Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients

Abstract

Objective Our objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation. Methods Data collected during a 6‐month prospective quality assurance intervention was compared with data from a prior 6‐month period. Interventions included 1) encouraging questions, 2) teach‐back communication, and 3) brown‐bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression. Results During the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach‐back communication was performed in more than 90% of visits. Brown‐bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology‐related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach‐back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE). Conclusion Implementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety‐net clinic, with particularly strong effects seen with teach‐back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real‐world setting.