Post on 07-Jan-2016
description
transcript
Advancing Clear Health Communication to Positively
Impact Health Outcomes
Presentation Sections
The Problem: Low Health Literacy – Scope and Impact
Finding a Solution
– The Partnership for Clear Health Communication
– Ask Me 3
How to Become Involved: Solutions into Action
The Problem:Low Health Literacy
Scope and Impact
Do You Know Which Critical Public Health Issue…
Impacts nearly one in every three people living in the United States
Can hit any population segment, regardless of age, race, education or income
Costs the healthcare system as much as $58 billion a year
Can’t be diagnosed by any new medical technology and is not visible to the eye
Answer:Low Health Literacy
The Issue: Low Health Literacy
What is health literacy?
– The ability to read, understand and act on health information
How Big Is the Problem?
Approximately 40 to 44 Million Adults in the US Are
Functionally Illiterate1
Approximately 50 Million Are Marginally Illiterate1
Average Reading Skills of Adults in the US Are Between the 8th and 9th Grade Levels2
More Than 90 Million People in the US Have Difficulty Reading
Sources:1 Kirsch et al., “A First Look at the Results of the National Adult Literacy Survey” Nat’l Center for Education Statistics, 19932 Stedman L, Kaestle C. Literacy and Reading Performance in the US From 1880 to Present. In: Kaestle C, Editor.
Literacy in the US: Readers and Reading Since 1880. New Haven (CT): Yale University Press; 1991. P. 75–128
Cannot Perform Basic Reading
Tasks Required to Function in Society
Have Trouble Reading Maps and
Completing Standard Forms
Reading Levels & Skills
Reading Skills
18
32
50
0
10
20
30
40
50
60
1 2 3
Reading Grade Level
% o
f U
S P
op
ula
tio
n
Functional Competency
23
2831
15
3
0
5
10
15
20
25
30
35
1 2 3 4 5
Levels
% i
n L
evel
0-5 6-9 10-16+
How Does Low Health Literacy Affect Your Practice?
Chances are high that some of your patients are among the 90 million who have low health literacy
You may not know that patients with poor health literacy skills are in your care:– They use well-practiced coping mechanisms that
effectively mask their problem– They are often ashamed to admit they have difficulty
understanding information and instructions
Defining the Problem Scope
Coping Mechanisms for Patients With Low Literacy
98%Bring Someone Who Can Read
Watch and Copy Others’ Actions
Ask for Help From Medical Staff
Ask Other Patients
90%
80%
88%
Source: Parikh et al., 1996
Who Is at Risk for Low Health Literacy?
Anyone in the US – regardless of age, race, education, income or social class – can be at risk for low health literacy
– Ethnic minority groups are disproportionately affected by low health literacy
– The majority of people with low literacy skills in the US are white, native-born Americans
– Older patients, recent immigrants, people with chronic diseases and those with low socioeconomic status are especially vulnerable to low health literacy
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
Low Health Literacy Negatively Impacts Health Outcomes
Adults with low health literacy:
– Are often less likely to comply with prescribed treatment and self-care regimens1
– Make more medication or treatment errors1
– Fail to seek preventive care1
– Are at a higher risk for hospitalization than people with adequate literacy skills2
– Remain in hospital nearly 2 days longer3
– Lack the skills needed to negotiate the health care system1
People with low health literacy AND diabetes:
– Were found to be less likely to have effective glycemic control4
– Were more likely to report vision problems caused by their diabetes4
1 Weiss, BD. 20 Common Problems in Primary Care. McGraw Hill. December 19992 Baker DW, Parker RM, Williams MV, Clark WS. Health Literacy and the Risk of Hospital Admission. Journal of General Internal Medicine. 1998; (13): 791-798.
3 Kirsch IS, Jugebut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: Department of Education 1993.
4 Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB. Association of Health Literacy With Diabetes Outcomes. JAMA. July 24/31 2002 (288) No 4.
Low Health Literacy Impacts Resource Utilization
Adults with low literacy:
– Averaged 6% more hospital visits1*
– Stayed in the hospital nearly 2 days longer than adults with higher literacy skills1*
– Had fewer doctor visits, but used significantly more hospital resources2
– Had annual health care costs 4 times higher than those with higher health literacy3
•Among adults who stayed overnight in a hospital
1Kirsch IS, Jugebut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: Department of Education 1993.
2Baker DW, Parker RM, Williams MV, Clark WS. Health Literacy and the Risk of Hospital Admission. Journal of General Internal Medicine. 1998; (13): 791-798.
3Weiss, BD. 20 Common Problems in Primary Care. McGraw Hill. December 1999.
Implications of Low Health Literacy
Poor Health Outcomes
Under-utilization of preventive services
Over-utilization of health services
Unnecessary health care expenditures
Limited effectiveness of treatment
Needless patient suffering
Higher patient dissatisfaction
Higher provider frustration
You Can’t Tell By Looking
Finding a Solution
Solutions: Focus on Care Providers and Materials
SKILLED READERS POOR READERS MANAGING THE PROBLEMS
Interpret meaning
Read with fluency
Get help for uncommon words
Grasp the context
Persistent reader
Take words literally
Read slowly, miss meaning
Skip over the word
Miss the context
Tire quickly
Explain the meaning
Use common words, examples
Use examples, review
Tell context first, use visuals
Short segments, easy layout
Differences between good and poor readers…
and how you can manage problems
But just 41% of those patients say they have
received this kind of assistance
17% of patients report trouble understanding
Rx Information
The Patient-Provider Relationship
70% of physicians say they provide patients
with additional resources to help them understand
their medications
75% of physicians report patients have trouble
understanding Rx information
There Is a Disconnect Between Patient and Provider: Bridging the Information Gap Will Help Improve Health Literacy
Source: Health Literacy & The Prescription Drug Experience: The Front Line Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002
Why is this?
Short-term memory has very limited capacity and short storage time
Most people can store 7 or fewer independent items at one time
This memory lasts less than 1 minute
Short-term memory
Long-term memory Long-term memory lasts for days and years
Long-term memory has no practical capacity limits
To move into long-term memory, use association and interaction
Getting Into Long-term Memory
• Gain the patient’s attention
• Present no more than seven items at a time
• Get to the point
Short-term memory
Long-term memory
•Associate new information with what patient already knows
•Involve the patient in interaction with the information
•Repeat or review
Written Communication
87% report reading Rx information Yet only 34% believe others read this same information
What Do We Do?
Develop Written Materials at 6th Grade or Below, Where 160MM Can Understand and Act
Written
Making Health Information Understandable
Source: Health Literacy & The Prescription Drug Experience: The Front Line Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002
50% of adults read at below 8th grade reading levels
20% of adults read at below 5th grade reading levels
40% of seniors read at below 5th grade reading levels
Consumer healthcare materials written at 10th grade or above, where only 50MM can understand and act
What You Need to Know About Low Blood Sugar
Treat low blood sugar quickly. If you have signs of low blood sugar, eat or drink something that has sugar in it. Some things you can eat are hard candy, sugar-sweetened soda, orange juice, or a glass of milk. Special tablets or gel made of glucose (a form of sugar) can be used to treat low blood sugar. You can buy these in a drug store. Always have some of these items handy at home or with you when you go out in case your blood sugar drops too low. After treating a low blood sugar reaction, eat a small snack like half a sandwich, a glass of milk, or some crackers if your next meal is more than 30 minutes away.
Source: The National Institute of Diabetes and Digestive and Kidney Diseases
Example of Health Communication That May Not Reach a Broad Consumer Audience
70 150
Blood Sugar Is Too Low if It Is Under 70
Blood Sugar Is Too High if It Is Over 240
Good Range
TooHigh
TooLow
9th Grade Reading Level
Example of Clear Health Communication – That Reaches a Broad Consumer Audience
Common visual used to explain concept
Uses action captions that clarify the point of the visual
Creates interaction with the reader
Verbal Communication
Patients experience shame around the issue
Only 14% of patients say they feel awkward admitting they don’t understand; yet 79% feel others don’t understand
Providers experience time challenges
Providers interrupt patients 30 seconds after they start speaking; if not interrupted, patients will speak less than two minutes
Communicate Effectively
What Can We Do?
Up to 80% of Patients Forget What Their Doctor Tells Them As Soon As They Leave the Doctor’s Office – AND
Nearly 50% of What They Do Remember is Recalled Incorrectly
Source: Health Literacy & The Prescription Drug Experience: The Front Line Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002
Reaching the Solution
In the Office - Best Opportunity for Immediate Impact
1. Tell patients that instruction is aimed at solving/managing their health problem. Ask what they know, then outline topics you plan to cover.
2. Get to the point quickly. Low literacy skills = short attention span.
3. Ask patients to solve a problem with the new information. Ask them to tell or show you how they will use the information just learned.
Limited Education Objectives (example)
Objectives (for patient) “Must Include” Topics Interactive Questions
1. Understand what hypertension is
2. Follows medication regimen
What is hypertension & what is patient’s BP?
Dangers of hypertension
Taking medicine can control hypertension
Must take medication every day even if you feel okay
What is HBP?
What is your blood pressure?
What are some dangers to you from HBP?
How can you lower your blood pressure?
What about taking medication on days you feel okay?
Choosing the Right Words
Concept words describe a general idea or abstract framework (i.e. eat a ‘variety’ of foods; keep your glucose level within a ‘normal range’) = often misunderstood
Category words describe groups of things; people with low literacy skills have trouble understanding categories
Value judgment words (i.e. ‘excessive’ bleeding; exercise ‘regularly’); need to be specific
Use examples of common ideas to explain uncommon words
Use visuals/pictures to emphasize or clarify
Guidelines for Health Education
Reaching the Solution
1. Set realistic objectives. Use a planning sheet to write down key points.
2. To change health behaviors, focus on behaviors and skills. Emphasize skills, rather than facts.
3. Present context first (before giving new information). State the use for new information before presenting it; relate it to context of patients’ lives.
4. Partition complex instructions. Break instruction into easy-to-understand parts. Provide opportunities for small successes.
5. Make it interactive. Consider including an interaction after each key topic. The patient must: write, tell, show, demonstrate, select or solve a problem.
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 communicationin 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
Finding a Solution
The Partnership’s First Solution
Addresses awareness and education
Creates a Call to Action for patients and providers
Is designed to promote clear communication between patients and providers to improve health outcomes
Was developed with health literacy experts, then tested and validated
Ask Me 3
Use of Ask Me 3 resulted in reduction in 30 day readmission rates for heart failure pts. (7.2% to 2.5%)
Patient surveys indicated a statistically significant improvement in perceived ability of nursing staff (p = .001)
Ask Me 3 does not add time to patient visits
Use of Ask Me 3 resulted in reduced call-backs and missed appointments
Over 1 million providers use the Ask Me 3 program
Ask Me 3 - For Patients
Patients Should Not Be Anxious About Asking Their Health Care Provider Questions!
Health information can be confusing at times
Everyone wants help with health information
Asking questions helps patients understand how to prevent or manage illness
ProviderPatient
All they can about their condition/medication
Why this advice/treatment is important for good health
Steps to take to prevent a condition or keep it under control
Ask Me 3 - For Providers
Health Care Providers Want Patients to Know:
Ask Me 3 – Creates Shared Responsibility for Clear Health Communication
Patient Provider
De-stigmatize andReduce Embarrassmentof Low Health Literacy
RecognizePatient 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
Ask Me 3 – For Patients
Element: Poster
Description: – Stimulates curiosity
about Ask Me 3– Informs patients and staff
about the program
Implementation (hang poster):– In waiting areas– In exam rooms– On the ceiling, above
the exam table– On a door– In a staff break room– Hang anywhere where provider-
patient interaction takes place – Anywhere patients might see it!
Ask Me 3 – For Patients
Element: Patient brochure
Description: – Educates patients about
the Ask Me 3
– Motivates patients to ask their healthcare provider questions
Implementation:– Display in waiting
rooms/registration area
– Distribute to patients upon arrival/sign-in
– Distribute with any paperwork
– Distribute during events or with mailings to patients
Ask Me 3 – For Providers
Element: Provider brochure
Description:– Explains the scope and impact
of low health literacy
– Offers communication tips
– Emphasizes how effective communication can positively impact patient health outcomes
Implementation: – Distribute to all staff interacting
with patients through staff meetings or mailings
– Conduct departmental in-service training on Health Literacy and Clear Health Communication
Ask Me 3 – For Providers
www.AskMe3.org:
– Has everything you need to start acting/implementing
– Materials can be downloaded/ordered from this website
– Other health literacy tools available on the site:
• Bibliography on health literacy
• List of literacy resources
• White paper on health literacy
• Links to other relevant websites
• Cultural competence primer
What Can You Do?
Six steps to improving patient understanding
1. Limit the amount of information provided at each visit
2. Slow down
3. Avoid medical jargon
4. Use pictures or models to explain important concepts
5. Assure understanding with the “show-me” technique
6. Encourage patients to ask questions
What Else Can You Do?
When making an appointment, provide people with simple options and clear facts
Appointment InstructionsAlso see: Urgent Care (if you are too sick to wait for an appointment)
Making a medical appointment for the first time, it is straightforward: You call 555-2222 and make a appointment at XYZ Health Services just like you would at any doctor's office.
You can request a specific clinician if you have someone in mind, or you can explain your need or problem to the appointment counselor, and he or she will schedule you with an appropriate clinician at the earliest possible date. At your first appointment you will receive a medical record card -- often referred to as your "gold card" -- which you will keep and use as your XYZ Health Services identification.
If you are unsure about whether you should make an appointment, you may call the Advice Nurse at 666-7777. Also, in advance of your first appointment, be sure to read "How to Make the Most of Your XYZ Visit."
Please call 643-7177 to make an appointment in the Specialty Clinics, including Allergy & Travel. Specialty appointments require a referral.
You may also drop by the Appointment Office to make a medical appointment. The Appointment Office is located on the first floor in Room 1111. You may also make an appointment in the Specialty Clinics by going to the Specialty Clinic reception desk, located behind the elevators on the first floor. If you need to cancel an appointment, please call our 24-hour cancellation line at 643-7033. Please note that you will be billed for a broken appointment fee if you do not show up for your appointment and have not called to cancel it.
Your Name
Your Appointment DateTimePlace
Our Telephone Number:Do not eat or drink for 6 hours before the day and time on this card.
People Have Difficulty Making Appointments
What Else Can You Do?
Phone answered by a tape recording. Speaking quickly, the caller is offered numerous options and alternatives
Speak slowly and clearly Provide an easy way to
connect with a live person Provide options in
other languages
People Have Trouble Understanding Phone Recordings
What Else Can You Do?
Ambulatory Entrance
Hospital XYZ
Some people become confused about whether this entry was intended for ambulances or for patients
Ambulatory Entrance
The use of visuals clarify the message
Contrast in color makes it easy to read
Try to be consistent when hanging signs
People Have Trouble Reading Signs
What Else Can You Do?
To make maps easier to follow: Match the color in the map with the
paint color on walls or floors Match the names in the map to the
names on the signs Use 14 point font size or larger
Maps are usually hard to follow: Too complicated Codes are hard to understand Names and directions not always match Small fonts
People Have Trouble Understanding Maps
How Can Enhanced Communication With Your Patients Benefit Your Practice?
Patients who understand health care information may:– Be more compliant with instructions and medications– Call back less often– Visit less often– Have fewer hospitalizations– Have better health outcomes– Have increased patient satisfaction
Greater Provider Satisfaction
Help Patients Understand…
The Practical Solution: