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Text 1.

Patients Struggle to Continue Taking Meds after

Hospital Discharge
Kate H. Gamble, Senior Editor
Published Online: Thursday, August 25, 2011

A.Following discharge from a hospital, patients are at an increased risk of

unintentional discontinuation of commonly prescribed chronic disease
medications, according to a study published in the Journal of the American
Medical Association, which found that the risk is even greater for patients
who were admitted to an intensive care unit. Transitions in care are
vulnerable periods for patients during hospitalization. Medical errors during
this period can occur as a result of incomplete or inaccurate communication
as responsibility shifts from one physician to another, the authors wrote.
B. In the study, Chaim M. Bell, MD, PhD, of St. Michaels Hospital and the
Institute for Clinical Evaluative Sciences, Toronto, and colleagues examined
the rates of unintended discontinuation of common medications for chronic
diseases after acute care hospitalization and ICU admission. They used
administrative records from 1997 to 2009 of all hospitalizations and
outpatient prescriptions in Ontario, Canada, which included 396,380
patients aged 66 and older with continuous use of at least 1 of 5 medication
groups prescribed for long-term use: statins, antiplatelet/anticoagulant
agents, levothyroxine (medication for thyroid problems), respiratory
inhalers, and gastric acid-suppressing drugs. Rates of medication
discontinuation were compared across 3 groups: patients admitted to the
ICU, patients hospitalized without ICU admission, and nonhospitalized
C.The researchers found that patients admitted to the hospital were more
likely to experience potentially unintentional discontinuation of medications
than controls across all medication groups examined. The highest rate of
medication discontinuation occurred in the antiplatelet or anticoagulant
agent group (19.4%). In this group, there were 552 patients (22.8%) with an
ICU admission who discontinued these medications after hospital discharge.
In contrast, of the patients not admitted to the hospital who were receiving
antiplatelet or anticoagulant medications, only 11.8% experienced
medication discontinuation at 90 days. The respiratory inhaler group had the
lowest rate of medication discontinuation (4.5%).

D.Dr. Bell and colleagues also found that there was an increased risk of
medication discontinuation in patients with an ICU admission compared with
nonhospitalized patients in 4 of the 5 medication groups. Long-term data
echoed similar results, as a 1-year follow-up of patients who discontinued
medications showed an elevated risk for the secondary composite outcome
of death, emergency department visit, or emergent hospitalization in the
statins group and in the antiplatelet/anticoagulant agents group.

E.Better communication and a system-based method have been

advocated as possible solutions to improve medication continuity and

safety, wrote the authors, noting that these strategies can range from
customized integrated hospital computer systems to simple preprinted
forms. However, their success is contingent on including all relevant
clinicians and the patients themselves. Formal programs such as medication
reconciliation and standard discharge summaries can provide a means to
improve interdisciplinary communication, including with primary care
clinicians. Identification of high-risk patients and transfers in care may help
improve program efficiency and focus valuable resources.

Text 1. Patients Struggle to Continue Taking Meds after Hospital Discharge

I.Mark your answers on the answer sheet.

I.The text is divided into sections: A,B,C,D and E. Using EACH
LETTER ONLY ONCE, identify which section in the text
1.Describes a study carried out with patients who were hospitalized and a
control group
2.alerts for the







3.proposes a possible solution to the problem

4.states that patients who stopped taking medicine are at a higher risk of
death and emergency hospitalization the method used in the study was the comparison of administrative
records from three groupsof patients.

II.Are these statements true (T) or false (F) according to the

6.Most patients taking anticoagulant medication discontinue its use
after hospitalization.
7.Less than 5% of the patients using respiratory inhalers discontinued
its use after being admitted to a hospital.
8.Patients admitted to ICU are at a lower risk of medication

III.What do these words or terms mean in the text:









Text 2. Helping Seniors Understand Their Medications

As part of Older Americans Month, the American Pharmacists Association
(APhA) has provided a list of topics that senior citizens and their families
should regularly discuss with pharmacists to gain better knowledge of the
medications they are taking. As the most accessible health care provider,
pharmacists are equipped to discuss many of the issues that medications
may present for older patients.

Pharmacists can play a pivotal role in helping these patients sort out any
confusion they may have about the medications they are taking, answering
questions, and assisting in better decision making. This relationship,
according to APhA, can provide seniors with more control over their
medications and can result in fewer side effects and interactions, which in
turn can lead to improvements in quality of life. Some of the topics seniors
and their caretakers and family members should discuss with pharmacists to
help improve their understanding of medications are as follows:
Understanding medicationshow to correctly take them, what they do,
and why they are being taken.
Understanding brand vs. generic prescription medications, as well as overthe-counter (OTC) and herbal supplements and how they may interact with
one another.
Reading a label correctly, including warnings and dosing information.
Overcoming loss of appetite, dry mouth, insomnia, or other dangerous
age-related medication side effects.
Taking medication at the appropriate time throughout the day and that
medications known side-effects.

Saving money at the pharmacy, including opportunities through patient

assistance programs.
Providing many of the vaccinations that older patients may need and may
not be aware of.
Various screenings including blood pressure, cholesterol, blood glucose
and osteoporosis.
APhA encourages all patients, especially older patients, to maintain regular
visits with all of their health care providers, fill all their prescriptions with
one pharmacy whenever possible, get to know their pharmacist on a first
name basis, carry an up-date medication and vaccination list, and share all
medical information with each of their care providers.

Text 2. Helping Seniors Understand Their Medications
I.Mark your answers on the answer sheet.
I.The text is divided into sections: A,B,C,D and E. Using EACH
LETTER ONLY ONCE, identify which section in the text
11.staters that a pharmacists association has prepared a list of things old
people can discuss with their pharmacists.
12.states that one way pharmacists can help senior patients is by providing
some simple exams.
13.argues that it is best to buy all your medication at a single drugstore and
get to know the pharmacist.
14.explains that pharmacist can help clear any doubts patients have about
their medication.

II.What do these words refer to in the text:




a)Senior citizens`




b)medical care




Text 3:Free Meds Offer Significant Benefits for Heart Patients

A.Heart attack patients who received free medications demonstrated lower rates of
rehospitalization compared to those who had prescription co-pays. These patients,
__________, did not experience a reduction in the rate of revascularization to reopen
clogged arteries, according to research presented at the American Heart
Associations Scientific Sessions 2011.In the study, ________ is published in The New
England Journal of Medicine, researchers also determined that patients who
received free medications were more likely to take their medicine as prescribed.


a myocardial infarction, patients are often sent home with several

prescriptions to prevent further heart problems. However, many patients fail to take
their medications _________ prescribed, researchers found .In a study of 5855 heart
attack patients, 2845 paid nothing for statins and other medications shown to
improve outcomes after a myocardial infarction. Those patients were 4% to 6%
more likely to take them than the 3010 patients who had co-pays.

C.Researchers found that 17.6% of those with free medications had a major cardiac
event (heart attack, angina, stroke, or heart failure) or underwent revascularization,
compared to 18.8% of those with co-pays. This difference was not statistically
significant; however, __________ assessed separately from revascularization, there
was a significant reduction in the rate of major cardiac events. After about a year,
the rate of heart attacks, angina and heart failure dropped 14% in the patients
getting free medications.Further, patients saved 26% on their overall out-of-pocket
healthcare costs. Because they had improved health, they paid fewer copayments
for doctors visits in addition to the savings from no drug co-pays, researchers said.


adherence is very low and thats a major public health problem,

said lead author Niteesh K. Choudhry, MD, PhD, associate professor at Harvard
University and associate physician at Brigham and Womens Hospital. There are

many reasons why only half of patients adhere to long-term therapies and cost
appears to be one reason, even for those with insurance.Based on the studys
findings, Dr. Choudhry recommends that insurers consider paying for the total cost
of heart medications after a heart attack The strategy we evaluated improves
quality of care, increases medication adherence, makes healthcare more affordable
for patients and doesnt appear to increase overall spending, and so appears very
attractive for patients and payers, he said in a statement. We have spent billions
of dollars developing medicines and testing them. Making sure patients actually
take those medicines is crucial.

I.The text is divided into sections A,B,C and D. Using each

letter only once, identify which sections of the text
18.describes a study that found out that patients who pay for their
medication are less likely to adhere to the treatment
19.shows that the price of medicaments may be a reason for low
adherence to treatments
20.states that patients who receive heart drugs freely tend to need
less hospitalization
21.Patients getting free medication had their health care costs
reduced to half.

II.Choose a word from each of the following sets to fill in the

numbered blank spaces in the text.
22.___________(line 2)
b)in addition

23._________(line 4)

24.__________(line 8)
d)how long

25._________(line 14)

III.What do these words refer to in the text:



Text4.Understanding Obama Health Care Reform Health

A.As part of Obama's campaign platform, the president promised to
make an affordable healthcare for all Americans. ______ the number of
Americans not insured continues to increase and premiums increase, the
present administration says that the time to make a better system will
B.Obama Health Care Reform is part of the Business Exchange proposed
by James Rickman. In March 2010, the president gave a speech in the
rally at Pennsylvania saying the needs of health insurance reform, also
calling the Congress to hold final up or down votes in reform. As of 2011,
legislation remains contentious with states challenging federal courts
and the majority of voters opposed.
C.Health Care Reform law is comprise of health related provision to take
effect several years, including the expansion of Medicaid eligibility for
individuals making up 133 percent of federal poverty levels, subsidizing
the insurance premiums for individuals making up 400 percent of FPL, so
their maximum out of pockets payment for yearly premiums would on
sliding scale of 2% - 9% of their income, offering incentive for the
business to give health care benefits, leaving out denial of coverage and
the denial of claims based in the pre-existing annual coverage capitals
and support for the medical research.
D.Beginning in the year 2014, the Obama Health Care Reform would
forbid insurers to deny their coverage to sicker applicant and imposing
special conditions _________ higher premiums or payments. Healthcare

expenditures are highly focused in most expensive 5 percent of

population of spender accounts for just half or aggregate healthcare
spending, while the bottom of 50 percent spenders account for just 3
percent, this means that the insurer gains to have from preventing the
sick outweigh any possible gains from care managing.
E.2010 acts needs insurers to cover cost, needing at least 80 percent of
the premiums should be spent in the medical care of the quality
improvement. It also requires full coverage for immunizations and
screenings and through prohibiting life time and yearly caps. Few
insurance schemes have been considered to be insufficient. Obama
Health Care Reform offered Medicare A and B coverage. Under the
revised contract during the previous presidency of Bush, Medicare was
over paying the private insurer. They estimated $12 billion per year of
over payment. It means that the average individual was paying $90
each year for traditional Medicare as subsidy in private insurer. The
systems conserve private insurance _________ private healthcare
providers and provide more subsidies to allow the poor to purchase

I.The text is divided into sections A,B,C,D and E. Using each

letter only once, identify which sections of the text

28.states that the reform incentives companies to offer their staff

medical plans.
29.says that there is a lot of opposition to the law.
30.argues that health insurance providers will not have losses that the plan will benefit the poor, who will be able to have
an insurance plan
32.states that a large number of people do not have insurance,
therefore the need for the reform

II.Are these statements true (T) or false (F) according to the


33.In 2014 health care providers will be forced to offer coverage to

the very sick people
34.Under this reform, health plan providers will have to offer full
coverage to all kinds of examinations and vaccinations

III.Choose the best word to replace the blank space in the



36.______(line 18)

37._______(line 32)
b)as well as
d)in addition

Iv.What do the underlined words or terms refer to:

38. their
b)poverty levels
d)health reform

39. it (line 25)

a)medical care
b)2010 act
c)none of the above

40. it (line 30)

b)12 billion
c)private insurer
d)none of the above