Using an Intervention Adapted to the Health Literacy Level to Improve Adherence to Medical Recommendations (ILIADE)

Using an Intervention Adapted to the Health Literacy Level to Improve Adherence to Medical Recommendations

Impact of a Strategy Dedicated to Low Health Literacy Level Patients to Improve Their Understanding and Ownership of the Discharge Prescription in Cardio-vascular Diseases

Health literacy is the ability to access, understand, evaluate and apply information in order to communicate with health professionals and understand health instructions but also, promote, maintain and improve health throughout life. Health literacy is known as a health determinant. Level of Health Literacy (HL) is low or limited within 47% of interrogated people in Europe, resulting in an inability to understand and/or use written texts and digital concepts about one's health. There is a demonstrated link between low HL and low therapeutic adherence, an increase in the number of re-admissions, and more generally poor health or survival that is even more limited. An association between low LS and higher health care costs has also been reported in the USA and Switzerland. WHO highlight the central role of LS in health inequalities, regardless of the region of the world. We chose to conduct this study in patients hospitalized for an acute cardiovascular event: acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF), as these patients have cumulative risk factors for misuse and medication errors. They are hospitalized in emergency, for shorter and shorter periods and are discharged with complex drug treatments. The data show that the return home after acute hospitalization for these conditions is a particularly high-risk period for medication errors and misuse, especially with low HL. The proportion of patients with preventable ADR in the weeks following their return home ranges from 23% to 30% and nearly 60% are re-hospitalized within 6 months. Our hypothesis is that in patients hospitalized for AMI or ADHF with low HL levels, information on discharge treatment using appropriate tools and techniques will reduce the risk of patient-related medication errors or misuse within 30 days of discharge. The purpose of this study is to develop an educational intervention model adapted to low HL levels and routinely feasible, even in case of short stays, in complementarity with traditional therapeutic education programmes that require higher investments and are therefore not accessible to all patients. This innovative approach could then be applied to a large number of chronic diseases.

Literacy, Cardiovascular Diseases, Interventional study, Randomized Controlled Trial, Tertiary prevention, Health promotion

Interventional educational toolkit specific to low Health Literacy patients, designed with patients and health professionals.

Two interviews between the patient and the nurse trained for the study: before discharge from hospital and a telephone reminder between 3 and 5 days after discharge. First interview: the nurse will evolve using tools developed in the first phase of the study. The nurse will provide detailed personalized information on the patient's discharge order and illness and the action to be taken depending on the potential situations the patient may encounter. Telephone interview: 3 to 5 days after discharge, the nurse will repeat the elements of the first interview with the patient to verify that the information has been properly understood and retained and that the patient is able to adopt appropriate behaviors in high-risk situations.

This criterion is defined as the proportion of patients who have made a medication error or misuse, with or without a clinical consequence. We will focus on patient-related medication errors and misuse, i.e. non-compliance with prescription (shorter or longer treatment time, dosage changes, self-medication, etc.), based on the definition proposed by Kripalani et al. An adjudication committee composed of three independent experts will be responsible for defining the potential severity of drug errors or misuses related to the main judgement criterion. Data on primary endpoint will be collected by a clinical researcher, blinded to the randomization group, using a standardized questionnaire administered during the 30-day telephone interview. The patient will be asked the names of the treatments, how he/she took them (number of units per intake, frequency of intake,...), self-medication taken and medical follow-up (medical consultations, biological follow-up,...) over the past 30 days.

Inclusion Criteria: Inadequate health literacy level according to the Brief Health Literacy Screening questionnaire Age greater than or equal to 18 years Hospitalization for acute myocardial infarction (myocardial infarction with or without ST segment elevation) or acute decompensated heart failure (systolic or diastolic) Return home after hospitalization Affiliated with a health insurance plan Exclusion Criteria: Short-term vital prognosis Bipolar disorders, active psychoses Severe dementia Inability to manage drug treatment alone Institutionalization at the end of hospitalization