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"The Impact of Health Literacy on Pharmacy Practice"

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  • Ask Me 3 is a new patient education program designed to promote communication between health care providers and patients, in order to improve health outcomes. The program promotes these three questions that patients should ask their providers in every health care interaction and that providers should always encourage their patients to understand the answers to.
  • Ask Me 3 is a new patient education program designed to promote communication between health care providers and patients, in order to improve health outcomes. The program promotes these three questions that patients should ask their providers in every health care interaction and that providers should always encourage their patients to understand the answers to.
  • Ask Me 3 is a new patient education program designed to promote communication between health care providers and patients, in order to improve health outcomes. The program promotes these three questions that patients should ask their providers in every health care interaction and that providers should always encourage their patients to understand the answers to.

"The Impact of Health Literacy on Pharmacy Practice" "The Impact of Health Literacy on Pharmacy Practice" Presentation Transcript

  • The Impact of Health Literacy on Pharmacy Practice Sandra Salverson, PharmD, BCPS OSF Saint Francis Medical Center Peoria, Illinois
  • 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
  • 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
    • “ I can’t pronounce the names of my pills. I ask for them by their shape, size, and color”
  • Definitions
  • 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)
  • Health Literacy
    • 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
  • National Adult Literacy Survey (1993)
    • ~50% of all U.S. adults read in the lowest two levels
  • Illinois Literacy Rates
    • 20% in Level 1 (at or below 5 th grade level)
    • 44% in Level 1 and 2 (at or below 8 th grade level)
  • Pharmacist and Health Literacy Myth #1
    • I practice in the “affluent” and “educated” part of town – all my patients can read and do math.
  • The Problem Literate ≠ Health Literate
  • Historic Health Information Model
    • Physician or health care providers have all the answers
    • Patients follow the directions
  • Model Influences
    • Managed care
    • Insurance dictums
    • Medical breakthroughs
    • Volumes of treatment options
  • Participatory Health Care
    • Consumers are more responsible for their own health
    • Physician – patient partnership
  • Patient Perspective
    • ~80% of the population say health literacy is a serious issue
  • 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… 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 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
    • 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
  • My husband, my premature son and Synagis
  • 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
  • Pharmacy and Health Literacy
    • 52% of patients say that prescription information and instructions are hard to read and understand
  • 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.
  • 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”
  • 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
  • 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
  • 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
  • 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?
  • Consequences
    • Misunderstood diagnoses
    • Misunderstood directions for administration of drugs
    • Misunderstood self-care instructions
  • Lack of Knowledge and Decreased Comprehension
    • Diabetes
    • Heart Failure
    • Hypertension
    • HIV
  • Lack of Understanding and Use of Preventive Services
    • Mammograms
    • Pregnancy
    • Vaccines
  • Poorer Compliance Rates
    • Heart failure
    • HIV
  • 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.
  • 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
  • Increased Health Care Costs
    • $30 - $73 billion more in health care costs
    • More physician visits
    • Higher Medicaid/Medicare charges
  • 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
  • Accreditation Issues
    • 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
  • Creating Solutions
    • Improve Patient Education Materials
    • Increase Use of Non-written Information
    • Ensure Patient Understanding
    • Promote Health Literacy
  • Pharmacist and Health Literacy Myth #3
    • I am only a staff pharmacist. I cannot change the material I use to advise patients.
  • 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
    • Do you, as a health-care professional have the capability of identifying quality on-line or printed patient health information?
  • FDA Guidelines for Pharmaceutical Manufacturers
    • Required
      • Disclosure of major risks
      • Side effects
      • Contraindications
      • Effectiveness
    • Optional
      • Success rate
      • Duration of treatment
      • Alternative treatments
  • 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?
  • 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
  • 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
  • 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
  • Evaluation Criteria
    • Patient Usability
    • Health Professional Usability
    • Currency
    • Content
  • Patient Usability Comparison
  • 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.
  • 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.
  • Target’s New Prescription Label
    • Target turns old pill bottle design on its head
    • Company hopes new container will grab customers'
    • Associated Press
    • Updated: 12:36 p.m. ET April 26, 2005
  • Non-written Information
    • Verbal communication
      • Open-ended questions
      • Show and Tell Questions
    • Visual illustrations
      • Picture labels
      • Color bands
  • Finding a Solution
  • Ask Me 3 – Creates Shared Responsibility for Clear Health Communication Patient Provider De-stigmatize and Reduce Embarrassment of Low Health Literacy Recognize Patient Coping Mechanisms
    • Provides a consistent approach to patient-provider dialogue
    • Allows patients to get information they need to manage their health
    • Time-efficient for providers to reinforce healthcare instructions
  • What Is Ask Me 3
    • Promotes three simple, but essential, questions and answers for every healthcare interaction:
      • Why Is It Important for Me to Do This?
    Context What Do I Need to Do? Treatment What Is My Main Problem? Diagnosis
  • Indian Health Service Technique
    • Promotes three simple, but essential, questions and answers for every Pharmacy interaction:
      • What should you expect from this medication?
    How do you take the medication? What is the medication for?
  • Clear Health Communication – We Can All Be a Part of the Solution
    • Even if you are not in a position to directly answer the three questions, keep clear health communication in mind and in your dialogue when communicating with patients
    • Many people have trouble understanding medical terms. Often, these terms are better understood when explained with common words, an example or visual interpretation
  • Clear Health Communication in Action Benign Harmless Chronic Happens again and again; does not end 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 Consider Using This One Instead Instead of Using This Word Start by Decreasing the Use of Medical Jargon
  • Pharmacist-Health Literacy Myth #4
    • If I ask my patients to ask more questions it will increase the length of time I need to spend with them. I cannot afford to spend more time with each patient.
  • Ensure Patient Understanding
    • “ Just to make sure that I did not forget to tell you anything important, will you go over how you are going to use the medication”
    • Demonstrate
      • Filling an insulin syringe
      • Giving an enoxaparin injection
      • Using an inhaler
      • Filling a medication box
  • Pharmacists Impact on Health Literacy
    • CHF
      • Multi-disciplinary health approach
      • Ongoing study
  • Promote Health Literacy
    • AMA Initiatives
      • Acknowledge low literacy is a barrier
      • Increase awareness in the health care community
      • Train clinicians in effective communication skills for patients with limited literacy
      • Include health related questions on NALS 2002
      • Research
  • Promote Health Literacy
    • Healthy People 2010 Objective
      • “ improve the health literacy of persons with inadequate or marginal literacy skills”
  • General Considerations
    • Create a shame-free environment and offer assistance when needed
    • Personalize the message
    • Open relationships
    • Invite family members or friends to participate in patient visits
  • General Considerations
    • Use simple and clear language
    • Reinforce and repeat information often
    • Link information to previous knowledge
    • Tailor the information to the individual by giving examples and explaining the relevance
  • Pharmacists Promoting Health Literacy
    • Ohio Patient Safety Institute
      • Medication Safety Brochure
        • Pictures and graphics
        • Circulated 65,000 brochures throughout Ohio
  • Enter a partnership with your patients.
  • Health Literacy
    • Patients are more involved with treatment choices
    • Patients are more informed regarding their disease
    • Patients are more invested in their health care
    • BETTER HEALTH CARE RESULTS!!
  • Knowledge Is Power! As your body grows bigger / Your mind will flower It's great to learn / 'Cause knowledge is power! It's Schoolhouse Rocky / That chip off the block of your favorite schoolhouse / Schoolhouse Rock