Limited health literacy is a barrier to medication reconciliation in ambulatory care

BACKGROUND: Limited health literacy may influence patients' ability to identify medications taken; a serious concern for ambulatory safety and quality. OBJECTIVE: To assess the relationship between health literacy, patient recall of antihypertensive medications, and reconciliation between patient self-report and the medical record. DESIGN: In-person interviews, literacy assessment, medical records abstraction. PARTICIPANTS: Adults with hypertension at three community health centers. MEASUREMENT: We measured health literacy using the short-form Test of Functional Health Literacy in Adults. Patients were asked about the medications they took for blood pressure. Their responses were compared with the medical record. RESULTS: Of 119 participants, 37 (31%) had inadequate health literacy. Patients with inadequate health literacy were less able to name any of their antihypertensive medications compared to those with adequate health literacy (40.5% vs 68.3%, p=0.005). After adjusting for age and income, this difference remained (adjusted odds ratio [OR]=2.9, 95% confidence interval [95%CI]=1.3-6.7). Agreement between patient reported medications and the medical record was low: 64.9% of patients with inadequate and 37.8% with adequate literacy had no medications common to both lists. CONCLUSIONS: Limited health literacy was associated with a greater number of unreconciled medications. Future studies should investigate how this may impact safety and hypertension control.