Abstract
Heart failure is a chronic disease requiring careful attention to self-care. Patients must follow instructions for diet and medication use to prevent or delay a decline in functional status, quality of life, and expensive care. However, there is considerable heterogeneity in heart failure patients’ knowledge of important care routines, their cognition, and their health literacy, which predict the ability to implement self-care. Our interdisciplinary team of cognitive scientists with health literacy expertise, pharmacists, and physicians spent 18 years designing and testing protocols and materials to assist ambulatory heart failure patients with their care. Our approach is theory- as well as problem-driven, guided by our process-knowledge model of health literacy as it relates to self-care among older adult outpatients with either heart failure or hypertension. We used what we had learned from this model to develop a pharmacy-based protocol and tailored patient instruction materials that were the central component of a randomized clinical trial. Our results showed improved adherence to cardiovascular medications, improved health outcomes and patient satisfaction, and direct cost reductions. These results demonstrate the value of our interdisciplinary efforts for developing strategies to improve instruction and communication with attention to health literacy, which are core components of pharmacy and other ambulatory healthcare services. We believe attention to health literacy with medication use will result in improved health outcomes for older adult patients with heart failure and other complex chronic diseases.
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The authors thank Rachel Gruber, MSIO, CCRP for her assistance with the preparation of this manuscript.
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This research was supported by the National Institute of Aging [R01 AG031718]. Dr Murray’s work on this manuscript was supported by the Regenstrief Foundation and an endowment in medication safety from Purdue University.
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Veronica Bonderski, Daniel G. Morrow, Jessie Chin, and Michael D. Murray declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.
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Bonderski, V., Morrow, D.G., Chin, J. et al. Pharmacy-Based Approach to Improving Heart Failure Medication Use by Older Adults with Limited Health Literacy: Learning from Interdisciplinary Experience. Drugs Aging 35, 951–957 (2018). https://doi.org/10.1007/s40266-018-0586-7
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DOI: https://doi.org/10.1007/s40266-018-0586-7