title: Challenges in ambulatory resident education: medication knowledge in disadvantaged patients.
abstract: BACKGROUND
  Medication mismanagement results in 10% of hospitalizations and 50% of therapeutic failures. Little is known about low-income patients' medication knowledge, a group disproportionately affected by chronic disease and often cared for by residents. This study assesses patients' medication knowledge, discrepancies between the patient and chart, and preferences for medication information in the training setting.
  
  
  METHODS
  This cross-sectional study evaluated adults receiving care in two teaching clinics. Patients were asked their medications' names, doses, frequencies, indications, and side effects (SE) and what information they needed to take medications safely. Charts served as a medication reference standard.
  
  
  RESULTS
  Most patients were female, nonwhite, had > or = one chronic condition, took a median of five drugs, and saw three different residents in the same clinic. Despite six clinic visits annually, patients could cite only 50% of their medication names, frequencies, and indications, 25% of doses, and 0% of SE, yet they paradoxically responded that SE knowledge was essential for safety. Forty-three percent reported > or = one medication that was undocumented in the chart. There were 84 total discrepant medications of which 63% were prescription only.
  
  
  CONCLUSIONS
  Low-income patients had poor medication knowledge despite good clinic access. Discontinuity of resident providers may contribute to this phenomenon. Poor global knowledge, the large discrepancy between reported and charted medications, and lack of SE knowledge threaten medication adherence, achievement of treatment goals, and patient safety.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8088, USA. nancy.kim@yale.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Kim
authors.forename: Jaideep
authors.initials: J
authors.lastname: Talwalkar
authors.forename: Eric
authors.initials: E
authors.lastname: Holmboe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003237:Connecticut; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations; D011203:Poverty
chemical_list: D004364:Pharmaceutical Preparations