Health literacy and the quality of physician-patient communication during hospitalization.

BACKGROUND: Overall, poor physician-patient communication is related to post-discharge adverse events and readmission. We analyzed patients' ratings of the quality of physician-patient communication during hospitalization and how this varies by health literacy. METHODS: Medical patients were interviewed during their hospitalization to assess personal characteristics and health literacy. After discharge, patients completed by telephone the 27-item Interpersonal Processes of Care in Diverse Populations Questionnaire (IPC). Using the IPC, patients rated the clarity and quality of physicians' communication during the hospitalization along the following 8 domains: General clarity, Responsiveness to patient concerns, Explanation of patients' problems, Explanation of processes of care, Explanation of self-care after discharge, Empowerment, Decision making, and Consideration of patients' desire and ability to comply with recommendations. RESULTS: A total of 84 patients completed both the in-hospital and telephone interviews. Subjects had a mean age of 55, and 44% had inadequate health literacy. Overall, patients gave the poorest ratings to communication that related to Consideration of patients' desire and ability to comply with recommendations. Patients with inadequate health literacy gave significantly worse ratings on the domains of General clarity, Responsiveness to patient concerns, and Explanation of processes of care (P < 0.05 for each). In multivariable analyses, the relationship with General clarity did not persist. CONCLUSIONS: Physicians received relatively poor ratings on their Consideration of patients' desire and ability to comply with recommendations. Patients with inadequate health literacy experienced lower quality and clarity of hospital communication along multiple domains. More attention to effective health communication is warranted in the hospital setting.

Rationale and design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study.

BACKGROUND: Medication errors and adverse drug events are common after hospital discharge due to changes in medication regimens, suboptimal discharge instructions, and prolonged time to follow-up. Pharmacist-based interventions may be effective in promoting the safe and effective use of medications, especially among high-risk patients such as those with low health literacy. METHODS AND RESULTS: The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study is a randomized controlled trial conducted at 2 academic centers-Vanderbilt University Hospital and Brigham and Women's Hospital. Patients admitted with acute coronary syndrome or acute decompensated heart failure were randomly assigned to usual care or intervention. The intervention consisted of pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and tailored telephone follow-up after discharge. The primary outcome is the occurrence of serious medication errors in the first 30 days after hospital discharge. Secondary outcomes are health care utilization, disease-specific quality of life, and cost-effectiveness. Enrollment was completed September 2009. A total of 862 patients were enrolled, and 430 patients were randomly assigned to receive the intervention. Analyses will determine whether the intervention was effective in reducing serious medication errors, particularly in patients with low health literacy. CONCLUSIONS: The PILL-CVD study was designed to reduce serious medication errors after hospitalization through a pharmacist-based intervention. The intervention, if effective, will inform health care facilities on the use of pharmacist-assisted medication reconciliation, inpatient counseling, low-literacy adherence aids, and patient follow-up after discharge. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00632021.