PILL

1. PILL Pharmacy Intervention for Limited Literacy Kara L. Jacobson, MPH, CHES Julie A. Gazmararian, PhD, MPH Sunil Kripalani, MD, MSc Karen J. McMorris, BA Sarah Blake, MA

2. Purpose of HL Tools • To improve medication adherence in pharmacy patients with limited health literacy • To use a systems-level approach to improving patient adherence

3. 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

4. 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.

5. 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 1: Assessment Tour

7. 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

8. 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

9. Interested in Conducting a Health Literacy Assessment? • Assessment guide developed during the PILL study is available at http://www.ahrq.gov/qual/pharmlit/

10. 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

11. 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

12. 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

13. Pill Card

14. 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

15. 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

16. 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

17. 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.” Phase 3: Outcome Evaluation