At the end of this presentation, I will:

Transcription

1 Health Literacy Donna R. Berryman, MLIS, EdD Senior Associate Director, Medical Center Libraries & Technologies Associate Professor, Public Health Sciences January 23, 2016

2 At the end of this presentation, I will: A. Put the clicker in my pocket and sneak out the back way B. Make sure I return the clicker C. Still be wondering how to use the clicker Put the clicker in my poc... 0% 0% 0% Make sure I return the cl... Still be wondering how t...

3 <Practice> Choose the answer that best describes you professionally: A. Nurse B. Physician C. Social Worker D. A big bundle of AWESOME 25% 25% 25% 25% Nurse Physician Social Worker A big bundle of AWESOME

4 What % of patients forget what their doctor told them as soon as they leave the office? A. Less than 10% B. 10% 25% C. 30% 50% D. 40% 80% 0% 0% 0% 0% Less than 10% 10% 25% 30% 50% 40% 80%

5 When information is remembered, what % is remembered correctly? A. Less than 50% B. Between 50% 75% C. Between 75% 100% D. All of it E. None of it 20% 20% 20% 20% 20% Less than 50% Between 50% 75% Between 75% 100% All of it None of it

6 Why do patients have difficulty correctly recalling information? A. Anxiety & distress B. Age related memory issues C. Low health literacy D. Perceived importance of the information Anxiety & distress Age related memory issues Low health literacy Perceived importance o... Possibly all of the above E. Possibly all of the above 20% 20% 20% 20% 20%

7 Today s topic Has a direct impact on an individual s ability to achieve and maintain good health Impacts an individual s ability to effectively use the healthcare system Is a stronger predictor of an individual s health status than age, income, employment status, education level, or racial/ethnic group

8 How confident are you that you understand health literacy? A. Very confident B. Somewhat confident C. I think I know D. Don t ask me just tell me about health literacy Very confident 0% 0% 0% 0% Somewhat confident I think I know Don t ask me just tell..

9 The ability to read and write Literacy

10 A 40 year old gentleman has multiple medical problems including polycystic kidney disease with CKD4, HTN, an unusual knee effusion that after multiple drainages and a synovectomy turned out to be just gout, and poly substance abuse. He sees multiple specialists and struggles with adherence and coordination of care.

11 So, our 40 year old gentleman with multiple medical problems who struggles with adherence and coordination of care.. It took me about a year to figure out that he could not read.

12 Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

13 The ability to read and write Health Literacy The ability to read, understand and act on health information

14 The ability to read and write Health Literacy The ability to take in, understand and act on health information

15 What is Health Literacy? The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Source: Institute of Medicine and the National Assessment of Health Literacy

16 What can happen if the chain is disrupted? The mother of a 3 year old boy called the pediatric primary care office late one weekday afternoon. She explained that her son was complaining of left ear pain and thought he might have an ear infection. The physician instructed the mother to give Tylenol for the ear pain and scheduled an appointment for 8:30 am the next morning.

17 What can happen if the chain is disrupted?

18 Dr. House & the Asthma Patient

19 A retired computer programmer in his late 70 s had major abdominal surgery at SMH. The patient was discharged to home with visiting nurse follow up scheduled. As part of his home treatment plan, the patient was prescribed a 30 day supply of low dose heparin syringes to help prevent DVT/PE. Prior to discharge, the patient s nurse explained to his wife, a retired real estate agent, how to give the heparin injections.

20 When the visiting nurse came to their home a few days after discharge, the patient mentioned in passing how painless the injections where. This raised a red flag for the visiting nurse and she asked the patient s wife to show her how she was giving the injections. At this point, it was discovered that the wife was not removing the cap from the needles and the patient had not been receiving his heparin since leaving the hospital.

21 How many American adults have difficulty reading and understanding health information? A. Fewer than 1 million B. 10 million C. 90 million D. 150 million 0% 0% 0% 0% Fewer than 1 million 10 million 90 million 150 million

22 Low health literacy can lead to: A. Medication errors B. A 50% increased risk of hospital admission C. Medical costs that are as much as 4x higher than those for people with adequate health literacy D. All of the above Medication errors 0% 0% 0% 0% A 50% increased risk of h... Medical costs that are a... All of the above

23 What is the estimated annual financial impact of low health literacy? A. $10 billion B. $50 billion C. $200 billion D. $800 billion 0% 0% 0% 0% $10 billion $50 billion $200 billion $800 billion

24 The majority of people with low health literacy skills belong to which group? A. Hispanic Americans B. White, native born Americans C. African Americans D. People over age 70 0% 0% 0% 0% Hispanic Americans White, native born Amer... African Americans People over age 70

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26 Screening Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010;304(1):76 84 (doi: /jama ). How confident are you filling out medical forms by yourself? (Not at all / A little bit / Somewhat / Quite a bit / Extremely) How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? (Never / Rarely / Sometimes / Often / Always)

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28 Use Living Room language What is this called? Abrasion Emesis Ingest Pruritis Subcutaneous

29 Write in PLAIN LANGUAGE elucidate the occurrence figure out how often this happens contact your physician call your doctor

30 Give CONTEXTUAL Cues Employees must depurate their metacarpal phalanges

31 Employees must depurate their metacarpal phalanges

32 You re a bus driver and at your first stop, 6 people get on and none get off. At the second stop 4 people get on and 1 gets off. At the third stop, 5 people get on and 3 get off. What color are the bus driver s eyes? A. Blue B. Green C. Brown D. Hazel 0% 0% 0% 0% Blue Green Brown Hazel

33 This is bad enough MXqPmk

34 Dispensing Information LIMIT CHUNK REPEAT

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36 RECAP: What to do? Slow down Use living room language Draw or show pictures Limit the amount of information provided and repeat it Use the Teach Back technique Create a shame free environment Encourage questions

37 A Word about WRITTEN materials Grade level for reading? How to judge? Fry? SMOG? Flesch tests (Flesch Kincaid and Flesch Reading Ease) Caution The goal is READABILITY

38 What to concentrate on going forward

39 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

40 Teach Back Teach back Training Toolkit the teach back toolkit Blog posting: Teaching clinicians the teachback for patient education Read the comments clinicians teachback patienteducation.html

41 Miner Library

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43 We all have health literacy issues at one time or another We all have to work together to make sure we communicate with patients and with each other in a way that is clear to all parties. Did they hear what you think you said?

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45 Please choose the item that most closely represents your thoughts now A. Whew! So glad that s over! B. I learned at least one new thing today C. Hey these clickers are fun! D. Both B & C Whew! So glad that s over! 0% 0% 0% 0% I learned at least one ne... Hey these clickers are fun! Both B & C

46 Read More About Health Literacy Broodman SM Helping patients understand their medical treatment. Literacy Understanding Medical Treatment.aspx Kessels RP. Patients' memory for medical information. J R Soc Med May;96(5): Review. No abstract available. PMID: Ouyang H. The Art of discharge. JAMA. 2015;313(20): doi: /jama Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010;304(1):76 84 (doi: /jama ). Torpy JM. Health Literacy (Patient Page). JAMA. 2011;306(10):1158. doi: /jama Vernon, et al Low Health Literacy: Implications for National Health Policy Weiss BD. Health Literacy: A Manual for Clinicians. American Medical Association/American Medical Association Foundation, p. 7.

47 Quick Guide to health Literacy Health Literacy: Accurate, accessible and actionable health information for all Health Literacy (NIH) Health Literacy (HRSA) Health Literacy (NN/LM) Health Literacy (AMA) assn.org/ama/pub/about ama/ama foundation/our programs/publichealth/health literacy program.page Health Literacy (MedlinePlus)

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