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How to form a team to assess the practice and raise awareness about health literacy Tools for improving spoken communication How to communicate clearly How to use teach-back Effective follow-up Effective phone communications “Brown bag” medication review How to address language differences Dealing with patients from different cultures Tools for improving written communication How to design easy-to-read material How to use health education material effectively Good signage Improving patient self-management and empowerment Encouraging patients to ask questions Helping patients to make action plans Improving medication adherence and accuracy Getting patient feedback Improving support systems Linking patients to nonmedical support services Linking patients to medication resources Linking patients to health and literacy resources in the community Adapted from ref. 11.
- Table 2. Characteristics of the Two Practices That Implemented the Brown Bag Medication Review Tool
Characteristic* Missouri Practice California Practice Practice type Private family medicine practice; patient-centered medical home Family medicine residency; federally qualified community health center Location Rural Suburban Clinicians (n)† Full time 7 4 Part time 0 30 Patient population (approximate n) 4,700 10,000 Patient sociodemographics (%) Medicaid 35 75 Black 1 5 White 95 10 Hispanic 2 79 Age >65 years 30 12 Non-English-speaking 1 50 Limited health literacy‡ 32 56 ↵* Data on practice characteristics were provided by the individual practices.
↵† Clinicians include physicians, advanced practice nurses, physician assistants.
↵‡ Percentage of patents with limited health literacy was based on the Health Literacy Prevalence Calculator, which uses practice demographics to estimate the prevalence of limited health literacy among a patient population (http://surroundhealth.net/Topics/Education-and-Learning-approaches/Health-literacy/Articles/Health-literacy-A-foundation-to-effective-patient/Health-Literacy-Prevalence-Calculator.aspx).
Ways to remind patients to bring medications Appointment cards During appointment reminder calls During office visits Posters in exam rooms and waiting rooms Bulletin board display of anonymous cases that make the case for bringing medications Emphasize that the review usually results in taking fewer medications Provide a carrier (bag or sack) in which patients can bring medications to visits What to tell patients to bring All prescription medications including pills and creams All over-the-counter medicines taken regularly All vitamins and supplements All herbal medications What to do during the medication review Offer praise for bringing the medications Τrack progress Track the percentage of patients each day who have had a medication review completed Aim for 90% of patients to have a review over a 12-month period Adapted from ref. 11.
- Table 4. Comparison of Medication Reviews Performed Before and After Implementation of the Brown Bag Medication Review Tool
Item Evaluated Before Implementation After Implementation P Value Missouri Clinic (n = 27) California Clinic (n = 18) Total (n = 45) Missouri Clinic (n = 20) California Clinic (n = 21) Total (n = 41)* Prescription medications brought to office visit, mean (SD) 0.44 (1.9) 1.8 (2.6) 1.0 (2.3) 8.0 (5.4) 5.6 (3.4) 6.8 (4.6) <.001 Prescription medications reviewed with patient, mean (SD) 3.25 (5.4) 3.3 (2.4) 3.3 (4.3) 7.4 (4.5) 4.9 (3.1) 6.1 (4.0) .003 All prescription medications brought to visit (patient report) 7.4 38.9 20 70.0 66.7 68.3 <.001 All nonprescription medications brought to visit (patient report) 11.1 5.9 9.1 25.0 14.3 19.5 .003 Problems found with medication regimen 25.9 5.6 17.8 40.0 28.6 34.2 .082 Changes made to medication regimen as a result of the review 25.9 5.6 17.8 50.0 33.3 41.5 .016 SD, standard deviation. Data are percentages unless otherwise indicated.
