For Better Medication Outcomes, Help Patients Do the Math?

December 16, 2014

Can you guess what proportion of patients in private rheumatology practices can't follow instructions for taking methotrexate? The authors of this study offer some suggestions to improve adherence.

Wong PKK, Christie L, Johnston J, et al. Observational Study: How Well Do Patients Understand Written Instructions?: Health Literacy Assessment in Rural and Urban Rheumatology Outpatients.Medicine, 2014, 93(25)e129doi: 10.1097/MD.0000000000000129

One-third of patients in private rheumatology practices can't follow dosing instructions for ibuprofen correctly and one-fifth can't follow instructions for methotrexate, judging from survey conducted in Australia.

The investigators gave three tests-including a standard test of general health literacy and a test of the ability to follow standard instructions for rheumatological medications-to 223 patients at two practices.

They report that only 32% of patients correctly understand dosing instructions for ibuprofen while 21% do so for methotrexate. The methotrexate question asked patients to count out the number of pills they would need in order to take a weekly dose of the medication, as well as a daily dose of folic acid.

Results for rural and urban patients were similar.

The authors recommend that doctors:

•   assess what patients understand before giving information,
•   use plain language,
•  
stick to one or two main points and repeat them,
•   ask patients to explain
what you've told them.



Results were better with simpler questions on tramadol, prednisone, and alendronate. Even so,

4% of patients were unable to say how many 50-mg tablets to take for a 150-mg dose of tramadol

.

Previous research shows that patients are unlikely to admit difficulty understanding instructions, and may overestimate their reading ability.

Who's most likely to need help? This study found demographic factors associated with better health literacy familiar from other studies: employment, higher education, English spoken at home, and (a fairly novel finding) regular use of the Internet. 

Because the private practice test sites charged fees, lower-income patients may have been under-represented. The study is funded in part by an unrestricted grant from Bristol-Myers-Squibb.