title: Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.
abstract: BACKGROUND
  Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices.
  
  
  METHODS
  The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation.
  
  
  RESULTS
  Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised.
  
  
  CONCLUSIONS
  Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems.
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB). bdweiss@u.arizona.edu.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Weiss
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: Angela G
authors.initials: AG
authors.lastname: Brega
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: William G
authors.initials: WG
authors.lastname: LeBlanc
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: Natabhona M
authors.initials: NM
authors.lastname: Mabachi
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: Juliana
authors.initials: J
authors.lastname: Barnard
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: Maribel
authors.initials: M
authors.lastname: Cifuentes
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: Cindy
authors.initials: C
authors.lastname: Brach
authors.affiliation: From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
authors.forename: David R
authors.initials: DR
authors.lastname: West
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D003142:Communication; D057286:Electronic Health Records; D019983:Guideline Adherence / Q000706:statistics & numerical data; D057220:Health Literacy; D006284:Health Plan Implementation; D006801:Humans; D007407:Interviews as Topic; D055118:Medication Adherence / Q000523:psychology; D059065:Medication Reconciliation / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D008923:Missouri; D009819:Office Visits; D019982:Organizational Case Studies; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D010817:Physician-Patient Relations; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D016635:Universal Precautions / Q000379:methods; D016903:Drug Monitoring
keywords: Education of Patients; Health Literacy; Medical Errors; Polypharmacy