This study found an alarming level of prevalence of poor medication self-management among patients on ambulatory care. Many patients had difficulties on reading and interpreting what has been written on the prescription matching with what they are carrying on the hand. The medication self-management model has six tasks i.e. fill, understands, organize, take, monitor and sustain [7]. The scope of this study was to measure the ability of patients to understand the prescription, organizing the plan to take medication as prescribed, ability to open a container and take right number or amount of the medications, patient’s ability to monitor for side effects or warnings or interactions and the ability to sustain taking medication by understanding timing and duration of the regimen. Understanding the regimen on the prescription, taking the correct number or amount of dose, and timing of doses and duration of the regimen are areas which troubled many participants in this study. These findings concurred with what was observed in India after Gupta and colleagues conducted a study on the impact of patient information leaflets on medication adherence. Many patients had difficulties in timing of taking medications and duration of the regimen [11]. It is possible that, poor understanding of what has been written on the prescription or narrated by the pharmaceutical personnel is the root cause of poor performance on many of the tasks as testified in the work of Wolf and colleagues [12]. Majority of study participants reported to be secondary level graduates. Therefore, tough the study didn’t focus on associated factors; it is most probable that education level of the study participants had a major influence of MMC as it was reported in study by Kripalani et al [6] and in the study which was conducted in Ethopia[13].
With regard to medication information seeking behavior, this study has shown that more than half of the patients were not eager to ask their healthcare provider issues concerning their medications. This finding second what was observed in study which was conducted in South Africa [14].Tough it was not in the scope of this study, the reason may be uncomfortable platform of hospital pharmacy facilities, long waiting queue, unfriendly and brief contact time. All these have impact on ability of the patient to comprehend with written and verbal communication which play big role in understanding the regimen [15].
In this study many patients were not aware of the side effects or warning label or contraindication or precaution or drug interactions for their medications on hand. This is in line with findings from review by Bailey and colleagues [7] and study conducted in India [11]. This increase the risk of medication errors and adverse drug reactions which may jeopardize adherence to prescribed regimen. Most probable low level of education among study participants and brief contact time with healthcare providers may be the possible reasons [16]
Majority of the participants had poor ability to pick the correct number or amount of medications. The key reason may still be the same a poor understanding of the prescription regimen means poor understanding of the downstream tasks [6][7].
Owing to detrimental consequences of poor MMC different implementation researches have come out with solution to mitigate the problem. Whenever possible, pharmaceutical personnel should use the principle of universal assumption i.e. assuming all patients have poor MMC [17]. But to maximize resources allocation identification of patient with poor MMC is the first important step. Normally these patients prefer no company, fail to establish rapport, tend to just release the written papers for a caregiver to read and take actions, use initials instead of signature and have unique ways (e.g. color, symbols) of identifying pills [6][17].
Therefore, pharmaceutical personnel should identify poor MMC patients and exercise clear health communication skill strategies using plain language and teach-back method [18]. Also, proper medications packaging, labeling and dispensing using reading materials and language or symbol understood by patient [19] have proved effective to counter limitation of MMC [20]. Furthermore, intensive counseling and close follow-up are very important to patients with any MMC limitation [21][22]. Volunteered social support on emotional, medication information, health reminder and tangible support are very important to patients with poor MMC because of their reluctance to seek help [23]. Continual training of healthcare providers on awareness, sensitization and collaboration to address the impact of poor MMC is important [24].