Emory Report
January 24, 2005
Volume 59, Number 16


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January 24, 2005
Grady study looks to improve medication compliance

by alicia sands lurry

Story Can an illustrated pill card or refill-reminder postcard improve medication adherence for low-literacy patients with coronary heart disease (CHD)? A School of Medicine study may be the key to determining the answer.

According to the American Heart Association (AHA), coronary heart disease is the leading cause of death in the United States. CHD patients often have high blood pressure, high cholesterol or diabetes, making it more likely for them to suffer heart attacks. Although medication can help prevent heart attack, only 50–60 percent of patients take their medicines as directed. Those who don’t are considered noncompliant.

Thanks to a $260,000 AHA grant, Sunil Kripalani, assistant professor of medicine at Grady Hospital, hopes to change those statistics by improving medication adherence among patients with CHD. The four-year grant will fund a randomized, controlled trial focused on CHD patients at Grady, where a large percentage of patients have limited literacy skills.

The study’s aim is twofold: to learn more about the relationship between low health literacy (defined as the ability to obtain, understand and act on basic health information) and medication compliance, and to test two different strategies designed to help patients take their medicines more regularly.

“There is some evidence that patients with low health literacy have difficulty understanding the instructions for how to take their medications correctly, and they also have difficulty obtaining refills on time,” said Kripalani, principal investigator of the study. “Both of these factors can lead to lower medication adherence.”

Two interventions are being used in the study to improve medication adherence. The first tool is a personalized, graphically illustrated medication schedule that shows each patient pictures of the pills he or she is taking. Symbols for morning, afternoon and evening make it easier for patients to remember when to take their medicine, and simple pictures like a blood pressure cuff and bacon and eggs, for example, show that certain medicines are used for hypertension and cholesterol, respectively. After receiving the card, patients repeat the medication instructions to pharmacists to make sure they understand.

A second group of patients receive a refill-reminder postcard before their medication runs out; a third group receives both interventions; and a fourth group receives regular care, which includes regular medication instructions printed on medicine bottles and no refill reminders. The goal is to determine how well each intervention works, both in isolation and in combination.

“What we’re trying to do with the reminder postcard is help patients with the advance planning required to get their medications before they actually run out,” Kripalani said. “The illustrated pill card provides patients an understandable schedule of how to take their medicines, which we hope will boost their understanding and confidence, making it more likely for them to take their medicines on time.”

Three months after enrolling in the study, patients are interviewed to find out how they’re using the pill card. So far, 80 percent of patients using the card report they like the tool and refer to it at least once a week. Many have said it helps them understand which pills to take, when to take them and their purpose. Some added it helps their family members and other physicians know what medicines they are taking.

Over the course of one year, researchers will determine the interventions’ impact on patients’ medication adherence. The study also will try to determine whether patients’ health literacy affects the success of the two interventions.

“Research already has shown that patients who adhere to their medical regimens live longer,” Kripalani said.
“We’re hoping these simple tools will help patients take their medicines more regularly, improve their blood pressure, cholesterol and diabetes, and ultimately help prolong their lives.”