Limited health literacy is a barrier to medication reconciliation in ambulatory care

J Gen Intern Med. 2007 Nov;22(11):1523-6. doi: 10.1007/s11606-007-0334-x. Epub 2007 Sep 5.


Background: Limited health literacy may influence patients' ability to identify medications taken; a serious concern for ambulatory safety and quality.

Objective: To assess the relationship between health literacy, patient recall of antihypertensive medications, and reconciliation between patient self-report and the medical record.

Design: In-person interviews, literacy assessment, medical records abstraction.

Participants: Adults with hypertension at three community health centers.

Measurement: We measured health literacy using the short-form Test of Functional Health Literacy in Adults. Patients were asked about the medications they took for blood pressure. Their responses were compared with the medical record.

Results: Of 119 participants, 37 (31%) had inadequate health literacy. Patients with inadequate health literacy were less able to name any of their antihypertensive medications compared to those with adequate health literacy (40.5% vs 68.3%, p = 0.005). After adjusting for age and income, this difference remained (adjusted odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 1.3-6.7). Agreement between patient reported medications and the medical record was low: 64.9% of patients with inadequate and 37.8% with adequate literacy had no medications common to both lists.

Conclusions: Limited health literacy was associated with a greater number of unreconciled medications. Future studies should investigate how this may impact safety and hypertension control.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care*
  • Antihypertensive Agents / therapeutic use*
  • Community Health Centers*
  • Educational Status*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Services Research
  • Humans
  • Hypertension / drug therapy*
  • Male
  • Michigan
  • Middle Aged
  • Patient Education as Topic


  • Antihypertensive Agents