Health Literacy: What did that doctor say??

1. Health Literacy: What did that doctor say?? May 13, 2009

2. Faculty MedicineNursingPharmacy Evelyn Kemp Peggy McConnell Charles Collins Forrest Lang Sue Grover Richard Hess Public HealthSocial Work Brian Martin Robin Lennon-Dearing

3. Objectives Participants will learn the following: • Extent of low literacy • Those most at risk • Correlates and results of low health literacy • Clinical red flags • Ways of assessing health literacy • Strategies for helping patients with low health literacy Finally, participants will identify quality improvement project goals that address patients’ health literacy levels.

4. Agenda for today • 11 -11:30 • Introduction to health literacy • Video followed by group’s discussion of what they see in the video and suggestions for change • Strategies for helping patients with limited literacy • 11:30-12 Practice with standardized pts

7. Literacy in the US • 14% of adults cannot read • 21-23% can read a little but not well enough to: • fill out an application • read a food label • read a simple story • 46% of US population have limited health literacy. (Paasche-Orlow, 2005.)

8. What is HealthLiteracy? Healthy People 2010: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

9. LiteracyDemographics • Limited health literacy is greatest among • Older adults • Poor • Rural • Those with limited education • Minorities • Those with limited English proficiency

10. Results of limited literacy • 12% of general population do not understand when their next appointment is. • Over 19% do not understand instructions to “take medication on an empty stomach”. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

11. Correlates of Low health literacy • Poor knowledge of chronic diseases such as HTN, diabetes • Poor glycemic control • Poor health outcomes • Increased risk of hospital admissions • Length of hospital stay increased by nearly 2 days

12. How good are we at detecting low literacy? • Clinicians identify only 47% of low literacy patients. (Rogers, 2006)

13. Clinical Red Flags Indicating Limited Health Literacy • Incorrect or incomplete forms. • Frequently missed appointments. • Lack of follow through with diagnostic testing or referrals. • Medication count, medication refill history, or lab tests inconsistent with patient report. • Patient asks no questions.

14. How we explain things to patients Video MDI Discussion

15. Strategies • Assess Literacy • Create a shame-free environment • Adjust approach to patient needs • Improve communication • Ask-Tell-Ask

16. Informal Assessmentof Health Literacy • The Indian Health Service model uses a series of three questions: • What did your prescriber tell you the medication is for? • How did your prescriber tell you to take the medication? • What did your prescriber tell you to expect? • Conduct a Medication Review: • Ask patients to bring in all their medications • Ask them to name and explain the purpose of each one – “Brown Bag Test”

17. Formal Assessmentof Health Literacy • Single Item Literacy Screener (SILS) • “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?”(Morris, 2006) • Sensitivity 54% - Specificity 83% • 1-Never, 2-Rarely, 3-Sometimes, 4-Often, and 5-Always • Score above 2 is considered positive

18. Creating a Shame-free Environment • Use ubiquity statements, “Many people have difficulty understanding medical information.” • Convey an attitude of helpfulness, caring and respect. • Avoid acting impatient or annoyed. • Involve the entire staff. • Offer to help with paperwork.

19. Adjustments based on patient need • Hearing • Vision • Cognition

20. Strategy: Improve Communication • Speak slowly. • Use simple, plain nonmedical language. • Focus on 1-3 key messages per visit. • Ask how the patient learns best. • Models, charts, pictures, analogies • Include a family member or friend.

21. Strategy: Improve Communication Avoid Use of Medical Jargon Jargon Common Language Benign Harmless Chronic Happens again and again Cardiac Heart Edema Swelling; build up of fluid Fatigue Tired Screening Test Intake What you eat or drink Generic Not a brand name Adverse events Side effects

22. Strategy: Improve communication Show or draw pictures. Visual images can improve the patient’s recall of ideas. Uses captions that clarify the point of the visual USP Pictograms http://www.usp.org/audiences/consumers/pictograms/

23. Strategy: Improve communication

24. Ask-Tell-Ask • ASK pt their understanding of their disorder and treatment. • TELL them missed or incorrect information. • ASK for a restatement of their understanding of information given “in your own words”. *Don’t ask, “Do you understand?”

25. Remember to do with every patient . . . • Assess health literacy: “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” • Ask the patient to restate their understanding of information given “in your own words”. *Don’t ask, “Do you understand?”

26. Practice Session - 30 minutes