The effectiveness of patient medication information leaflets for African-American hypertensive patients

Abstract

The utilization of patient information leaflets (PILs) for medication has increased tremendously over the past decade. While previous research has demonstrated positive health outcomes for patients using theses educational resources, there has been no such research conducted with a group of chronically ill, minority patients. This study assessed two methods of presenting a PIL to African American hypertensive patients attending an ambulatory care clinic in Baltimore, Maryland. At baseline, patient knowledge regarding a newly prescribed antihypertensive medication, satisfaction with medical care, and adherence to the medication regimen were assessed. Patients were randomized into one of four PIL educational groups: (1) easy-to-read (ETR) PIL; (2) ETR PIL with verbal consultation by a pharmacist; (3) standard PIL; or (4) standard PIL with verbal consultation by a pharmacist. The ETR PILs were written at the 5-7th grade level and the standard PILs were written at the 11th grade level. Patient were contacted 7 days and 3 months after receiving an intervention. Level of knowledge about the medication was assessed at the 7 day and 3 month interviews. Patients were asked about their medical care satisfaction and adherence at the three month interview. Medical appointment adherence and blood pressure control were assessed from the medical record measurements for the six month period pre-intervention and post-intervention. Ninety-seven patients were approached to enter the study. Ninety-two patients were recruited and six were lost to follow-up. Based on a maximum score of 6, the ETR PIL group knowledge scores were 5.00 (baseline), 5.25 (7-day), and 5.45 (3 months); the ETR + verbal group scores were 4.91, 5.26, and 5.64; the standard PIL group scores were 4.76, 5.28, and 5.40; and the standard + verbal group scores were 5.04, 5.59, and 5.41, respectively. Although not statistically significant, patient satisfaction scores (maximum of 70) improved for all groups increasing from an average of 53.7 to 55.1, with the exception of the standard + verbal group whose average decreased from 54.5 to 53.8. The medication adherence scores (maximum of 5) improved for the ETR groups by 0.49 and decreased for the standard PIL groups by 0.13, % = 1.93, p = 0.05. Medical appointment adherence decreased for all groups from 92.7% to 89.6%. Patient blood pressure measurements were reduced for the entire sample. There was a significant effect of an ETR PIL in the change of diastolic blood pressure (T = -1.80, p = 0.05) and systolic blood pressure (T = -1.70, p = 0.05) when gender, type of antihypertensive prescribed, adherence with taking the antihypertensive medication, and time diagnosed with hypertensive were controlled for in the statistical model. This research attempted to examine the effect of presenting a PIL, with and without verbal consultation, to a group of patients with a chronic illness. The study suggests that the ETR groups and the PIL + verbal groups tended to have better improvements than the standard PIL and PIL only groups in the patient outcomes studied. This research illustrates that ETR PILs and/or PILs with verbal counseling may contribute to enhanced patient outcomes for a group of inner-city African American hypertensive patients.