Define health literacy and appreciate its value in PA education. Recognize the impact of low health literacy on patient outcomes. Describe how health

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2 Define health literacy and appreciate its value in PA education. Recognize the impact of low health literacy on patient outcomes. Describe how health literacy can be incorporated into a PA program curriculum. Discuss specific methods used to teach and evaluate health literacy instruction. Explore resources to support PA faculty in teaching health literacy.

3 The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. DHHS, Health People 2010

4 Poorer health status Higher mortality Health care costs Hospitalizations Preventive care Low Health Literacy Lack of self care Use of services Less healthy behaviors Emergency care Knowledge regarding health issues Medication/treatment errors

5 Enhance student knowledge, skills and attitudes Enhance patient provider communication Promote patient centered care Improve patient outcomes Reduce strain on health care system Provide opportunities for leadership, policy change & research

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8 Health People 2020 Patient Protection & Affordable Care Act 2010 Plain Writing Act 2010 US DHHS National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care US DHHS National Action Plan to Improve Health Literacy Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit Centers for Disease Control and Prevention (CDC) And many more

9 56% utilize health literacy in their curriculum 63% have objectives related to health literacy Taught during didactic and clinical years Primary teaching strategies included lecture, role playing, small group and web based tutorials 67% of programs felt health literacy education is important Self rated effectiveness of health literacy curriculum is 53% Source: Assessing the Current Status of Health Literacy Curricula in US PA Programs Survey (project supported by Stony Brook University Seed Grant Program)

10 Didactic Year Lecture Small group exercises Video review Cooperative learning brochure project Health literacy standardized patient encounters during clinical skills week Service learning experiences Clinical Year Health literacy standardized patient encounters Patient case presentations Masters projects

11 Define health literacy. Discuss the impact of low literacy on patient health outcomes. Describe tools and techniques that can be used to identify low health literacy. Assess the readability level of common health information materials found in print and on public websites using formulas discussed in class. Prepare a patient education brochure for low health literacy populations. Provide strategies and tools to improve communication between healthcare providers and patients.

12 Problem Oriented Medical Record Course Community Health and Service Learning Course Clinical Medicine I-IV Pharmacology Suggestions from other PA Programs Clinical Prevention Cultural Competency Medical Communications Health Care Issues Health Promotion and Patient Counseling

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14 Assessment instruments Newest vital sign

15 Simple measure of gobbledygook (SMOG)

16 Microsoft Word readability tool tutorial: Sample Online Resources Joe s web tools Online utility Includes lists of sentences to review Readability Formulas

17 Each group (4-5 students) develops an original 2 sided color trifold brochure on a pre-approved topic using 8 x 11½ size paper Must incorporate guidelines discussed in lecture regarding content, text construction, font and layout Each group presents their final project to the class and faculty and includes a. reason for choosing the topic b. target audience c. description of the layout and content Presentation and brochure assessed using evaluation form

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22 Determine the level of health literacy in a standardized patient. Identify patient barriers in obtaining, processing and understanding health information. Establish a treatment plan to promote patient adherence. Demonstrate the teach back method. Demonstrate effective patient-provider communication skills.

23 20 minute video recorded OSCE with SP Standardized patients are trained in 2 scenarios OSCEs focus on patient health literacy communication skills Mary Pearson (newly diagnosed with Diabetes) Mildred Roberts (medication non-compliance) Assessments Standardized patient evaluations of students Independent reviewer of student videos Student surveys Student self assessment/reflection through video review Evaluation of Physician Assistant Student Health Literacy Communication Skills using Standardized Patients (project supported by NCCPA Foundation Grant Program)

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25 Schilinger D, et al. Closing the loop: physicians communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163: patients with DM and low HL and 38 physicians Audio-taped visits Teach back method was used in 1 of 5 visits Teach back method used with fewer than 1 in 8 new concepts No reassessment of patient s understanding 9X increase number of glucose controlled patients exposed to teach back Duration of visits using teach back were not longer

26 86% better educational experience compared to other clinical skills experiences 86% found comments from standardized patients a valuable educational exercise 79% considered the OSCE a significant aid in preparing me for clinical practice 93% felt prepared to address patient s health literacy needs 88% thought that OSCEs should be used for future PA students as an educational tool Source: Health Literacy SP Encounter Student Survey Class of 2013 (project supported by NCCPA Foundation Grant Program)

27 Students are required to perform a minimum of 15 hours of service learning activities School based health literacy program Community based education projects Community health fairs International medical missions

28 Preceptor modeling Clinical observation Case studies Role Playing Seminars (student, faculty or preceptor) Conferences Web based tutorials

29 Health literacy is covered with considerable variability in PA education programs Close the gap between what is being taught and what is being done in clinical practice Need more educational and clinical research

30 Lynn Timko-Swaim Donna Ferrara

31 Accreditation standards for PA education 4 th edition. Accreditation Review Commission on Education for PAs, Inc. March Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment Number 199 (AHRQ Pub No. 11-E006-1). Health literacy interventions and outcomes: an updated systematic review. March 2011 Berkman ND, Sheridan SL, Donohue KE, Halpern DJ, Crotty K. Low Health Literacy and health outcomes: an updated systematic review. Annals of Internal Medicine. 2011;155(2): and w Coleman C. Teaching health care professionals about Health Literacy: a review of the literature. Nursing Outlook. 2011;59: Coleman C. Health Literacy & clear communications: assessing students clinical skills using standardized patients. Power Point Presentation from Health and Literacy: Constructing Curriculum for Health Care Providers, A Learning Institute, Calgary, AB Accessed June 1, Coleman C, Appy S. Health Literacy Teaching in US Medical Schools, Family Medicine. 2012;44(7):

32 Competencies for the physician assistant profession. Revised Accessed at: r%20publication.pdf Accessed on August 30, Engel KG, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Annals of Emergency Medicine. 2009;53(4): Kripalani SK, Jacobson KL, Brown S, Manning K, Rask KJ, Jacobson TA. Development and implementation of a health literacy training program for medical residents. Medical Education Online. 2006;11(13):1-7. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. Journal of General Internal Medicine. 2006;21: Kutner M, Greenberg E, Jin Y, Paulson C. The Health Literacy of America s adults: results from the 2003 national assessment of adult literacy (NCES ). U.S. Department of Education. Washington, DC: National Center for Education Statistics Schilinger D, et al. Closing the loop: physicians communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163:83-90