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Advancing Health Literacy

Advancing Health Literacy

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Advancing Health Literacy

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  1. Advancing Health Literacy Ruth M. Parker, M.D. Professor of Medicine, Pediatrics and Public Health; Emory University

  2. Health Literacy ….“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Parker/Ratzan NLM Complete Bibliographies of Medicine, 2000 Healthy People 2010

  3. Health Literacy Framework

  4. Health Literacy Challenges Most people cannot understand health information they need It’s hard to be a patient these days and it’s easy to mess up An issue of quality—essential for self-management, reducing disparities and reducing costs

  5. Meet Dave.

  6. Meet Dave. • Inconsistently controlled. • No plan for improvement. • Not activated, not empowered. • Inadequate knowledge • Inadequate skills • = Overwhelmed

  7. A $200 Billion Problem HL The business case for health literacy • Inadequate/inaccurate knowledge of disease, treatment • Poorer self-care skills (medication use, monitoring, device use) • Inappropriate health services use Translates to: • Non-adherence • Costly urgent services (Unscheduled visits, ED, Hospitalizations) • Medication Errors & Adverse Events • Poorer outcomes (HTN, Diabetes, CHF, Asthma/COPD)

  8. The Forecast for 2030 From the ETS report America’s Perfect Storm: Three Forces Changing Our Nation’s Future written by Irwin Kirsch, Henry Braun, Kentaro Yamamoto and Andrew Sum. The full report is available from ETS at

  9. Health Literacy Framework (Parker) Health Literacy

  10. A social determinant of health…and more • Essential for reducing costs, improving quality and decreasing disparities Framework for interventions reflects alignment →intervene at system/org. level-examples →What is a “health literate” organization?

  11. Closer look…at medication labels Demands/Complexity Skills/Ability

  12. A Current, Broken “System” of Patient Rx Information Rx Labeling

  13. Medication Labels—At the Intersection of Health Literacy and Patient Safety

  14. Reprogramming the Rx Label. Michael Wolf 04/29/71 Rx #: 1234567 9/8/2009 Do not drink alcoholic beverages while taking this medicine You have 11 refills 180 pills Glyburide 5mg Take for Diabetes Discard after 9/8/2010 Carry or wear medical identification stating you are taking this medicine Provider: RUTH PARKER, MD Emory Medical Center (414) 123-4567 Take: 2 pills in the morning 2 pills in the evening You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medicine Pharmacy: NoVA ScriptsCentral 11445 Sunset Blvd. Reston, VA (713) 123-4567 Morning 7-9 AM Noon 11-1 PM Evening 4-6 PM Bedtime 9-11 PM 2 2 NDC # 1234567

  15. Figure 5. Davis et al J Gen Intern Med, 2010; Wolf et al Arch Intern Med 2011; Med Care 2011; Bailey J Gen Intern Med 2012

  16. What Constitutes the Label? Container Label Consumer Medication Information (CMI) 3) Package Insert 4) Medication Guide William H. Shrank, MD, MSHS, Nov. 2006

  17. A Prescription for Confusion.

  18. September 22, 2009 ¾ teaspoon dose: 5 ml (volume of teaspoon) x .75 x 12 mg per ml Tamiflu suspension = 45 mg on syringe

  19. Lessons from the field Patients/consumers are the real experts… partner with them to communicate

  20. What Can We Do? • Believe the numbers…health literacy is a problem. • “Clear and simple” does not offend anyone. • Know the public…their needs/ questions. Meet them where they are. --Measure how well we do this. What gets measured gets done.

  21. leadership promotes

  22. “We envisage a society in which people have the skills they need to obtain, interpret, and use health information effectively…and within which a wide variety of health systems and institutions take responsibility for providing clear communication and adequate support to facilitate health promoting actions”.

  23. A Shared Conversation…4 Questions for Every Provider and Patient • What are my choices for health insurance? • How do I get it? • How do I use it? • How much will it cost? REQUIRES understanding: “insurance” options-private, employer-based, public (Medicaid and Medicare) “co-pay” “deductible”

  24. From “Deductible: The amount you must pay for covered care before your health insurance begins to pay. Insurers apply and structure deductibles differently. For example, under one plan, a comprehensive deductible might apply to all services while another plan might have separate deductibles for benefits such as prescription drug coverage.”

  25. References Institute of Medicine • Health Literacy: A Prescription to End Confusion • Round Table Joint Commission (JCAHO) • “What Did the Doctor Say?”: Improving Health Literacy to Protect Patient Safety Agency for Healthcare Quality and Research (AHRQ) • AMA Toolkit •