Dr. Debra Lacey May, 2013 HEALTH LITERACY AND MEDICAL DECISION MAKING

Transcription

1 Dr. Debra Lacey May, 2013 HEALTH LITERACY AND MEDICAL DECISION MAKING

2 GOALS Recognize multiple dimensions of health literacy Recognize relevance of health literacy to: Health outcomes Social justice Medical decision making Develop multiple strategies to improve health literacy in older adult client systems.

3 WHAT IS HEALTH LITERACY? An OK definition: the degree to which individuals can obtain, process, and understand and communicate about health-related information needed to make informed health decisions (Berkman, et. al., in Ridpath, et. al., 2011)

4 SOME COSTS OF POOR HEALTH LITERACY Reinforcement of prejudicial behavior (e.g., condescension) by providers Unwanted care or lack of appropriate care Preventable re-hospitalizations ($12 billion?) Poor self-management of chronic diseases

5 WHAT IS HEALTH LITERACY? the ability to use [health-related] information and services in ways that enhance health the ability to personalize relevant health information and apply in context for personal benefit (Smith, 2010)

6 DIMENSIONS OF HEALTH LITERACY (RIDPATH, ET. AL., 2011) Understanding health information Clear communication Information patient needs and preferences Plain English or preferred language Teach-back Navigating health services Improved access Options for point of contact Coordinated teambased care Help accessing services and treatment Making treatment decisions Shared decision making Focus on patient values and priorities Active participation in decisions Use of patient decision aids Participating in self care Self-management support Evidence-based reminders Proactive outreach and follow-up Family and caregiver engagement

7 EXPERT V. NOVICE KNOWLEDGE ORGANIZATION

8 CASE David Lopez, 78, was admitted to the hospital with complications from heart failure fluid retention, dizziness, nausea, weakness. During his three-day admission, he was treated by three different physicians, none of whom were his primary doctor (who did not have admitting privileges to that hospital). Marta, his frail wife, visited daily, but never met the doctors who treated her husband. Before discharge, Mr. Lopez met with a nurse who reviewed his discharge instructions. He was given a prescription for a new heart medication. Neither his wife, nor his daughter, Amelia were there. Mr. L. was told to follow up with his primary doctor. Mrs. L.went to the pharmacy, but could not afford the $40 copay for the new medication, so she called their primary doctor. Not knowing about the hospitalization, the primary doctor s office thought Mrs. L. was confused, but scheduled Mr. L., for a visit in two weeks. One week later, Mr. L. s symptoms increased again. Marta called 911, and he was taken to the hospital emergency room.

9 UNDERSTANDING HEALTH INFORMATION Clear communication Information tailored to patient needs and preferences Plain English and preferred language Capacity for using teach back Considerations for older adults Sensory deficits and need to slow down Emotional states (anxious, depressed) Self efficacy and power differentials ( isms )

10 SCHILLINGER MODEL

11 TOOL PROJECT BOOST: PATIENT PASS FORM

12 MAKING TREATMENT DECISIONS: SHARED DECISION MAKING 1. Information- Physician/health care provider provide objective, unbiased presentations of reasonable options to consider and the pros and cons of those options. 2. Deliberation - With that information, patients spend time considering goals and concerns and how each option is likely to play out with respect to those goals and concerns. 3. Interaction - Patients must have an interaction with providers in which their goals and concerns are shared and incorporated into the decision-making process. Fowler, Levin, Sepucha, 2011

13 FIMDM INTRODUCTION TO SDM

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16 PATIENT PREFERENCES AND VALUES: PRIMARY DIAGNOSIS POORLY MANAGED CHF Mr. Johnson, 66 Caucasian, Retired salesman; college degree; former (he says) smoker Gay lives with longtime partner; has close group of friends Wears hearing aids; 50 pounds overweight Drinks regularly; high-fat diet Hates exercise Mrs. Bastien, 77 Haitian-American; prefers Creole to English Completed 5 th grade in Haiti; minimal reading/writing skills Lives in subsidized housing Reliant on family for some IADLs and much emotional support Religious/spiritual Frequently anxious (per family)

17 REFERENCES AND RESOURCES Freedman, A.m., Echt., K.V., Cooper, H.L.F., Miner, K.R., & Parker, R. (2012). Better learning through instructional science: A health literacy case study in how to teach so learners can learn. Health Promotions Practice, 13(5), National Academy of Sciences (2011?). Health Literacy: A prescription to end confusion. Retrieved from: Ridpath, J.R., Larson, E.B., & Green, S.M. (2012). Can integrating health literacy into the patient-centered medical home help us weather the perfect storm? Journal of General Internal Medicine, 27(5), Smith, S.A., (2011). Health literacy and human services delivery. In S.A. Estrine, R.T., Hettenbach, H. Arthur, & M. Messina (Eds.), Service Delivery for Vulnerable Populations, New York: Springer.