Revista de Cuidados Farmacêuticos e Sistemas de Saúde
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Impact of Clinical Pharmacist Intervention on Medication Adherence and Disease related Knowledge among Patients with Low Health Literacy in Puerto Rico

Franccesca Elaine Soto Santiago, Kyle Melin

Introduction: Patients living in central rural towns in Puerto Rico comprise one of the most critical at-risk populations of limited health literacy due to the higher incidence of poverty and lower educational levels within this sector. The objective of this study was to assess the effect of clinical pharmacist intervention on medication adherence and disease knowledge among patients with low health literacy from the municipalities of Adjuntas and Lares in Puerto Rico. Methods: This study used a prospective analysis of patients referred for a pharmacist educational intervention in two rural outpatient clinics of Puerto Rico. Thirteen patients with inadequate glycemic control (A1C ≥ 9%), uncontrolled hypertension (≥ 150/90) or medication non-adherence (PDC < 0.80) were referred to the study by a primary care physician. Initial health literacy was measured by the Spanish Short Test of Functional Health Literacy in Adults (S-TOFHLA). The primary outcome of the study was average change of medication adherence assessed by calculating the proportion days covered (PDC) at baseline and at the end of the study period. The secondary outcome of the study was average change in patient’s disease-related knowledge using the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument measured at baseline and at the end of the study period. The average change on hemoglobin A1C and blood pressure was also calculated between baseline and post-intervention evaluation. Results: The study showed a significant improvement in disease-related knowledge and modest improvements in disease clinical markers and medication adherence. Adherence improved from an average PDC of 0.59 to a PDC of 0.64. Disease related knowledge improved from an average 58% to an 83% in questionnaire scores. Conclusion: Due to small patient recruitment and the lack of statistically significant data in this study, further research with a larger patient population is required to accurately identify the potential benefits of these interventions.