The Impact of Health Literacy on Pharmacy Practice

1. The Impact of Health Literacy on Pharmacy Practice Sandra Salverson, PharmD, BCPS OSF Saint Francis Medical Center Peoria, Illinois

2. Objectives • Compare and contrast health literacy, low literacy, and illiteracy • Describe the health-related consequences of inadequate health literacy • Identify three patient populations at risk for medication misadventures due to low health literacy or low literacy levels

3. Objectives • Devise a patient education program that includes resources other than written information • Use the three questions from either the Ask-Me-3 campaign or the Indian Health Service Patient Counseling technique during a patient interaction to ensure patient understanding of medication regimens

4. “ I can’t pronounce the names of my pills. I ask for them by their shape, size, and color”

5. Definitions

6. Literacy Definitions • Literacy: The ability to read and speak English • Functional Literacy: The ability to use reading, writing, and computation skills…in everyday life situations…on the job…in society (National Literacy Act 1991)

7. The ability to read, understand, and act on health information and services to make appropriate health decisions. (Healthy People 2010 and IOM 2004) Pill bottles Appointment slips Informed consents Discharge instructions Health education materials Insurance applications Health Literacy

8. National Adult Literacy Survey (1993) • ~50% of all U.S. adults read in the lowest two levels

9. Illinois Literacy Rates • 20% in Level 1 (at or below 5th grade level) • 44% in Level 1 and 2 (at or below 8th grade level)

10. Pharmacist and Health Literacy Myth #1 I practice in the “affluent” and “educated” part of town – all my patients can read and do math.

11. The Problem Literate ≠ Health Literate

12. Physician or health care providers have all the answers Patients follow the directions Historic Health Information Model

13. Model Influences • Managed care • Insurance dictums • Medical breakthroughs • Volumes of treatment options

14. Participatory Health Care • Consumers are more responsible for their own health • Physician – patient partnership

15. Patient Perspective ~80% of the population say health literacy is a serious issue

16. Low Health Literacy Impacts a Patient’s Ability to Fully Engage in the Healthcare System The Largest Study Conducted to Date on Health Literacy Found That… 33% Were unable to read basic health care materials 42% Could not comprehend directions for taking medication on an empty stomach 26% Were unable to understand information on an appointment slip 43% Did not understand the rights and responsibilities section of a Medicaid application 60% Did not understand a standard informed consent Source: Williams MV, Parker RM, Baker DW, et al. Inadequate Functional Health Literacy Among Patients at Two Public Hospitals. JAMA 1995 Dec 6; 274(21):1,677–82

17. Limited health literacy is not restricted to adults with limited overall literacy • Most health education materials are also “above the heads” of average readers • When context is unfamiliar, most of us are confused • Many of us have low health literacy at times

18. My husband, my premature son and Synagis

19. Who is at highest risk? • Seniors over age 65 • Those living in poverty • Minority populations • Immigrant populations • People with chronic mental and/or physical health conditions

20. Pharmacy and Health Literacy • 52% of patients say that prescription information and instructions are hard to read and understand

21. At-Risk Patients Pharmacy Experiences “I never ask questions when I don’t get it. I don’t feel like I have the right to question the doctors”. “I can’t pronounce the names of my pills. I ask for them by their shape, size, and color”. …Take the capsules twice a day. “The label does not say when to take the capsules.

22. Unfamiliar Health Care Terms • “orally” • “apply locally” • “hypertension” • Cancer terms such as “screening”, “lesion”, “mammogram”, “polyp”, “digital rectal examination” • Consent terms such as “placebo”, “randomly”, “efficacy”, “Institutional Review Board”

23. Importance of Print Materials in Healthcare • Research: Patients remember only 40-50% of what a doctor says in an office visit • Use of jargon: In one study, about 80% of patients self-reported “no” or “little” understanding of doctor’s jargon • Understandable print resources can be critical to supporting people in their journey toward vibrant heath

24. Health-literacy Gap • Average reading level of our materials is grade 10 to 13 • Best reading level for at-risk populations is grade 4 to 6

25. Impact of the Gap • Decreased patient satisfaction • Don’t get our messages • Don’t follow our recommendations • Will not achieve desired health outcome • We are trying to maintain “power” • Lost trust and confidence • Less likely to return

26. The Health Literacy Challenge • Is the information we provide useful? • Is it clear and readable to our patients? • Do printed materials support our mission of pharmaceutical care? • Are we using our resources wisely in the print and web materials we produce and provide?

27. Consequences • Misunderstood diagnoses • Misunderstood directions for administration of drugs • Misunderstood self-care instructions

28. Lack of Knowledge and Decreased Comprehension • Diabetes • Heart Failure • Hypertension • HIV

29. Lack of Understanding and Use of Preventive Services • Mammograms • Pregnancy • Vaccines

30. Poorer Compliance Rates • Heart failure • HIV

31. Pharmacy Myth #2 • I practice in a hospital pharmacy. I cannot control if patients do not understand prescription information. This problem does not impact my practice.

32. Increased Hospitalization • Patients with inadequate health literacy are twice as likely to be hospitalized • Potential impact • Medication reconciliation • Adverse drug events • Non-compliance • Drug-drug interactions

33. Increased Health Care Costs • $30 - $73 billion more in health care costs • More physician visits • Higher Medicaid/Medicare charges

34. Increased Legal Risks • Lack of attention to health literacy could become a corporate negligence issue • In the future, providers may be negligent if problems related to health literacy were not addressed

35. JCAHO “The patient receives education and training specific to the patient’s abilities…” Scoring includes evaluating whether education is presented in a manner understandable to the patient Accreditation Issues

36. Creating Solutions

37. Improve Patient Education Materials • Increase Use of Non-written Information • Ensure Patient Understanding • Promote Health Literacy

38. Pharmacist and Health LiteracyMyth #3 I am only a staff pharmacist. I cannot change the material I use to advise patients.

39. Quality of On-line Drug Information • Research shows on-line patient drug information varies in coverage and quality • Health-care professionals should be able to discern good quality • Consumers often cannot

40. Do you, as a health-care professional have the capability of identifying quality on-line or printed patient health information?

41. Required Disclosure of major risks Side effects Contraindications Effectiveness Optional Success rate Duration of treatment Alternative treatments FDA Guidelines for Pharmaceutical Manufacturers

42. What do people want to know? • What is the medication for? • What does the medication do? • How to take the medication? • What are the side-effects?

43. The Saint Francis Experience • Re-design of Patient and Family Education Committee • Multidisciplinary commitment to develop, implement, and disseminate appropriate education materials • Expand methods of delivery and presentation

44. Quality of Education Materials • Meet patients’ educational needs and literacy level • Need-to-know information essential to the plan of care • Based on the adult learning theory • Plain language • Clear and inviting layout • Employ several learning methods • Printed materials, interactive tutorials, and return demonstrations

45. Goal for Patient Written Drug Information • Evaluate and recommend one patient drug information education resource for OSF-Saint Francis Medical Center • Resource would be available on-line and readily accessible

46. Evaluation Criteria • Patient Usability • Health Professional Usability • Currency • Content

47. Patient Usability Comparison

48. Lexi-online • What is this medicine used for? • This medicine is used to prevent or control seizures. • This medicine is used to treat migraine headaches. • This medicine is used to treat trigeminal neuralgia. • How does it work? • Phenytoin calms the brain.

49. www.safemedications.com Why is this medication prescribed? Phenytoin is used to treat various types of convulsions and seizures. Phenytoin acts on the brain and nervous system in the treatment of epilepsy. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

50. Target’s New Prescription Label Target turns old pill bottle design on its head Company hopes new containerwill grab customers' Associated Press Updated: 12:36 p.m. ET April 26, 2005