Health literacy:Effective patient-physiciancommunication strategiesDr. Jennifer Adams
Thanks to   Dr. Jenny Lin   Dr. Michael.Paasche-Orlow
Learning Objectives1.   Define health literacy and review national statistics2.   List at least two ways in which low heal...
Quiz1.        Approximately what percentage of the          US population reads at or below a          basic (8th) grade r...
Health Literacy Is…“The degree to which individuals have the capacity toobtain, process, and understand basic health infor...
What patients needhealth literacy forAbility to perform essential health care tasks:   –   Understand appointment slips   ...
Health Literacy in AmericaNational Assessment of Adult Literacy (NAAL)  – National sample survey, 2003, N~20,000  – Prose,...
Health Literacy in America:   Results from the NAAL100%         Proficient: Define medical term from complex document,    ...
Why Is Health LiteracyImportant in Patient Care?   Most patient instructions are written   Verbal instructions     – Oft...
Low Literacy AffectsPatients’ Understanding                                         Percent                               ...
Literacy and Health Outcomes Health Outcomes/Health Services   Behaviors Only  General health status            Substanc...
All-Cause Mortality byLiteracy                        10.6% mortality                             vs.                     ...
Low Literacy and    Mortality   Limited literacy    independently    predicts all-cause    and cardiovas-    cular deaths...
Patient TestimonialsVideo
Strategies to ImproveCommunication   Strategies recommended for ALL patients     – Universal Precautions   Explain thing...
Explain Things Clearly    in Plain Language   Slow down the pace of your speech   Use plain, non-medical language    – “...
Using Plain Language:     What could we say instead of…   Angina                   Chest pain   Atherosclerosis       ...
Teach Back Scripts   “I want to make sure I explained everything    clearly. If you were talking to a friend, what    wou...
Effectively solicitquestions   Don’t say:    – Do you have any questions?    – Any questions?   Instead ask:       What ...
What did we learn?   Limited Health literacy is a barrier to    optimal health   All members of the health care team    ...
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Improving Patient Outcomes

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Improving Patient Outcomes:
Effective Physician-Patient Communication
Dr. Jennifer Adams

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Improving Patient Outcomes

  1. 1. Health literacy:Effective patient-physiciancommunication strategiesDr. Jennifer Adams
  2. 2. Thanks to Dr. Jenny Lin Dr. Michael.Paasche-Orlow
  3. 3. Learning Objectives1. Define health literacy and review national statistics2. List at least two ways in which low health literacy adversely impacts health3. Know the core components of clear health communication and be able to use these4. Describe at least two communication strategies to combat low health literacy5. Explore low literacy patient materials for use
  4. 4. Quiz1. Approximately what percentage of the US population reads at or below a basic (8th) grade reading level? 1. 15% 2. 25% 3. 35% 4. 45% 5. 55%
  5. 5. Health Literacy Is…“The degree to which individuals have the capacity toobtain, process, and understand basic health informationand services needed to make appropriate healthdecisions.” Healthy People 2010
  6. 6. What patients needhealth literacy forAbility to perform essential health care tasks: – Understand appointment slips – Follow instructions on medication labels – Obtain information about an illness – Participate in discussions of informed consent – Enroll in health insurance plan
  7. 7. Health Literacy in AmericaNational Assessment of Adult Literacy (NAAL) – National sample survey, 2003, N~20,000 – Prose, document, and quantitative literacy Prose Document Quantitative – Provided first national assessment of health literacy – Levels: below basic, basic, intermediate, or proficient From http://nces.ed.gov/naal/
  8. 8. Health Literacy in America: Results from the NAAL100% Proficient: Define medical term from complex document, 12% 90% Calculate share of employee’s health insurance costs 80% 70% Intermediate: Determine healthy weight from BMI 60% 53% chart, Interpret prescription and over-the-counter drug 50% labels 40% 30% 22% Basic: Understand simple patient education handout 20% 10% Below Basic: Circle date on appointment slip, 14% Understand simple pamphlet about pre-test instructions 0% Kutner et al. National Assessment of Adult Literacy, 2006
  9. 9. Why Is Health LiteracyImportant in Patient Care? Most patient instructions are written Verbal instructions – Often complex – Delivered rapidly – Easy to forget in stressful situation Increasingly complex health system – More medications – More tests and procedures – Greater self-care requirements – Participatory/informed decision-making
  10. 10. Low Literacy AffectsPatients’ Understanding Percent Correct  Identify next appointment 73%  Take medicine every 6 hours 52%  Take medicine on empty stomach 46%  Interpret blood sugar value 32%  Upper GI instructions (4th grade) 24%  Medicaid Rights (10th grade) 0% Gazmararian, JAMA 1999
  11. 11. Literacy and Health Outcomes Health Outcomes/Health Services Behaviors Only  General health status  Substance abuse*  Hospitalization  Breastfeeding  Emergency department use  Behavioral problems  Prostate cancer stage  Adherence to medication*  Depression  Smoking*  Diabetes control Knowledge Only  HIV control  Birth control knowledge  Mammography  Cervical cancer screening  Pap smear  Emergency department  Pneumococcal immunization instructions  Influenza immunization  Asthma knowledge  STD screening  Hypertension knowledge  Cost Mortality
  12. 12. All-Cause Mortality byLiteracy 10.6% mortality vs. 19.7% mortality (p<.001) Sudore, JGIM 2006; ; 21: 806-12
  13. 13. Low Literacy and Mortality Limited literacy independently predicts all-cause and cardiovas- cular deaths in the elderly (39.4% vs 18.9% with HR 1.52, CI 1.26- 1.83) Baker et al, Arch Int Med 2007;167: 1503-9
  14. 14. Patient TestimonialsVideo
  15. 15. Strategies to ImproveCommunication Strategies recommended for ALL patients – Universal Precautions Explain things clearly in plain language Use a “teach back” or “show me” technique to check understanding Effectively solicit questions Focus on key messages and repeat Use patient-friendly educational materials to enhance interaction
  16. 16. Explain Things Clearly in Plain Language Slow down the pace of your speech Use plain, non-medical language – “Pain killer” instead of “analgesic” – Use patient’s own terms Define new terms Be specific – What does taking medicine “on an empty stomach” really mean? Avoid concept words – “Hamburger” instead of “red meat” Draw pictures and use analogies – “Arthritis is like a creaky hinge on a door.”
  17. 17. Using Plain Language: What could we say instead of… Angina  Chest pain Atherosclerosis  Clogged blood vessels Benign  Not cancer  Shot, vaccine Immunization   High blood pressure Hypertension  Normal test “Negative” test  Take 1 pill in the Take one tablet morning and 1 pill in twice daily for the evening for 7 seven days days
  18. 18. Teach Back Scripts “I want to make sure I explained everything clearly. If you were talking to a friend, what would you tell her we talked about today?” “Let’s review the next steps. Can you tell me the 3 things that you need to do before the next visit?” “Show me how you would...” “How would you know if your blood sugar was low?”
  19. 19. Effectively solicitquestions Don’t say: – Do you have any questions? – Any questions? Instead ask: What questions do you have?
  20. 20. What did we learn? Limited Health literacy is a barrier to optimal health All members of the health care team must work together to help patients with limited health literacy Using Clear communications skills will help provide optimal care for patients with limited literacy skills

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