How to Improve Medication Adherence Among Visually Impaired Patients

Every day, pharmacists in all care settings work tirelessly to overcome patients’ language, literacy, and financial barriers to improve medication adherence.

However, one of the most under-recognized and under-addressed barriers to safe and effective care is low vision.

Low vision is defined by the American Academy of Ophthalmology as “a loss of eyesight that makes everyday tasks difficult.” It cannot be corrected with eyeglasses, medications, or surgery, and it can encompass the loss of central vision, peripheral vision, contrast sensitivity, depth perception, and visual processing.

Nearly 10 million Americans are blind or visually impaired. Impairment of eye function can have diverse origins, including congenital conditions, injury to the eye (trauma or infection), and diseases like diabetic retinopathy, glaucoma, and macular degeneration.

Age-related macular degeneration holds particular significance as the leading cause of adult blindness, contributing to it more than glaucoma, cataracts, and diabetic retinopathy combined. Although the elderly only represent 13% of the US population, they fill 40% of the more than 4 billion prescriptions filled annually and purchase 35% of all OTC drugs sold annually.

As highly accessible health care providers, pharmacists must prepare to spearhead efforts to increase medication adherence and improve health outcomes among patients with low vision, as well as direct them to resources that will aid them in leading an independent lifestyle.

Medication Adherence Strategies for the Visually Impaired

Low-tech methods involve adjusting what the patient reads. The following are common, easy-to-implement techniques:

· Use large print (at least 16-point font)

· Label AM or PM on the prescription bottle with black marker

· Color code prescription bottles by time of day (red for morning, blue for night)

· Put rubber bands around the bottle or epoxy stickers on caps to indicate frequency of administration

· Don’t use tape on prescription labels to avoid glare

· Use braille labels

Other methods include improved contrast lighting, various magnifiers, and even manufacturer packaging like Zithromax Z-paks and oral contraceptives.

More elaborate approaches encompass both classic and electronic medication organizers. Blister cards and color-coded pill boxes may be enough for many patients, but others may require visual or voice alarms that come with higher-end devices.

Insulin-measuring devices can be chosen based on factors like cost, reusability, insulin unit capability, and whether the patient is on more than 1 type of insulin. Talking glucose meters often accompany these devices and allow patients to more accurately monitor their blood glucose levels.

Talking Devices

Auditory aids are widely available and range from clocks and watches, to blood pressure meters, to thermometers, to liquid-measuring devices. Talking prescription containers allow patients to rely less on reading when it comes to identifying their medications.

For instance, Talking Rx is a pharmacist-developed medication counseling and adherence-enhancing device that provides 60 seconds of verbal directions, which are customizable for each patient and medication. This type of device reduces the need to rely on sight and decreases the possibility of error.

In addition, AudibleRx provides useful information, offering consumer medication information for initial patient education.

Key Take-Home Points

1. Counsel all visually impaired patients on the importance of medication adherence.

2. Clearly describe and help label new medications.

3. Direct your patients to resources, catalogs, and organizations designed for the visually impaired.

4. Ask patients how you can help them stay adherent to their medications.

Some of your visually impaired patients may prefer braille lettering, while others may want auditory aids. In any case, communication and patient preferences are key factors in increasing adherence and maximizing therapeutic outcomes.

Delivery of safe, effective health care involves accommodation of patient- and condition-specific needs. Pharmacists must pioneer efforts to ensure thorough, effective care and medication management for their visually impaired patients.