Language, Literacy, and Communication Regarding Medication in an Anticoagulation Clinic: Are Pictures Better Than Words?

Abstract

Despite the importance of clinician-patient communication for safe medication management, little is known about rates and predictors of medication miscommunication. Measuring rates of miscommunication, as well as differences between verbal and visual modes of assessment, can inform efforts to more effectively communicate about medications. The researchers performed a study among long-term warfarin users in an anticoagulation clinic to assess concordance between patient and clinician reports of patient warfarin regimens. Bilingual research assistants asked patients to verbalize their prescribed weekly warfarin regimen, and identify this regimen from a digitized color menu of warfarin pills. The researchers obtained clinician reports of patient regimens from chart review. Patients were categorized as having regimen concordance if there were no patient-clinician discrepancies in total weekly dosage. Quantitative differences in concordance to the regimen were assessed verbally or visually. The researchers then examined whether verbal and visual concordance rates varied with the patient's language and level of health literacy. Fifty percent of patients achieved verbal concordance and 66 percent achieved visual concordance with clinicians regarding the weekly warfarin regimen (P<0.001). In adjusted models, being a Cantonese speaker and having inadequate health literacy were associated with a lower odds ratio for verbal concordance compared to being an English speaker and having adequate health literacy. Neither language nor health literacy was associated with visual discordance. The authors conclude that clinician-patient discordance regarding patients' warfarin regimen was common, but occurred less frequently when patients identified their regimen with a visual aid. Visual aids may improve the accuracy of medication assessment and may be especially beneficial for patients with communication barriers.