Coordinated care teams help patients navigate the maze of post-discharge care

Image credit: Getty/Stewart Sutton

Editor’s note: The following is an excerpt from the FierceHealthcare eBook, The Expanding Role of Pharmacy to Cut Readmissions.

Low literacy rates hurt medication compliance, readmission rates and outcomes. And in the U.S., it’s a big problem. Consider that an estimated 21 percent of adults in the U.S. read below a fifth grade level and that just 9 percent score among the highest levels for numeracy, the grasp and application of mathematical skills in everyday living.

It’s little wonder many patients have trouble reading and comprehending their medical prescriptions, let alone guides for managing their chronic conditions. Low health literacy is a major obstacle to effective healthcare delivery.

“There are a lot of patients across the country who are not as medically literate as the healthcare industry thinks they are,” says Kevin Day, an executive resident and associate director of strategic initiatives for the National Community Pharmacists Association (pictured right). 

“When they’re discharged, their health literacy is often underestimated. They leave the hospital loaded down with a lot of information, distressed and worried, and getting back into the flow of things can be difficult,” he says. As a result, medication adherence--a key factor in readmissions--can often prove difficult. 

Confronting relatively low health literacy and medication adherence among its patients--especially congestive heart failure patients who must manage a complex maze of multiple medications--has been a challenge at the 455-bed South Nassau Communities Hospital in Oceanside, New York.

Some of the tactics they’re using:

  • A cardiac health program, where patients are counseled weekly for the first four weeks after discharge by specialist caregivers, including pharmacists, dietitians and nurse practitioners
  • A hotline number that connects patients to those caregivers if they have any questions.
  • Similar counseling for all patients based on risk factors such as prior admissions and for psychiatric patients, who are often at risk for poor medication compliance.
  • Education about when to take--and when not to take--certain medications that could, for example, interfere with sleep.

South Nassau has some 30 pharmacists on staff. Along with discussion about the medications the patient is taking, the pharmacist also tries to create a rapport with the patient.

To read more about how healthcare organizations are helping patients better understand complex self-care regimens and other ways pharmacists can improve patient care, download our free eBook, The Expanding Role of Pharmacy to Cut Readmissions.

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