COMMUNICATING
CLEARLY ABOUT
MEDICINES
PROCEEDINGS OF A WORKSHOP
Joe Alper, Rapporteur
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and AbbVie Inc.; Aetna Foundation; Agency for Healthcare Research and Quality (HHSP23337024); American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Health Resources and Services Administration (HHSH25034011T); Humana; Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; National Institutes of Health (HHSN26300054); National Library of Medicine; Northwell Health; Office of Disease Prevention and Health Promotion (HHSP23337043); and UnitedHealth Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-46185-6
International Standard Book Number-10: 0-309-46185-5
Digital Object Identifier: https://doi.org/10.17226/24814
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Copyright 2017 by the National Academy of Sciences. All rights reserved.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Communicating clearly about medicines: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24814.
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PLANNING COMMITTEE ON COMMUNICATING CLEARLY ABOUT MEDICINE1
IRENE Z. CHAN, Deputy Director, Division of Medication Error Prevention and Analysis, U.S. Food and Drug Administration
TERRY DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center
JAMES (JAY) DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.
JOAN GUTHRIE MEDLEN, Training Development Specialist, Office of Adult Abuse Prevention and Investigations, Oregon Department of Human Services; and President, Medlen Consulting, LLC
LAURIE MYERS, Global Health Literacy Director, Merck Sharp & Dohme Corp.
H. SHONNA YIN, Assistant Professor of Pediatrics and Population Health, New York University School of Medicine and Bellevue Hospital Center
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON HEALTH LITERACY1
BERNARD ROSOF (Chair), Chief Executive Officer, Quality in Healthcare Advisory Group LLC
MARIN P. ALLEN, Deputy Associate Director for Communications and Public Liaison and Director of Public Information, National Institutes of Health
WILMA ALVARADO-LITTLE, Principal and Founder, Alvarado-Little Consulting, LLC
SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University
CINDY BRACH, Senior Health Policy Researcher, Agency for Healthcare Research and Quality
GEM DAUS, Public Health Analyst, Office of Health Equity, Health Resources and Services Administration
TERRY DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center
CHRISTOPHER DEZII, Director, Healthcare Quality and Performance Measures, Bristol-Myers Squibb
JENNIFER DILLAHA, Medical Director for Immunizations, Medical Advisor, Health Literacy and Communication, Arkansas Department of Health
JAMES (JAY) DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.
ALICIA FERNANDEZ, Professor of Clinical Medicine, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco
LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association
LORI HALL, Director, Health Literacy, U.S. Medical Strategy and Operations, Lilly USA, LLC
LINDA HARRIS, Director, Division of Health Communication and ehealth Team, U.S. Department of Health and Human Services
BETSY L. HUMPHREYS, Acting Director, National Library of Medicine
LAURIE MYERS, Global Health Literacy Director, Merck Sharp & Dohme Corp.
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Media
MARYLYNN OSTROWSKI, Executive Director, Aetna Foundation
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
MICHAEL PAASCHE-ORLOW, Professor of Medicine, Boston University School of Medicine
TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners
KIM PARSON, Strategic Consultant, Proactive Care Strategies, Humana
KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution
ANDREW PLEASANT, Senior Director for Health Literacy and Research, Canyon Ranch Institute
LINDSEY A. ROBINSON, Thirteenth District Trustee, American Dental Association
STACEY ROSEN, Associate Professor of Cardiology, Hofstra Northwell Health School of Medicine and Vice President, Women’s Health, The Katz Institute for Women’s Health
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard T.H. Chan School of Public Health
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement
EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin
MICHAEL WOLF, Professor, Medicine and Learning Sciences, Associate Division Chief, Research Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
WINSTON WONG, Medical Director, Community Benefit, Disparities Improvement, and Quality Initiatives, Kaiser Permanente
Consultant
RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine
Health and Medicine Division Staff
LYLA HERNANDEZ, Senior Program Officer
MELISSA FRENCH, Program Officer
ALEXIS WOJTOWICZ, Senior Program Assistant
ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
SUZANNE BAKKEN, Columbia University
SHARON E. BARRETT, Association of Clinicians for the Underserved
CATHRYN GUNTHER, Merck Sharp & Dohme Corp.
ALICE HOROWITZ, University of Maryland School of Public Health
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Hugh H. Tilson, University of North Carolina at Chapel Hill. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Acknowledgments
The sponsors of the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Health Literacy made it possible to plan and conduct the workshop on communicating clearly about medicines, which this Proceedings of a Workshop summarizes. Federal sponsors included the Agency for Healthcare Research and Quality, Health Resources and Services Administration, National Institutes of Health, National Library of Medicine, and Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services. Non-federal sponsorship was provided by AbbVie Inc.; Aetna Foundation; American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Humana; Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; Northwell Health; and UnitedHealth Group.
The roundtable would like to thank each of the speakers, reactors, and panel moderators for their time and effort. Speakers, reactors, and moderators were, in alphabetical order, Irene Chan, Donna Horn, Ed Israelski, Brian Jack, Charles Lee, Darvece A. Monson, Dan Morrow, Laurie Myers, Terri Ann Parnell, Bobbie Reed, Heather Rennie, Bernard Rosof, Caleb Sexton, William Shrank, Steve Sparks, Elisabeth Walther, Michael Wolf, and H. Shonna Yin.
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Contents
1 INTRODUCTION AND WORKSHOP OVERVIEW
Organization of the Proceedings
2 PATIENT AND CAREGIVER PERSPECTIVES
3 APPROACHES TO HEALTH-LITERATE MEDICATION INSTRUCTIONS
An Overview of Research on Written Communications
The Role of Human Factors Engineering
4 TRANSLATING RESEARCH INTO PRACTICE: CASE STUDIES
Adopting an Easy-to-Read Medication Label in Wisconsin
Including Individuals with Low Health Literacy in the Development and Testing of Patient Labeling
Project RED: Engaging Patients in Medication Management at Hospital Discharge
Boxes and Figures
BOXES
4-1 The 11 Mutually Reinforcing Components of a Health-Literate Discharge Program
FIGURES
3-1 Human factors core methods
4-1 A prescription label designed by focus group members
4-2 Current and working-draft redesigned labels
4-3 Patient labeling created through Merck’s new process to create health-literate labeling
4-4 Personalized cover page of an after-hospital care plan
4-5 Medication instructions in an after-hospital care plan
4-6 Evaluation results for the medication section of the after-hospital care plan
4-9 A sample Polyglot Systems Meducation drug information sheet
4-10 Medication discharge instructions to improve medication adherence
4-11 Mobile patient education for the Spiriva inhaler
4-12 Different pictograms for illustrating the same dose
4-13 A visual presentation of tapering instructions
5-1 The process/knowledge model of health literacy
Acronyms and Abbreviations
| AAMI |
Association for the Advancement of Medical Instrumentation |
| AHRQ |
Agency for Healthcare Research and Quality |
| ANSI |
American National Standards Institute |
| EHR |
electronic health record |
| FDA |
U.S. Food and Drug Administration |
| FFS |
fee-for-service |
| HCAHPS |
Hospital Consumer Assessment of Healthcare Providers and Systems |
| HHS |
U.S. Department of Health and Human Services |
| IEC |
International Electrotechnical Commission |
| ISO |
International Organization for Standardization |
| NVS |
Newest Vital Sign |
| PEMAT |
Patient Education Materials Assessment Tool |
| Project RED |
Reengineered Discharge Program |
| QR |
Quick Response |
| UMS |
Universal Medication Schedule |
| UPMC |
University of Pittsburgh Medical Center |
| USP |
U.S. Pharmacopeia |
