Kimberly S. Plake

Effect of health literacy on drug adherence in patients with heart failure.

To assess the effect of health literacy on drug adherence in the context of a pharmacist‐based intervention for patients with heart failure.

Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence

BACKGROUND It has been argued that only 12% of adults have the necessary health literacy to manage their health care effectively, which can lead to difficulties in self-care activities, such as medication adherence. Prior research suggests that health literacy may influence knowledge, self-efficacy and self-care, but this has not been fully examined. OBJECTIVE To test a model to explain the relationships between health literacy, heart failure knowledge, self-efficacy, and self-care. METHODS Prior to receiving clinic-based education, newly referred patients to 3 heart failure clinics completed assessments of health literacy, heart failure knowledge, self-efficacy, self-care, and demographics. Structural equation modeling was completed to examine the strength of the inter-variable relationships. RESULTS Of 81 participants recruited, data from 63 patients were complete. Health literacy was independently associated with knowledge (P < 0.001). Health literacy was not related to self-care. Self-efficacy was independently-associated with self-care adherence (P = 0.016). No other relationships were statistically significant. The model had good fit (comparative fit index = 1.000) and explained 33.6% of the variance in knowledge and 27.6% in self-care. CONCLUSIONS Health literacy influences knowledge about heart failure but not self-care adherence. Instead, self-efficacy influenced self-care adherence. Future research should incorporate additional factors that may better model the relationships between health literacy, knowledge, self-efficacy, and self-care.

Self-Efficacy and Educational Interventions in Heart Failure: A review of the Literature

Purpose:The purpose of this study was to conduct a systematic review of the literature to better understand how to structure educational interventions for heart failure patients to improve their self-efficacy for self-care behaviors. Methods:A computer search of the literature from 1966 through May 2009 was conducted, yielding 84 articles. All articles were reviewed in relation to the search criteria, resulting in 12 articles that were evaluated. Results:Each of the reviewed studies used an intervention plus education to improve self-efficacy. Self-efficacy was a primary outcome for 7 of the studies and a secondary outcome for 5 of the studies in this literature search. Both short- and long-term interventions can improve self-efficacy demonstrating that the duration of the intervention can vary and still be successful. Conclusions:Existing evidence suggests that it is not the amount of education (number of sessions/length of sessions) that improves self-efficacy, but some other factor or factors that remain unknown at present. Education delivery costs, flexibility, and the ability to more easily integrate new discoveries need to be explored. Interventions that include components specifically geared toward increasing self-efficacy for self-care in patients with heart failure are needed. Learning activities need to be incorporated into patient education programs to provide practice time that may result in behavior changes. The opportunity to practice self-care behaviors within the context of the education provided to those with heart failure, along with ongoing support, needs to be explored in future studies.

Health Literacy and Self-Care of Patients with Heart Failure

Background and Research Objective:Todays complex healthcare system relies heavily on sophisticated self-care regimens. To navigate the system and follow self-care protocols, patients must be able to understand and use health information, which requires health literacy. However, nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Understanding how to effectively care for ones self is thought to improve heart failure symptoms and patient outcomes, but little is actually known about how health literacy influences self-care in patients with heart failure. The purpose of this pilot study was to examine the relationship between health literacy and self-care of patients with heart failure. Subjects and Methods:Patients with a diagnosis of heart failure were recruited from a variety of community settings. Participants completed the Short-Form Test of Functional Health Literacy (measured health literacy), the Self-care Index of Heart Failure (measured self-care maintenance, management, and confidence), and a demographic questionnaire. Spearman ρ correlations were used to assess the strength of the relationship between health literacy level and self-care scores. Results and Conclusions:Among the 49 participants recruited, health literacy was positively related to self-care maintenance (Rs = 0.357, P = .006). Health literacy had a negative relationship with self-care management (Rs = −0.573, P = .001). There was no association between health literacy and self-care confidence (Rs = 0.201, P = .083). This project provides preliminary data regarding the association between health literacy and self-care in heart failure, showing support for higher health-literate patients performing more self-care maintenance, which has been shown to improve patient outcomes in heart failure. Patients with higher health literacy trended toward having greater self-care confidence, which can increase the likelihood of performing self-care, but this finding was not statistically significant. It was unexpected to find that lower health-literate patients performed more self-care management.

Patient Safety Instruction in US Health Professions Education

Objective. To describe patient safety instruction in health professional curricula, including medicine, nursing, pharmacy, and dentistry. Methods. A systematic review of the literature from 1966 through 2010 was conducted using 6 databases and based on 3 search criteria: safety management, patient safety, and curriculum. Results. One hundred fifty-four articles were identified and 23 met inclusion criteria. A variety of educational methods have been used in health profession curricula to promote patient safety including lectures, workshops, objective structured clinical examinations, standardized patients, simulation exercises, root cause analysis, quality assurance projects, and other interactive learning methods. The development of patient safety curricula has been primarily discipline-specific, with little interdisciplinary research found. Conclusions. Safe, patient-centered care is directly influenced by the quality of education that healthcare professions students receive. From this literature review, research is needed to guide curricular change, specifically focusing on instructional methods and interdisciplinary collaborations.

Validation of an empathy scale in pharmacy and nursing students.

Objective. To validate an empathy scale to measure empathy in pharmacy and nursing students. Methods. A 15-item instrument comprised of the cognitive and affective empathy domains, was created. Each item was rated using a 7-point Likert scale, ranging from strongly disagree to strongly agree. Concurrent validity was demonstrated with the Jefferson Scale of Empathy – Health Professional Students (JSE-HPS). Results. Reliability analysis of data from 216 students (pharmacy, N=158; nursing, N=58) showed that scores on the empathy scale were positively associated with JSE-HPS scores (p<0.001). Factor analysis confirmed that 14 of the 15 items were significantly associated with their respective domain, but the overall instrument had limited goodness of fit. Conclusions. Results of this study demonstrate the reliability and validity of a new scale for evaluating student empathy. Further testing of the scale at other universities is needed to establish validity.

Impact of the Geriatric Medication Game on Pharmacy Students’ Attitudes Toward Older Adults

Objective. To examine the impact of participation in the Geriatric Medication Game on pharmacy students’ perceptions of and attitudes toward older adults and familiarity with common disabilities that affect them and the process of seeking health care. Design. In the game, first-year pharmacy students “became” older adults during a 3-hour pharmacy practice laboratory. They were given aging-related challenges (eg, impaired vision or mobility) and participated as patients in simulated healthcare scenarios, such as a visit to a physicians office and a pharmacy. Assessment. After playing the game, students completed a 5-question reflection about their experiences and attitudes toward older adults. Content analysis was performed to identify themes from 4 years of student (n = 625) reflections. Predominant themes included: improved attitudes toward older adults, better understanding of patient experiences, and increased willingness to provide assistance. Conclusions. Incorporating the Geriatric Medication Game into the pharmacy curriculum may facilitate students’ understanding of the challenges that older adults face and improve future interactions.

A Graduate Student Mentoring Program to Develop Interest in Research

Objective. To assess the impact of a graduate student mentoring program on student interest in research and postgraduate education and on graduate student confidence in mentoring. Methods. Undergraduate and pharmacy students (mentees) and graduate students (mentors) were matched and participated in the study, which required them to engage in at least 2 discussions regarding research and careers. Mentees completed a pre- and post-assessment of their perceptions of research, postgraduate training plans, and perceptions about mentors. Mentors completed a pre- and post-assessment of their perceptions about themselves as mentors and their confidence in mentoring. Results. Although there were no significant differences among the mentees’ perceptions of research or the mentors’ confidence in mentoring, qualitative analysis indicated that the mentees’ perceptions of research improved and that the mentors believed their mentoring skills improved. Conclusions. Based on the results of the qualitative analysis, implementing a graduate student mentoring program may help improve students’ perceptions of research and graduate students’ confidence in mentoring, which could increase student interest in postgraduate education and prepare mentors for future leadership roles.

An Introductory Pharmacy Practice Experience on Improving Medication Adherence

Objective. To evaluate the impact of a medication adherence activity on introductory pharmacy practice experience students’ perceptions of patient adherence as well as student development of empathy and confidence in patient counseling. Design. Students participated in a personal medication simulation using an automated medication dispenser. Students then identified a patient with nonadherence and provided counseling on use of the dispenser. After 4 to 6 weeks, students interviewed the patient about their experience with the dispenser and assessed changes in adherence. Assessment. One hundred fifty-three students completed the assignment and 3 surveys instruments. Following the experience, the majority of students agreed or strongly agreed that they developed more empathy for patients with multiple medications and felt confident counseling a patient in the use of a dispenser (92.0% and 88.2%, respectively). Most students (91.4%) reported feeling that their patient education session was successful. Conclusion. An introductory pharmacy practice experience involving an automated medication dispenser and patient counseling to improve medication adherence resulted in the development of empathy and improved student confidence.

Pharmacy Quality Alliance: Five Phase I demonstration projects: Descriptions and lessons learned

OBJECTIVES To describe the five Phase I Pharmacy Quality Alliance (PQA) demonstration projects and discuss lessons learned across the projects. DESIGN Descriptive nonexperimental study. SETTING United States from July 2008 to November 2009. PARTICIPANTS Community pharmacies from five states. INTERVENTION Pharmacies viewed their performance scores on a reporting website and provided feedback. MAIN OUTCOMES MEASURES Pharmacy performance scores and pharmacist feedback about the scores and reporting websites. RESULTS Considerable variation was found in the pharmacy performance scores. Some pharmacies did not have enough patients taking medications that were included in specific performance measures. Use of a website to report pharmacy performance was feasible across several different approaches. PQA has developed measures of pharmacy performance that can be used in programs intended to report pharmacy performance. CONCLUSION It is feasible to calculate pharmacy performance scores and create Web-based pharmacy performance reports to provide feedback to community pharmacists. Further development of pharmacy performance reporting should occur.