Experts | University of the Sciences

Health Literacy: Recognizing the Need for Better Communication

In 2003, the National Assessment of Adult
Literacy found that only 12% of Americans were proficient in health literacy. As defined by the Patient Protection and Affordable Care Act of 2010, health literacy is the “degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions.” By the basis of this definition, literacy rates do not directly correlate with health literacy rates. The fact that nearly 9 out of 10 Americans experience difficulty when using everyday health related information that is readily available sheds light on the need for interventions to improve communication.

Researchers have found that low health literacy can be a major contributing factor to poor medication adherence, which together, can impair treatment success for patients. Simply put, if patients are unable to understand what medications they are taking and how they should be taking them, clinicians cannot expect clinical benefits from their prescribed treatment regimens. It is in these instances that the utility of the pharmacist can be appreciated. As one of the most readily accessible health care providers, pharmacists are a in a unique position to improve provider-patient
communication and bridge any gaps in misunderstanding that are caused by health illiteracy. For example, upon discharge from a hospital, patients are often bombarded with packets of discharge paperwork, lists of medications and a stack of new prescriptions. One study that examined the
relationship between health literacy and hospital reutilization found that patients with low health literacy were more likely than patients with adequate health literacy to return to the hospital or emergency room within 30 days of discharge. If a pharmacist could determine the health literacy level of the patient and counsel accordingly, patients would be able to walk away with an enhanced understanding, which could provide the foundation for medication adherence and potentially reduce re-hospitalizations. The issue is that at this time, it is not so easy to determine what level of health literacy patients fall into so it would be especially difficult to determine this in a quick visit to a retail pharmacy. However, with improved patient-clinician interactions, health literacy levels could be determined more efficiently thereby paving the way for patient-specific solutions.

While there is no Hooked On Phonics approach to improve health literacy, steps have been made in the right direction. As an objective of Healthy People 2020, health literacy and the knowledge of its
barriers  are getting an increasing amount of attention. As initiatives like the National Action Plan to Improve Health Literacy tackle the issue head on, clinicians can implement strategies to shorten the gap in misunderstanding and thereby improve health outcomes.

Anita A. Pothen, PharmD ‘14

Forecasting Medication Non-Adherence: A Profitable Approach That Helps Patients

$290 billion a year—a study by the New England Healthcare Institute found this to be the amount spent in the United States as a result of medication non-adherence and other avoidable issues. An analysis by Capgemini Consulting estimated that $188 billion account for pharmaceutical industry losses in the United States for the same reason. With such considerable monetary losses in addition to the health risks associated with non-adherence, the profitable future for health information technology (health IT) is becoming increasingly apparent.

After recognizing the significant financial costs associated with non-adherence, many insurance providers are utilizing new initiatives based on health IT that aim to predict non-adherence in an effort to proactively address the issue. In early 2011, CVS Caremark introduced its Pharmacy Advisor™ Program, which pays special attention to patients with chronic conditions like diabetes, who are likely to be non-adherent.  In April of 2012, Express Scripts^® launched a similar predictive tool called ScreenRx, which detects risk for medication non-adherence and then subsequently provides personalized interventions for those patients. Additionally, companies like RxAnte^© and Allazo Health^© apply behavioral science, predictive analytics and claims data to formulate algorithms that will allow them to determine which patients would be at an increased risk for non-adherence. They then take it a step further by tailoring interventions according to patient characteristics.

So since there’s no magic crystal ball one can look into to predict medication non-adherence, how do these companies determine who to monitor and intervene with? The key to the above-mentioned initiatives is the incorporation of patient behavior in forecasting non-adherence.

One commonly used model in analyzing health behavior is the Health Belief Model (HBM). This model explains that a patient’s behavior when it comes to health is motivated and influenced by varying perceptions. In essence, the HBM finds that perceived susceptibility, perceived benefits, perceived barriers and perceived seriousness all contribute to decision making when it comes to health, which in this case, would be in reference to taking their medications.

So how relevant is patient behavior when it comes to medication non-adherence? Express Scripts^® found that 69% of medication non-adherence was attributed to patient behavior factors including simple procrastination and forgetfulness. With even more advancements in health IT, providers will be able to dissect and rationalize reasons for non-adherence and further analyze patient behavior to formulate optimal regimens that will save billions of dollars all while promoting better health outcomes.

 Anita A. Pothen, PharmD’14

Research Day Showcases Faculty and Student Research

From metabolic engineering to computational chemistry and from structural prediction of proteins to rational design of new therapeutics, University of the Sciences in Philadelphia showcased the diversity and growth of research pursuits on campus during its 7th Annual Research Day starting on Thursday, April 2, 2009. Posters representing approximately 120 topics were on display.

Research Day recognizes undergraduate and graduate student research efforts, and highlights aspects of faculty scholarly activity to encourage and promote communication and collaboration among investigators. The University is distinctive in that most undergraduate students conduct research with faculty early in their academic careers.

The diverse research activity on display spans several aspects of the University’s scholarly pursuits, including:

• Biological Sciences: Dr. Jennifer Anthony’s research involving the metabolic engineering of E. coli for the production of vitamin A.
  • Chemistry: Dr. Randy Zauhar’s use of computer-aided drug design to identify new antimicrobial lead compounds.
• Pharmaceutical Sciences: Dr. Bin Chen’s evaluation of the effects of vascular-targeting photodynamic therapy on prostate cancer metastasis.
• Physical Therapy: Dr. Therese Johnston’s usage of treadmill training for children with cerebral palsy.
• Social Sciences: Psychology major Mark Paullin’s (Philadelphia, Pa.) study of mild cognitive impairment in Alzheimer’s disease.
• Health Policy: Master in public health major Sekinat Kekere-Ekun’s (Deptford, N.J.) work on the descriptive epidemiology of viral hepatitis in methadone maintenance clients.
• Pharmacy Practice: Doctor of pharmacy students Neha Patel (Fairless Hills, Pa.), Puja Patel (Hillsborough, N.J.), and Isha Shah’s (Bensalem, Pa.) analysis of the usage of ondansetron in non-chemotherapy patients at a community teaching hospital.