented their medicines and dosing schedules in a way that was accessible to them:
“You know what, my pill card made me excited about knowing about my medicines, it excited me because I didn’t understand my medicines. I took it because the doctor told me to take it but I am proud of the pill card... I love my pill card. That’s the only reason… because I’m excited about the pill card.”