October, being designated both Health Literacy Month and American Pharmacists Month, is an appropriate time to recognize pharmacists’ roles in improving health literacy. Given the complexity of our healthcare system, it is not surprising that many individuals struggle to manage their health and treatment regimens, including medications. Of the 3.8 billion prescriptions written each year, one in five is not filled. And of those filled, approximately 50 percent are taken incorrectly.
Direct health care costs associated with medication non-adherence are estimated to be $100 billion to $300 billion annually. Non-adherence is often unintentional and may involve taking the wrong dose, taking medications at the wrong time, forgetting to take them, or failing to obtain refills.
Approximately 80 million adults in the U.S. have low health literacy and lack the skills to make informed decisions about their health. In addition to medication non-adherence, some consequences are longer hospital stays, an increase in avoidable hospital readmissions, ineffective management of chronic conditions, and higher mortality. Annual health care expenditures potentially associated with lower health literacy in the U.S. are $215 billion.
Lower educational attainment, limited English proficiency, being a senior, a minority, and lower socioeconomic status correlate with low health literacy. Vulnerable populations with lower health literacy are more likely to experience health disparities. They are at risk for worse health outcomes, limiting their opportunity to attain their highest level of health.
A recent study suggests sizable differences in several medication self-management outcomes across individuals’ health literacy levels. Results from a meta-analysis of 48 articles on the association of higher health literacy with patient adherence to medications found a positive and highly significant correlation. Lower health literacy was associated with worse medication self-management in several areas, including understanding dosing and instructions and medication indication. This evidence indicates a dire need to increase personal and organizational health literacy, especially pharmacy health literacy. The Agency for Healthcare Research and Quality (AHRQ) defines pharmacy health literacy as “the degree to which individuals can obtain, process, and understand basic health and medication information and pharmacy services needed to make appropriate health decisions.”
Pharmacists are highly accessible healthcare providers who are well positioned to take on this challenge across multiple care settings and diverse patient populations. They can establish trusting relationships with patients, assessing their ability to understand their conditions and medications, and fill in the gaps in knowledge. According to the American Society of Health System Pharmacists Guidelines on Pharmacist-Conducted Patient Education and Counseling, “Providing pharmaceutical care entails accepting responsibility for patients’ pharmacotherapeutic outcomes. Pharmacists can contribute to positive outcomes by educating and counseling patients to prepare and motivate them to follow their pharmacotherapeutic regimens and monitoring plans.”