Flashcards Improve Medication Adherence in Patients with Diabetes


Low health literacy, financial instability, and lack of social support promote poor adherence.

Poor medication adherence contributes to 125,000 deaths annually, causes up to half of all treatment failures, and costs the US healthcare system $100 billion each year. Low health literacy, financial instability, transportation issues, and lack of social support promote poor adherence.

Low health literacy is associated with impaired ability to take medications appropriately, lower ability to interpret labels and health messages, poorer overall health status, and higher mortality. These patient barriers increase hospitalizations and emergency department visits. Smartphones are nearly ubiquitous, even for patients with no other means of Internet connectivity. Quick response (QR) codes—those square, machine-readable, optical bar codes—allow patients to access education materials using their cell phones.

An article published ahead of print in theJournal of the American Pharmacists Associationhas found that flashcards and QR-coded prescription bottles improve low-health literate patients’ adherence to diabetes, hypertension, and heart failure medications.

The study had a prospective, matched, quasi-experimental design and enrolled 68 primary care heart failure, hypertension, and diabetes patients in a health system in the Dallas, Texas, area. The researchers validated the flashcards and QR-coded videos with the Newest Vital Sign, Rapid Estimate of Adult Literacy Medicine-Short Form, and Short Assessment of Health Literacy-50 health literacy tools.

Patients exposed to the pharmacist-provided study materials had better adherence than unexposed patients at 90 and 180 days. The exposed patients reported satisfaction with the education, greater disease state knowledge, and better understanding of their medications. The flashcards and QR codes are portable, which allows patients to use them when time permits during their daily activities.

Previous studies have found text messaging, mobile applications, and audiobooks improve medication adherence. This study’s flashcards targeted patients with a first-grade education or less, using pictures and videos less than 30 seconds in length. Each 10 seconds in video length beyond 30 seconds decreased views sharply.

The study had some limitations. Its researchers assumed that patients took any medications they picked and did not stockpile. Control group patients took more OTC medications on average, increasing their overall pill load (which may have decreased adherence). In addition, primary care providers enrolled patients into the intervention group, which may have predisposed participants to greater adherence.

Pharmacist-driven flashcards and QR codes for low-literacy patients improved medication adherence considerably. These results can guide future research using novel methods of patient education.

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