Limited Health Literacy is a Barrier to Medication Reconciliation in Ambulatory Care
Limited health literacy may influence patients’ ability to identify medications taken; a serious concern for ambulatory safety and quality.
To assess the relationship between health literacy, patient recall of antihypertensive medications, and reconciliation between patient self-report and the medical record.
In-person interviews, literacy assessment, medical records abstraction.
Adults with hypertension at three community health centers.
We measured health literacy using the short-form Test of Functional Health Literacy in Adults. Patients were asked about the medications they took for blood pressure. Their responses were compared with the medical record.
Of 119 participants, 37 (31%) had inadequate health literacy. Patients with inadequate health literacy were less able to name any of their antihypertensive medications compared to those with adequate health literacy (40.5% vs 68.3%, p = 0.005). After adjusting for age and income, this difference remained (adjusted odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 1.3–6.7). Agreement between patient reported medications and the medical record was low: 64.9% of patients with inadequate and 37.8% with adequate literacy had no medications common to both lists.
Limited health literacy was associated with a greater number of unreconciled medications. Future studies should investigate how this may impact safety and hypertension control.
KEY WORDShealth literacy medication reconciliation medication adherence hypertension knowledge ambulatory care
Special thanks to Diane Cornelius and Marolee Neuberger for their technical and methodological guidance in conducting the research activities. Funding for this study was provided in part by a research grant awarded to Cherry Street Health Services by the Michigan Department of Community Health. Dr. Wolf is supported by a Centers for Disease Control and Prevention Career Development Award (K01 EH000067-01). Dr. Persell is supported in part by a career development award 1 K08 HS015647-01 from the Agency for Healthcare Research and Quality.
Conflict of Interest
Dr. Wolf has received research funding from Target Corporation and Pfizer Pharmaceuticals for health literacy-related intervention studies. No other conflicts are identified with authors of this manuscript.
- 1.American Hospital Association, American Society of Health-System Pharmacists, Hospitals & Health Networks. Medication safety issue brief. Medication reconciliation. Hosp Health Netw. 2005;79:33–4.Google Scholar
- 4.Institute of Medicine. Preventing Medication Errors. In: Aspden P, Wolcott J, Bootman L, Cronenwett LR eds. Washington, D.C.: National Academy Press; 2006.Google Scholar
- 9.Institute of Medicine. Health literacy: a prescription to end confusion. In: Nielsen-Bohlman L, Panzer A, Kindig DA, eds. Washington, D.C.: National Academy Press; 2004.Google Scholar
- 15.Davis TC, Kennen EM, Gazmararian JA, Williams MV. Literacy testing in health care research. In: Schwartzberg JG, VanGeest JB, Wang CC, eds. Understanding health literacy: implications for medicine and public health. Chicago, IL: AMA Press; 2004:157–79.Google Scholar