eracy, age, language, and culture. Providers must have resources available to manage the knowledge, practical, and attitudinal barriers that affect provider–patient communication. Information should be easy for patients to understand and follow when they are at home self-managing their regimen. For example, providers should be aware that the majority of individuals with literacy problems have difficulty following prescription directions and will require communication consistent with their literacy level (Safeer and Keenan, 2005). Patients may misunderstand the instruction to “take a tablet X times a day” but understand “take a tablet every X hours.” When necessary, providers should have resources available to facilitate the patient’s understanding of medication information orally and in writing. Such resources may include translation services for patients. Ambulatory care providers can have a nurse or technician on staff with the language skills necessary to support the needs of the practice’s patient population, develop a partnership with a local pharmacist that can assist certain patients in confirming details of their medication regimen in their native language, or utilize centrally located telephone translation services.

Opportunities for Consultation

Successful medication self-management requires that consumers have multiple opportunities to gain knowledge about safe and effective medication use. Such consultations with providers should be readily available to consumers in all health care settings and at key points along the medication-use continuum. Specifically, consultations should take place during clinical decision making in ambulatory and hospital care, at hospital discharge, and at the time of dispensing by the local community pharmacy. Telephone consultations may be used to provide additional support to patients as they manage problems with and the effects of their medications. Access to consultation at these critical points in the medication-use continuum creates, in effect, a chain of communication that serves as the medication self-management support system. Conversely, poor communication at any of these points can lead to medication errors due to misunderstanding, inaccurate or incomplete information, or nonadherence (Morrow et al., 1988).

Because most health care is provided in community settings, the chain of communication begins with provider–patient consultations during ambulatory care. As discussed earlier, primary care providers play a crucial role in educating patients about the safe and effective use of prescription and nonprescription medications. Thus during ambulatory care consultations, providers must allow sufficient time for consultations with patients or surrogates about medication management (Raynor et al., 2004). Providers should be able to adapt to information needs that shift over time and



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