Promoting safe and effective use of OTC medications: CHPA-GSA National Summit.

Research on the ways older people use prescription medications (Rx) is a mainstay of the gerontological literature because use of Rx medications is common, and appropriate use is central to effective management of chronic disease. But older adults are also major consumers of over-the-counter (OTC) medications, which can be equally significant for self-care. Nearly half of older adults aged 75-85, for example, are regular users of an OTC product.

Self-management behaviors in older adults with asthma: associations with health literacy.

Objectives: To examine self-management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy.

Design: Observational cohort study.

Setting: Primary care and pulmonary specialty practices in two tertiary academic medical centers and three federally qualified health centers in New York, New York, and Chicago, Illinois.

Impact of electronic prescribing on medication use in ambulatory care.

Objectives: To investigate differences before and after rollout of electronic prescribing (e-prescribing) in (1) patients' primary adherence to newly prescribed medications, (2) patients' understanding of how to use their medications, and (3) multiple pharmacy use.

Study Design: Postvisit interviews and follow-up phone calls were done with 344 patients at an academic general internal medicine clinic.

Methods: Patient interviews and follow-up phone calls were done (1) before e-prescribing, (2) 1 to 6 months after e-prescribing, and (3) 12 to 18 months after e-prescribing.

Disease-related distress, self-care and clinical outcomes among low-income patients with diabetes.

Background: The purpose of this study is to determine the prevalence of diabetes distress and its relationship with health behaviours and clinical outcomes in low-income patients.

Methods: Secondary analyses were conducted using baseline data from a clinical trial evaluating a diabetes self-management intervention. Interviews were conducted with 666 participants receiving care at nine safety net clinics in Missouri.

Health literacy, cognitive ability, and functional health status among older adults.

Objective: To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.

Data Sources/study Setting: Health Literacy and Cognition in Older Adults ("LitCog," prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55-74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.

Expanding the Universal Medication Schedule: a patient-centred approach.

Objective: Improved drug labelling for chronic pill-form medications has been shown to promote patient comprehension, adherence and safety. We extended health literacy principles and included patients' perspectives to improve instructions for: (1) non-pill form, (2) short term, (3) 'as needed,' (4) tapered and (5) escalating dose medications.

Setting: Participants were recruited via convenience sampling from primary care clinics in Chicago, Illinois and San Francisco, California, USA.

Strategies to improve repeat fecal occult blood testing cancer screening.

Background: A comparative effectiveness intervention by this team improved initial fecal occult blood testing (FOBT) rates from 3% to 53% among community clinic patients. The purpose of this study was to evaluate the effectiveness and costs associated with a literacy-informed intervention on repeat FOBT testing.

Methods: Between 2008 and 2011, a three-arm quasi-experiential comparative effectiveness evaluation was conducted in eight community clinics in Louisiana.

Asthma outcomes are poor among older adults with low health literacy.

Objective: To examine the association of health literacy (HL) with asthma outcomes among older asthmatics.

Methods: The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1 s (FEV1) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life.

Take-Wait-Stop: a patient-centered strategy for writing PRN medication instructions.

Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as "Take-Wait-Stop") or standard label.

A drug by any other name: patients' ability to identify medication regimens and its association with adherence and health outcomes.

Understanding and organizing medication regimens can be challenging, and many patients struggle to properly dose prescribed medicine, potentially leading to less effective treatment or even harm. Generic prescriptions are increasingly common and may change in appearance, adding further complexity. The authors aimed to investigate familiarity with the drug regimen among a cohort of patients with diagnosed hypertension.

Patient factors that affect quality of colonoscopy preparation.

Background & Aims: Optimal colonoscopy preparation requires patients to adhere to written instructions and be activated to complete the task. Among patients with chronic disease, health literacy and patient activation have been associated with outcome, but these factors have not been studied for colonoscopy. We examined the association between health literacy, patient activation, and quality of bowel preparation.

What patients think doctors know: beliefs about provider knowledge as barriers to safe medication use.

Objective: We examined patient beliefs about provider awareness of medication use, patient-reported prevalence and nature of provider counseling about medications, and the impact of health literacy on these outcomes.

Methods: Structured interviews were conducted at academic general internal medicine clinics and federally qualified health centers with 500 adult patients. Interviewer-administered surveys assessed patients' beliefs, self-reported prevalence and nature of provider counseling for new prescriptions, and medication review.

Literacy and race as risk factors for low rates of advance directives in older adults.

Objectives: To examine the effect of the relationship between literacy and other individual-level factors on having an advance directive (AD).

Design: Face-to-face structured interview.

Setting: Participants were recruited from an academic general internal medicine clinic and one of four federally qualified health centers in Chicago.

Eliciting patient and caregiver perspectives to improve the public reporting of rehabilitation quality measures.

Purpose: To evaluate patients' and caregivers' abilities to comprehend information on rehabilitation quality measures, and select high-quality rehabilitation facility.

Design: We used exploratory, qualitative study using cognitive interviewing.

Setting: Three Outpatient rehabilitation facilities in metropolitan Chicago, Illinois, USA.

The influence of health literacy on comprehension of a colonoscopy preparation information leaflet.

Background: Successful bowel preparation is important for safe, efficacious, cost-effective colonoscopy procedures; however, poor preparation is common.

Objective: We sought to determine whether there was an association between health literacy and comprehension of typical written instructions on how to prepare for a colonoscopy to enable more targeted interventions in this area.

Design: This is a cross-sectional observational study.

The association between language proficiency and outcomes of elderly patients with asthma.

Background: Asthma is a growing cause of morbidity for elderly Americans and is highly prevalent among Hispanic people in the United States. The inability to speak English poses a barrier to patient-provider communication.

Objective: To evaluate associations between limited English proficiency, asthma self-management, and outcomes in elderly Hispanic patients.

Asthma beliefs are associated with medication adherence in older asthmatics.

Background: Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics.

Objective: To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics.

Design: An observational study of asthma beliefs and self-management among older adults.

An EMR-based tool to support collaborative planning for medication use among adults with diabetes: design of a multi-site randomized control trial.

Patients with type II diabetes often struggle with self-care, including adhering to complex medication regimens and managing their blood glucose levels. Medication nonadherence in this population reflects many factors, including a gap between the demands of taking medication and the limited literacy and cognitive resources that many patients bring to this task. This gap is exacerbated by a lack of health system support, such as inadequate patient-provider collaboration.

Literacy, cognitive function, and health: results of the LitCog study.

Background: Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities.

Objective: To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status.

Design: Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring 'fluid' abilities necessary to learn and apply new information, and 'crystallized' abilities such as background knowledge.

Helping patients simplify and safely use complex prescription regimens.

Background: There is considerable variability in the manner in which prescriptions are written by physicians and transcribed by pharmacists, resulting in patient misunderstanding of label instructions. A universal medication schedule was recently proposed for standardizing prescribing practices to 4 daily time intervals, thereby helping patients simplify and safely use complex prescription regimens. We investigated whether patients consolidate their medications or whether there is evidence of unnecessary regimen complexity that would support standardization.

Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes.

More than 14% of the American population is food insecure, or at risk of going hungry because of an inability to afford food. Food-insecure (FI) adults often reduce food intake or substitute inexpensive, energy-dense carbohydrates for healthier foods. We hypothesized these behaviors would predispose FI adults with diabetes to hypoglycemia and impaired diabetes self-management.

Literacy, cognitive ability, and the retention of health-related information about colorectal cancer screening.

Interventions to mitigate the impact of low literacy on patients' recall of information by simplifying language have had limited success. The current study examines the extent to which cognition explains the relationship between literacy and retention of health information. Primary care patients aged 40 to 85 years watched a video about colorectal cancer (CRC) screening and then answered knowledge-based questions about the video's content as well as a literacy assessment and cognitive assessments measuring processing speed, working memory, and-long term memory.

Ask, understand, remember: a brief measure of patient communication self-efficacy within clinical encounters.

Patients' ability to effectively communicate with their health care providers is an essential aspect of proper self-care, especially for those with chronic conditions. We wanted to develop and validate a brief, reliable measure of patient communication self-efficacy within clinical encounters. Consecutively recruited patients (n = 330) with diagnosed hypertension from seven primary care clinics in Chicago, Illinois, Grand Rapids, Michigan, and Shreveport, Louisiana completed an in-person interview including chronic disease self-efficacy, hypertension knowledge, health literacy assessments, and items modified from the Communication and Attitudinal Self-Efficacy (CASE) - Cancer scale.

Measuring patients' self-efficacy in understanding and using prescription medication.

Objective: To create a brief assessment tool, the Medication Understanding and Use Self-Efficacy Scale (MUSE).

Methods: An existing scale (Communication and Attitudinal Self-Efficacy Scale) was modified, augmented, and piloted among 267 primary care patients in Chicago, New York City, and Shreveport, LA. Participant sociodemographics, literacy, current medication use, understanding medication instructions, and medication self-efficacy were measured.