Medicine safety – the importance of health literacy

Communication is key to ensuring patient health literacy.

The prevalence and impact of patient harm have been well reported. The World Health Organization (WHO) estimates that 4 out of every 10 patients experience harm due to medical care received in primary and ambulatory care settings.¹

The most harmful errors are related to the use of medicines, diagnosis and prescribing.² In its Medicine Safety: Take Care report, PSA outlined the extent of medicine-related harm in community, residential aged care and hospital settings, and the enormous cost to the Australian health care system.³

Up to 80% of patient harm can be avoided.² As pharmacists, our role is to ensure patient safety, that is, as WHO states, ‘the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum. An acceptable minimum refers to … the context in which care was delivered weighed against the risk of non-treatment or other treatment’.¹

While the health care system and health care professionals have an important role to ensure patient safety, patients are a key stakeholder, and should be more actively engaged to ensure their own safety when receiving medical care.

‘Engaging patients and families for safer healthcare’ is one of the key strategic areas of WHO’s response to global patient safety.⁴

Clear and understandable spoken and written health communication facilitates patient engagement, and increases their understanding of medical conditions and treatments. Poor health literacy can contribute to issues including limiting patient engagement and involvement in consultations and health care to incorrect and/or inappropriate medicine administration, which can lead to patient harm.

Clear communication that addresses functional health literacy, that is, a person’s ability to find, understand and act on health-related information⁵ and ‘be able to function effectively in everyday [health-related] situations’⁶ is critical in ensuring people can:

• use medicines correctly,
• recognise when a medicine is working and monitor its impact
• recognise and act on adverse reactions (including side effects) during treatment, or on treatment cessation.

Without adequate functional health literacy, patients may have difficulty reading and understanding labels on medicines, written consumer medicine information and instructions given for self-management.⁷

Simply providing information does not increase a person’s health literacy. Health literacy is not an individual person’s issue alone. It is a “system” issue,⁸ reflecting the complexities of navigating the health care system, obtaining and understanding relevant information and the interplay of the system and individual.

Pharmacists can promote patient safety through addressing health literacy by improving health communication. This can be done by⁹:

• ensuring pharmacists as well as team members are educated in the principles of health literacy and plain language
• providing clear and understandable health and medicine information tailored for individuals and/or their carer’s needs
• determining the patient’s (and carer’s) understanding of the information provided
• ensuring individuals have the capacity to self-manage and have support and assistance where required.

Through effective communication, we can support patients, improve health literacy, and ensure patient safety throughout the patient medicine-taking journey.

References 

1. World Health Organization. Patient safety [Internet]. World Health Organization; 2020. At: who.int/patientsafety/en/
2. Auraaen A, Slawomirski L, Klazinga N. The economics of patient safety in primary and ambulatory care: flying blind, OECD Health Working Papers No. 106. Paris: OECD Publishing; 2018. At: www.oecd.org/health/health-systems/The-Economics-of-Patient-Safety-in-Primary-and-Ambulatory-Care-April2018.pdf 
3. Pharmaceutical Society of Australia. Medicine safety: take care. Canberra: PSA; 2019. At: www.psa.org.au/wp-content/uploads/2019/01/PSA-Medicine-Safety-Report.pdf 
4. World Health Organization. Patient safety: Key facts [Internet]. World Health Organization; 2020. At: who.int/news-room/fact-sheets/detail/patient-safety
5. Institute of Medicine. Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004. At: www.ncbi.nlm.nih.gov/pubmed/25009856
6. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000;15(3):259–267. At: academic.oup.com/heapro/article/15/3/259/551108 
7. Parker RM, Baker DW, Williams MV, et al. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med 1995;10(10):537–541. At: www.ncbi.nlm.nih.gov/pubmed/8576769 
8. Rudd RE. Improving Americans’ health literacy. N Engl J Med 2010;363(24):2283–2285. At: www.ncbi.nlm.nih.gov/pubmed/21142532 
9. Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health Literacy Universal Precautions 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; 2015. At: www.ncbi.nlm.nih.gov/pmc/articles/PMC5085259/