"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
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
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”
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)
The ability to read, understand, and act on health information and services to make appropriate health decisions. (Healthy People 2010 and IOM 2004)
Health education materials
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
Volumes of treatment options
Participatory Health Care
Consumers are more responsible for their own health
Physician – patient partnership
~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
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
“ apply locally”
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
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?
Misunderstood directions for administration of drugs
Misunderstood self-care instructions
Lack of Knowledge and Decreased Comprehension
Lack of Understanding and Use of Preventive Services
Poorer Compliance Rates
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.
Patients with inadequate health literacy are twice as likely to be hospitalized
Adverse drug events
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
“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
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
Disclosure of major risks
Duration of treatment
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
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
Health Professional Usability
Patient Usability Comparison
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.
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'
Updated: 12:36 p.m. ET April 26, 2005
Show and Tell Questions
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”
Filling an insulin syringe
Giving an enoxaparin injection
Using an inhaler
Filling a medication box
Pharmacists Impact on Health Literacy
Multi-disciplinary health approach
Promote Health Literacy
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
Promote Health Literacy
Healthy People 2010 Objective
“ improve the health literacy of persons with inadequate or marginal literacy skills”
Create a shame-free environment and offer assistance when needed
Personalize the message
Invite family members or friends to participate in patient visits
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.
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